Evaluating the Impacts of Health, Social Network and Capital on Craft Efficiency and Productivity: A Case Study of Construction Workers in China.

PubMed

Yuan, Jingfeng; Yi, Wen; Miao, Mengyi; Zhang, Lei

2018-02-15

The construction industry has been recognized, for many years, as among those having a high likelihood of accidents, injuries and occupational illnesses. Such risks of construction workers can lead to low productivity and social problems. As a result, construction workers' well-being should be highly addressed to improve construction workers' efficiency and productivity. Meanwhile, the social support from a social network and capital (SNC) of construction workers has been considered as an effective approach to promote construction workers' physical and mental health (P&M health), as well as their work efficiency and productivity. Based on a comprehensive literature review, a conceptual model, which aims to improve construction workers' efficiency and productivity from the perspective of health and SNC, was proposed. A questionnaire survey was conducted to investigate the construction workers' health, SNC and work efficiency and productivity in Nanjing, China. A structural equation model (SEM) was employed to test the three hypothetical relationships among construction workers' P&M health, SNC and work efficiency and productivity. The results indicated that the direct impacts from construction workers' P&M health on work efficiency and productivity were more significant than that from the SNC. In addition, the construction workers' social capital and the network can indirectly influence the work efficiency and productivity by affecting the construction workers' P&M health. Therefore, strategies for enhancing construction workers' efficiency and productivity were proposed. Furthermore, many useable suggestions can be drawn from the research findings from the perspective of a government. The identified indicators and relationships would contribute to the construction work efficiency and productivity assessment and health management from the perspective of the construction workers.

Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis

PubMed Central

2011-01-01

Background Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. Objective This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. Methodology We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. Results The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Conclusions Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care. PMID:22828358

[Managment system in safety and health at work organization. An Italian example in public sector: Inps].

PubMed

Di Loreto, G; Felicioli, G

2010-01-01

The Istituto Nazionale della Previdenza Sociale (Inps) is one of the biggest Public Sector organizations in Italy; about 30.000 people work in his structures. Fifteen years ago, Inps launched a long term project with the objective to create a complex and efficient safety and health at work organization. Italian law contemplates a specific kind of physician working on safety and health at work, called "Medico competente", and 85 Inps's physicians work also as "Medico competente". This work describes how IT improved coordination and efficiency in this occupational health's management system.

Determinants of expenditure variation in health care and care of the elderly among Finnish municipalities.

PubMed

Häkkinen, U; Luoma, K

1995-01-01

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.

Technical efficiency of nursing homes: do five-star quality ratings matter?

PubMed

Dulal, Rajendra

2017-02-28

This study investigates associations between five-star quality ratings and technical efficiency of nursing homes. The sample consists of a balanced panel of 338 nursing homes in California from 2009 through 2013 and uses two-stage data envelopment (DEA) analysis. The first-stage applies an input oriented variable returns to scale DEA analysis. The second-stage uses a left censored random-effect Tobit regression model. The five-star quality ratings i.e., health inspections, quality measures, staffing available on the Nursing Home Compare website are divided into two categories: outcome and structure form of quality. Results show that quality measures ratings and health inspection ratings, used as outcome form of quality, are not associated with mean technical efficiency. These quality ratings, however, do affect the technical efficiency of a particular nursing home and hence alter the ranking of nursing homes based on efficiency scores. Staffing rating, categorized as a structural form of quality, is negatively associated with mean technical efficiency. These findings show that quality dimensions are associated with technical efficiency in different ways, suggesting that multiple dimensions of quality should be included in the efficiency analysis of nursing homes. They also suggest that patient care can be enhanced through investing more in improving care delivery rather than simply raising the number of staff per resident.

Efficient Airframe Management Using In-Situ Structural Health Monitoring

DTIC Science & Technology

2012-07-01

As a result, the Air Force intends to transition to a process that services aircraft based on their actual condition instead of the presumptive...at predetermined times regardless of their actual conditions . This _____________ Mark M. Derriso and Matthew S. Leonard, Air Force Research...services aircraft based on their actual condition instead of the presumptive schedule-based approach. Structural health monitoring (SHM) technologies are

An efficient signal processing tool for impedance-based structural health monitoring

NASA Astrophysics Data System (ADS)

O'Brien, Megan K.; Taylor, Stuart G.; Farinholt, Kevin M.; Park, Gyuhae; Farrar, Charles R.

2009-03-01

Various experimental studies have demonstrated that an impedance-based approach to structural health monitoring can be an effective means of damage detection. Using the self-sensing and active-sensing capabilities of piezoelectric materials, the electromechanical impedance response can be monitored to provide a qualitative indication of the overall health of a structure. Although impedance analyzers are commonly used to collect such data, they are bulky and impractical for long-term field implementation, so a smaller and more portable device is desired. However, impedance measurements often contain a sizeable number of data points, and a smaller device may not possess enough memory to store the required information, particularly for real-time analysis. Therefore, the amount of data used to assess the integrity of a structure must be significantly reduced. A new type of cross correlation analysis, for which impedance data is instantaneously correlated between different sensor sets and different frequency ranges, as opposed to be correlated to pre-stored baseline data, is proposed to drastically reduce the amount of data to a single correlation coefficient and provide a quantitative means of detecting damage relative to the sensor positions. The proposed analysis is carried out on a 3-story representative structure and its efficiency is demonstrated.

Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece.

PubMed

Oikonomou, Nikolaos; Tountas, Yannis; Mariolis, Argiris; Souliotis, Kyriakos; Athanasakis, Kostas; Kyriopoulos, John

2016-12-01

This is a study to measure the efficiency of the rural Health Centres (HCs) and their Regional Surgeries (RSs) of the 6th Health Prefecture (HP) of Greece, which covers Southern and Western Greece. Data Envelopment Analysis (DEA) was applied under Constant and Variable Returns to Scale, using a weight-restricted, output-oriented model, to calculate pure technical efficiency (PΤΕ), scale efficiency (SE) and total technical efficiency (TE). The selection of inputs, outputs and their relative weights in the model was based on two consecutive consensus panels of experts on Primary Health Care (PHC). Medical personnel, nursing personnel and technological equipment were chosen as inputs and were attributed appropriate weight restrictions. Acute, chronic and preventive consultations where chosen as outputs; each output was constructed by smaller subcategories of different relative importance. Data were collected through a questionnaire sent to all HCs of the covered area. From the 42 HCs which provided complete data, the study identified 9 as technical efficient, 5 as scale efficient and 2 as total efficient. The mean TE, PTE and SE scores of the HCs of the 6th Health Prefecture were 0.57, 0.67 and 0.87, respectively. The results demonstrate noteworthy variation in efficiency in the productive process of the HCs of Southern and Western Greece. The dominant form of inefficiency was technical inefficiency. The HCs of the 6th HP can theoretically produce 33 % more output on average, using their current production factors. These results indicated potential for considerable efficiency improvement in most rural health care units. Emphasis on prevention and chronic disease management, as well as wider structural and organisational reforms, are discussed from the viewpoint of how to increase efficiency.

Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: an expert opinion perspective

PubMed Central

Nzioki, Japheth Mativo; Onyango, Rosebella Ogutu; Ombaka, James Herbert

2015-01-01

Introduction Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya. In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluate the efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCH services in the district. Methods This was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO. Framework analysis and quasi statistics were used in data analysis. Results Expert opinion data indicated that the CHS was efficient in providing MCH services. Factors influencing efficiency of the CHS in provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs. Conclusion Though CHS was found to be efficient in providing MCH services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed. PMID:26090046

Pathway to Support the Sustainable National Health Information System

NASA Astrophysics Data System (ADS)

Sahavechaphan, Naiyana; Phengsuwan, Jedsada; U-Ruekolan, Suriya; Aroonrua, Kamron; Ponhan, Jukrapong; Harnsamut, Nattapon; Vannarat, Sornthep

Heath information across geographically distributed healthcare centers has been recognized as an essential resource that drives an efficient national health-care plan. There is thus a need for the National Health Information System (NHIS) that provides the transparent and secure access to health information from different healthcare centers both on demand and in a time efficient manner. As healthiness is the ultimate goal of people and nation, we believe that the NHIS should be sustainable by taking the healthcare center and information consumer perspectives into account. Several issues in particular must be resolved altogether: (i) the diversity of health information structures among healthcare centers; (ii) the availability of health information sharing from healthcare centers; (iii) the efficient information access to various healthcare centers; and (iv) the privacy and privilege of heath information. To achieve the sustainable NHIS, this paper details our work which is divided into 3 main phases. Essentially, the first phase focuses on the application of metadata standard to enable the interoperability and usability of health information across healthcare centers. The second phase moves forward to make information sharing possible and to provide an efficient information access to a large number of healthcare centers. Finally, in the third phase, the privacy and privilege of health information is promoted with respect to access rights of information consumers.

Pregnancy care in Germany, France and Japan: an international comparison of quality and efficiency using structural equation modelling and data envelopment analysis.

PubMed

Rump, A; Schöffski, O

2018-07-01

Healthcare systems in developed countries may differ in financing and organisation. Maternity services and delivery are particularly influenced by culture and habits. In this study, we compared the pregnancy care quality and efficiency of the German, French and Japanese healthcare systems. Comparative healthcare data analysis. In an international comparison based mainly on Organisation for Economic Co-operation and Development (OECD) indicators, we analysed the health resources significantly affecting pregnancy care and quantified its quality using structural equation modelling. Pregnancy care efficiency was studied using data envelopment analysis. Pregnancy output was quantified overall or separately using indicators based on perinatal, neonatal or maternal mortality. The density of obstetricians, midwives, paediatricians and the average annual doctor's consultations were positively and the caesarean delivery rate negatively associated with pregnancy outcome. In the international comparison at an aggregate level, Japan ranked first for pregnancy care quality, whereas Germany and France were positioned in the second part of the ranking. Similarly, at an aggregate level, the Japanese system showed pure technical efficiency, whereas Germany and France revealed mediocre efficiency results. Perinatal, neonatal and maternal care quality and efficiency taken separately were quite similar and mediocre in Germany and France. In Japan, there was a marked difference between a highly effective and efficient care of the unborn and newborn baby, and a rather mediocre quality and efficiency of maternal care. Germany, France, and Japan have to struggle with quality and efficiency issues that are nevertheless different: in Germany and France, disappointing pregnancy care quality does not correspond to the high health care expenditures and lead to low technical efficiency. The Japanese system shows a high variability in outcomes and technical efficiency. Maternal care quality during delivery seems to be a particular issue that could possibly be addressed by legally implementing quality assurance systems with stricter rules for reimbursement in obstetrics. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Survey of social health insurance structure in selected countries; providing framework for basic health insurance in Iran

PubMed Central

Mohammadi, Effat; Raissi, Ahmad Reza; Barooni, Mohsen; Ferdoosi, Massoud; Nuhi, Mojtaba

2014-01-01

Introduction and Objectives: Health system reforms are the most strategic issue that has been seriously considered in healthcare systems in order to reduce costs and increase efficiency and effectiveness. The costs of health system finance in our country, lack of universal coverage in health insurance, and related issues necessitate reforms in our health system financing. The aim of this research was to prepare a structure of framework for social health insurance in Iran and conducting a comparative study in selected countries with social health insurance. Materials and Methods: This comparative descriptive study was conducted in three phases. The first phase of the study examined the structure of health social insurance in four countries – Germany, South Korea, Egypt, and Australia. The second phase was to develop an initial model, which was designed to determine the shared and distinguishing points of the investigated structures, for health insurance in Iran. The third phase was to validate the final research model. The developed model by the Delphi method was given to 20 professionals in financing of the health system, health economics and management of healthcare services. Their comments were collected in two stages and its validity was confirmed. Findings: The study of the structure of health insurance in the selected countries shows that health social insurance in different countries have different structures. Based on the findings of the present study, the current situation of the health system, and the conducted surveys, the following framework is suitable for the health social insurance system in Iran. The Health Social Insurance Organization has a unique service by having five funds of governmental employees, companies and NGOs, self-insured, villagers, and others, which serves as a nongovernmental organization under the supervision of public law and by decision- and policy-making of the Health Insurance Supreme Council. Membership in this organization is based on the nationality or residence, which the insured by paying the insurance premiums within 6-10% of their income and employment status, are entitled to use the services. Providing services to the insured are performed by indirect forms. Payments to the service providers for the fee of inpatient and outpatient services are conservative and the related diagnostic groups system. Conclusions: Paying attention to the importance of modification of the fragmented health insurance system and financing the country's healthcare can reduce much of the failure of the health system, including the access of the public to health services. The countries according to the degree of development, governmental, and private insurance companies and existing rules must use the appropriate structure, comprehensive approach to the structure, and financing of the health social insurance on the investigated basis and careful attention to the intersections and differentiation. Studied structures, using them in the proposed approach and taking advantages of the perspectives of different beneficiaries about discussed topics can be important and efficient in order to achieve the goals of the health social insurance. PMID:25540789

Survey of social health insurance structure in selected countries; providing framework for basic health insurance in Iran.

PubMed

Mohammadi, Effat; Raissi, Ahmad Reza; Barooni, Mohsen; Ferdoosi, Massoud; Nuhi, Mojtaba

2014-01-01

Health system reforms are the most strategic issue that has been seriously considered in healthcare systems in order to reduce costs and increase efficiency and effectiveness. The costs of health system finance in our country, lack of universal coverage in health insurance, and related issues necessitate reforms in our health system financing. The aim of this research was to prepare a structure of framework for social health insurance in Iran and conducting a comparative study in selected countries with social health insurance. This comparative descriptive study was conducted in three phases. The first phase of the study examined the structure of health social insurance in four countries - Germany, South Korea, Egypt, and Australia. The second phase was to develop an initial model, which was designed to determine the shared and distinguishing points of the investigated structures, for health insurance in Iran. The third phase was to validate the final research model. The developed model by the Delphi method was given to 20 professionals in financing of the health system, health economics and management of healthcare services. Their comments were collected in two stages and its validity was confirmed. The study of the structure of health insurance in the selected countries shows that health social insurance in different countries have different structures. Based on the findings of the present study, the current situation of the health system, and the conducted surveys, the following framework is suitable for the health social insurance system in Iran. The Health Social Insurance Organization has a unique service by having five funds of governmental employees, companies and NGOs, self-insured, villagers, and others, which serves as a nongovernmental organization under the supervision of public law and by decision- and policy-making of the Health Insurance Supreme Council. Membership in this organization is based on the nationality or residence, which the insured by paying the insurance premiums within 6-10% of their income and employment status, are entitled to use the services. Providing services to the insured are performed by indirect forms. Payments to the service providers for the fee of inpatient and outpatient services are conservative and the related diagnostic groups system. Paying attention to the importance of modification of the fragmented health insurance system and financing the country's healthcare can reduce much of the failure of the health system, including the access of the public to health services. The countries according to the degree of development, governmental, and private insurance companies and existing rules must use the appropriate structure, comprehensive approach to the structure, and financing of the health social insurance on the investigated basis and careful attention to the intersections and differentiation. Studied structures, using them in the proposed approach and taking advantages of the perspectives of different beneficiaries about discussed topics can be important and efficient in order to achieve the goals of the health social insurance.

Secure and Privacy-Preserving Distributed Information Brokering

ERIC Educational Resources Information Center

Li, Fengjun

2010-01-01

As enormous structured, semi-structured and unstructured data are collected and archived by organizations in many realms ranging from business to health networks to government agencies, the needs for efficient yet secure inter-organization information sharing naturally arise. Unlike early information sharing approaches that only involve a small…

Cost-efficient designs for three-arm trials with treatment delivered by health professionals: Sample sizes for a combination of nested and crossed designs

PubMed Central

Moerbeek, Mirjam

2018-01-01

Background This article studies the design of trials that compare three treatment conditions that are delivered by two types of health professionals. The one type of health professional delivers one treatment, and the other type delivers two treatments, hence, this design is a combination of a nested and crossed design. As each health professional treats multiple patients, the data have a nested structure. This nested structure has thus far been ignored in the design of such trials, which may result in an underestimate of the required sample size. In the design stage, the sample sizes should be determined such that a desired power is achieved for each of the three pairwise comparisons, while keeping costs or sample size at a minimum. Methods The statistical model that relates outcome to treatment condition and explicitly takes the nested data structure into account is presented. Mathematical expressions that relate sample size to power are derived for each of the three pairwise comparisons on the basis of this model. The cost-efficient design achieves sufficient power for each pairwise comparison at lowest costs. Alternatively, one may minimize the total number of patients. The sample sizes are found numerically and an Internet application is available for this purpose. The design is also compared to a nested design in which each health professional delivers just one treatment. Results Mathematical expressions show that this design is more efficient than the nested design. For each pairwise comparison, power increases with the number of health professionals and the number of patients per health professional. The methodology of finding a cost-efficient design is illustrated using a trial that compares treatments for social phobia. The optimal sample sizes reflect the costs for training and supervising psychologists and psychiatrists, and the patient-level costs in the three treatment conditions. Conclusion This article provides the methodology for designing trials that compare three treatment conditions while taking the nesting of patients within health professionals into account. As such, it helps to avoid underpowered trials. To use the methodology, a priori estimates of the total outcome variances and intraclass correlation coefficients must be obtained from experts’ opinions or findings in the literature. PMID:29316807

Energy efficient wireless sensor network for structural health monitoring using distributed embedded piezoelectric transducers

NASA Astrophysics Data System (ADS)

Li, Peng; Olmi, Claudio; Song, Gangbing

2010-04-01

Piezoceramic based transducers are widely researched and used for structural health monitoring (SHM) systems due to the piezoceramic material's inherent advantage of dual sensing and actuation. Wireless sensor network (WSN) technology benefits from advances made in piezoceramic based structural health monitoring systems, allowing easy and flexible installation, low system cost, and increased robustness over wired system. However, piezoceramic wireless SHM systems still faces some drawbacks, one of these is that the piezoceramic based SHM systems require relatively high computational capabilities to calculate damage information, however, battery powered WSN sensor nodes have strict power consumption limitation and hence limited computational power. On the other hand, commonly used centralized processing networks require wireless sensors to transmit all data back to the network coordinator for analysis. This signal processing procedure can be problematic for piezoceramic based SHM applications as it is neither energy efficient nor robust. In this paper, we aim to solve these problems with a distributed wireless sensor network for piezoceramic base structural health monitoring systems. Three important issues: power system, waking up from sleep impact detection, and local data processing, are addressed to reach optimized energy efficiency. Instead of sweep sine excitation that was used in the early research, several sine frequencies were used in sequence to excite the concrete structure. The wireless sensors record the sine excitations and compute the time domain energy for each sine frequency locally to detect the energy change. By comparing the data of the damaged concrete frame with the healthy data, we are able to find out the damage information of the concrete frame. A relative powerful wireless microcontroller was used to carry out the sampling and distributed data processing in real-time. The distributed wireless network dramatically reduced the data transmission between wireless sensor and the wireless coordinator, which in turn reduced the power consumption of the overall system.

The structure of state health agencies: a strategic analysis.

PubMed

Ford, Eric W; Duncan, W Jack; Ginter, Peter M

2003-03-01

Leaders in public organizations are adopting many private sector management practices to control costs and increase efficiency. Nowhere is this more evident than among state health agencies. State health agencies were encouraged to change the way they operate by the 1988 Institute of Medicine (IOM) report on The Future of Public Health. This report portrayed public health as being in disarray. To address major deficiencies identified by the IOM study, some public health leaders have reevaluated their environments, reconfigured their organizations, and adopted a strategic mindset. The purpose of this research is to explore the various organizational configurations of state health agencies. Replicating methods used in studies of private sector organizations, five distinct strategic configurations or archetypes were identified. This comprehensive public health agency taxonomy will assist future researchers in analyzing public health organizations' environments, structures, and strategies.

Voluntary health insurance in the European Union: a critical assessment.

PubMed

Mossialos, Elias; Thomson, Sarah M S

2002-01-01

The authors examine the role and nature of the market for voluntary health insurance in the European Union and review the impact of public policy, at both the national and E.U. levels, on the development of this market in recent years. The conceptual framework, based on a model of industrial analysis, allows a wide range of policy questions regarding market structure, conduct, and performance. By analyzing these three aspects of the market for voluntary health insurance, the authors are also able to raise questions about the equity and efficiency of voluntary health insurance as a means of funding health care in the European Union. The analysis suggests that the market for voluntary health insurance in the European Union suffers from significant information failures that seriously limit its potential for competition or efficiency and also reduce equity. Substantial deregulation of the E.U. market for voluntary health insurance has stripped regulatory bodies of their power to protect consumers and poses interesting challenges for national regulators, particularly if the market is to expand in the future. In a deregulated environment, it is questionable whether this method of funding health care will encourage a more efficient and equitable allocation of resources.

Performance of rural health clinics: an examination of efficiency and Medicare beneficiary outcomes.

PubMed

Ortiz, J; Wan, T H

2012-01-01

In 2011, some 3800 Rural Health Clinics (RHCs) delivered primary care in underserved rural areas throughout the USA. To date, little research has been conducted to identify the variability in RHC performance. In an effort to address the knowledge gaps, a national, longitudinal study was conducted of a panel of 3565 RHCs. The goals of the study were to determine: (1) the relationship between two aspects of performance: efficiency and effectiveness; and (2) the factors that influence variation in RHC performance. A non-experimental study of RHC performance was conducted using 2 years of secondary data from multiple sources. A study panel of RHCs was formed. This panel was composed of all RHCs continuously in operation during the period 2006-2007. The study panel was divided into two subsets - one for the provider-based clinics; another for the independent clinics. The individual RHC was the unit of analysis throughout the study. Descriptive statistics were calculated for each subset. Bivariate analyses was conducted of the relationships between the clinic characteristics and the performance outcome measures, as well as the interrelationships between various clinic characteristics using χ², t-tests, Cramer's V, Pearson correlation, and Spearman correlation statistics. Next, using covariance structure analysis, the interrelationships were examined among the context (community or demographic factors), design (organizational structure and other mediating factors), and performance (efficiency and effectiveness) of RHCs. Three hypotheses were tested: (1) the effectiveness of RHCs is positively influenced by efficiency; (2) there is a reciprocal relationship between RHC efficiency and effectiveness; and (3) large RHCs are more efficient than small RHCs. To test the hypotheses that effectiveness of RHCs is positively influenced by efficiency and that there is a reciprocal relationship between efficiency and effectiveness, two covariance structure models were developed and revised: one for independent and one for provider-based RHCs. However, the revised models were not supported by the data. To test the hypothesis that large RHCs are more efficient than small ones, two additional efficiency-based structural equation models were constructed (one for independent RHCs and another for provider-based RHCs). Both of these models were supported by the data (independent model: χ² = 13.8, df = 8, p = 0.088, relative χ² = 1.723, adjusted goodness of fit index [AGFI] = .981, root mean square error of approximation [RMSEA] = .034; provider-based model: χ² = 19.011, df = 8, p = 0.015, relative χ² = 2.376, AGFI = .978, RMSEA = .043). This study examined the relationship between efficiency and effectiveness of RHCs. In addition, it identified several factors that influence the variation in RHC performance. The study has implications for optimizing RHC performance, providing quality services to rural populations, and enhancing the value of RHC data. The present is a critical time in the history of RHCs as they transition to meet the goals and expectations of the US health system reform. Additional research is needed to quantify and trend RHCs' contribution to the rural health delivery system in order to optimize their service to rural populations.

Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

PubMed Central

Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

2014-01-01

Background: In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. Objectives: This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Results: Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions. Conclusions: Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system. PMID:25763257

Structural and contextual dimensions of Iranian primary health care system at local level.

PubMed

Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

2015-01-01

In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions. Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

A Study on the Data Compression Technology-Based Intelligent Data Acquisition (IDAQ) System for Structural Health Monitoring of Civil Structures

PubMed Central

Jeon, Joonryong

2017-01-01

In this paper, a data compression technology-based intelligent data acquisition (IDAQ) system was developed for structural health monitoring of civil structures, and its validity was tested using random signals (El-Centro seismic waveform). The IDAQ system was structured to include a high-performance CPU with large dynamic memory for multi-input and output in a radio frequency (RF) manner. In addition, the embedded software technology (EST) has been applied to it to implement diverse logics needed in the process of acquiring, processing and transmitting data. In order to utilize IDAQ system for the structural health monitoring of civil structures, this study developed an artificial filter bank by which structural dynamic responses (acceleration) were efficiently acquired, and also optimized it on the random El-Centro seismic waveform. All techniques developed in this study have been embedded to our system. The data compression technology-based IDAQ system was proven valid in acquiring valid signals in a compressed size. PMID:28704945

A Study on the Data Compression Technology-Based Intelligent Data Acquisition (IDAQ) System for Structural Health Monitoring of Civil Structures.

PubMed

Heo, Gwanghee; Jeon, Joonryong

2017-07-12

In this paper, a data compression technology-based intelligent data acquisition (IDAQ) system was developed for structural health monitoring of civil structures, and its validity was tested using random signals (El-Centro seismic waveform). The IDAQ system was structured to include a high-performance CPU with large dynamic memory for multi-input and output in a radio frequency (RF) manner. In addition, the embedded software technology (EST) has been applied to it to implement diverse logics needed in the process of acquiring, processing and transmitting data. In order to utilize IDAQ system for the structural health monitoring of civil structures, this study developed an artificial filter bank by which structural dynamic responses (acceleration) were efficiently acquired, and also optimized it on the random El-Centro seismic waveform. All techniques developed in this study have been embedded to our system. The data compression technology-based IDAQ system was proven valid in acquiring valid signals in a compressed size.

Interdisciplinary Health Team Care: Proceedings of the Annual Conference (8th, Columbus, Ohio, September 18-20, 1986).

ERIC Educational Resources Information Center

Brunner, Marjorie L., Ed.; Casto, R. Michael, Ed.

The following are among the 40 papers included in this proceedings: "Code of Ethics for Interdisciplinary Care" (Thomasma); "Training Model for Increasing Team Excellence and Efficiency" (Clayton, Lund); "Organizational Structures of Health Care Teams" (Farrell, Schmitt, Heinemann); "Nutrition Support Practice" (Johnson); "Dividing up the Work on…

Assessment of productivity of hospitals in Botswana: a DEA application.

PubMed

Tlotlego, Naomi; Nonvignon, Justice; Sambo, Luis G; Asbu, Eyob Z; Kirigia, Joses M

2010-11-05

Botswana national health policy states that the Ministry of Health shall from time to time review and revise its organization and management structures to respond to new developments and challenges in order to achieve and sustain a high level of efficiency in the provision of health care. Even though the government clearly views assuring efficiency in the health sector as one of its leadership and governance responsibilities, to date no study has been undertaken to measure the technical efficiency of hospitals which consume the majority of health sector resources. The specific objectives of this study were to quantify the technical and scale efficiency of hospitals in Botswana, and to evaluate changes in productivity over a three year period in order to analyze changes in efficiency and technology use. DEAP software was used to analyze technical efficiency along with the DEA-based Malmquist productivity index which was applied to a sample of 21 non-teaching hospitals in the Republic of Botswana over a period of three years (2006 to 2008). The analysis revealed that 16 (76.2 percent), 16 (76.2 percent) and 13 (61.9 percent) of the 21 hospitals were run inefficiently in 2006, 2007 and 2008, with average variable returns to scale (VRS) technical efficiency scores of 70.4 percent, 74.2 percent and 76.3 percent respectively. On average, Malmquist Total Factor Productivity (MTFP) decreased by 1.5 percent. Whilst hospital efficiency increased by 3.1 percent, technical change (innovation) regressed by 4.5 percent. Efficiency change was thus attributed to an improvement in pure efficiency of 4.2 percent and a decline in scale efficiency of 1 percent. The MTFP change was the highest in 2008 (MTFP = 1.008) and the lowest in 2007 (MTFP = 0.963). The results indicate significant inefficiencies within the sample for the years under study. In 2008, taken together, the inefficient hospitals would have needed to increase the number of outpatient visits by 117627 (18 percent) and inpatient days by 49415 (13 percent) in order to reach full efficiency. Alternatively, inefficiencies could have been reduced by transferring 264 clinical staff and 39 beds to health clinics, health posts and mobile posts. The transfer of excess clinical staff to those facilities which are closest to the communities may also contribute to accelerating progress towards the Millennium Development Goals related to child and maternal health.Nine (57.1 percent) of the 21 hospitals experienced MTFP deterioration during the three years. We found the sources of inefficiencies to be either adverse change in pure efficiency, scale efficiency and/or technical efficiency.In line with the report Health financing: A strategy for the African Region, which was adopted by the Fifty-sixth WHO Regional Committee for Africa, it might be helpful for Botswana to consider institutionalizing efficiency monitoring of health facilities within health management information systems.

Protocol for Reliability Assessment of Structural Health Monitoring Systems Incorporating Model-assisted Probability of Detection (MAPOD) Approach

DTIC Science & Technology

2011-09-01

a quality evaluation with limited data, a model -based assessment must be...that affect system performance, a multistage approach to system validation, a modeling and experimental methodology for efficiently addressing a ...affect system performance, a multistage approach to system validation, a modeling and experimental methodology for efficiently addressing a wide range

Facing the dilemma of patient-centred psoriasis care: a qualitative study identifying patient needs in dermatological outpatient clinics.

PubMed

Khoury, L R; Skov, L; Møller, T

2017-08-01

Caregivers must be aware of patients' current needs by providing care responsive to patients' values and preferences and by identifying what approach improves and encourages patients to participate in their treatment and disease management. Patients with psoriasis healthcare needs perhaps change as medical knowledge improves, new drugs emerge and the healthcare system improves its efficiency as a result of constant structural development. To explore the unmet needs and health perceptions of people with psoriasis, regarding interaction with clinicians and the structure inherent to consultations in a hospital outpatient dermatological clinic. A qualitative investigation with data generated from semi-structured interviews. Transcriptions were subsequently analysed using the template analysis method. Sixteen patients with psoriasis were interviewed. Challenges and dilemmas of patient-centred psoriasis care were identified. Patients have a strong need to be met as individuals as the burden of living with psoriasis goes beyond the skin. Patients strive for efficient treatment and ultimately dream of being cured of psoriasis. They prefer individualized health education in order to adjust their knowledge and self-management skills. These central issues are as yet rarely addressed in clinical consultations. Consultations with a standardized structure do not match the individual challenges and healthcare needs of patients with psoriasis. In order to achieve a more patient-centred approach, health professionals should implement minor structural changes to dermatological services to meet patients' current needs and invite dialogue about the patients' emotional well-being and concerns that go beyond biomedical factors, as well as offer individualized health education. © 2016 British Association of Dermatologists.

Are we measuring what matters in health technology assessment of disease management? Systematic literature review.

PubMed

Steuten, Lotte; Vrijhoef, Bert; Severens, Hans; van Merode, Frits; Spreeuwenberg, Cor

2006-01-01

An overview was produced of indicators currently used to assess disease management programs and, based on these findings, provide a framework regarding sets of indicators that should be used when taking the aims and types of disease management programs into account. A systematic literature review was performed. Thirty-six studies met the inclusion criteria. It appeared that a link between aims of disease management and evaluated structure, process, as well as outcome indicators does not exist in a substantial part of published studies on disease management of diabetes and asthma/chronic obstructive pulmonary disease, especially when efficiency of care is concerned. Furthermore, structure indicators are largely missing from the evaluations, although these are of major importance for the interpretation of outcomes for purposes of decision-making. Efficiency of disease management is mainly evaluated by means of process indicators; the use of outcome indicators is less common. Within a framework, structure, process, and outcome indicators for effectiveness and efficiency are recommended for each type of disease management program. The link between aims of disease management and evaluated structure, process, and outcome indicators does not exist in a substantial part of published studies on disease management. The added value of this study mainly lies in the development of a framework to guide the choice of indicators for health technology assessment of disease management.

Structure, function and five basic needs of the global health research system

PubMed Central

Rudan, Igor; Sridhar, Devi

2016-01-01

Background Two major initiatives that were set up to support and co–ordinate global health research efforts have been largely discontinued in recent years: the Global Forum for Health Research and World Health Organization's Department for Research Policy and Cooperation. These developments provide an interesting case study into the factors that contribute to the sustainability of initiatives to support and co–ordinate global health research in the 21st century. Methods We reviewed the history of attempts to govern, support or co–ordinate research in global health. Moreover, we studied the changes and shifts in funding flows attributed to global health research. This allowed us to map the structure of the global health research system, as it has evolved under the increased funding contributions of the past decade. Bearing in mind its structure, core functions and dynamic nature, we proposed a framework on how to effectively support the system to increase its efficiency. Results Based on our framework, which charted the structure and function of the global health research system and exposed places and roles for many stakeholders within the system, five basic needs emerged: (i) to co–ordinate funding among donors more effectively; (ii) to prioritize among many research ideas; (iii) to quickly recognize results of successful research; (iv) to ensure broad and rapid dissemination of results and their accessibility; and (v) to evaluate return on investments in health research. Conclusion The global health research system has evolved rapidly and spontaneously. It has not been optimally efficient, but it is possible to identify solutions that could improve this. There are already examples of effective responses for the need of prioritization of research questions (eg, the CHNRI method), quick recognition of important research (eg, systems used by editors of the leading journals) and rapid and broadly accessible publication of the new knowledge (eg, PLoS One journal as an example). It is still necessary to develop tools that could assist donors to co–ordinate funding and ensure more equity between areas in the provided support, and to evaluate the value for money invested in health research. PMID:26401270

[How to optimize the efficiency of international sanitary aid in the Democratic Republic of Congo].

PubMed

Kuwekita, Joseph Manzambi; Bruyère, Olivier; Guillaume, Michèle; Gosset, Christiane; Reginster, Jean-Yves

2015-01-01

Analysis of national health insurance accounts in the Democratic Republic of Congo (DRC) clearly shows the importance of international sanitary aid, particularlyfor thefunding ofgeneral referral hospitals, the management of inpatients with AIDS, administration of health zones andfunding of preventive care providers. It The targeted changes described in this article could possibly optimize the efficiency ofinternational aidfor the DRC population, mainly for disorders considered to be a health care priority (i.e. malaria, AIDS, tuberculosis) as well as in the fight against malnutrition. Recommendations target the implementation of procedures for control offood chain security, changes in lifestyle and dietary habits of the population but also comprise extensive restructuring of the health care administration. A dramatic change of the structure in charge of drug distribution as well as eradication of the transfer of part of public health structure income to public health administrative personnel could result in the allocation of significantfunds to thefight against the most important diseases. Better collaboration between the various departments in charge of health care professional training, together with enhanced responsibility of health care personnel is essential. Independent and respected non-governmental organizations should be involved in an audit process, targeting all aspects of the current DRC health system. Eventually, in an equal opportunity perspective, taking into consideration the very high degree of poverty ofDRC inhabitants, implementation of health insurance programmes, use ofgeneric drugs and generalization ofmicro-credit initiatives should also be implemented.

Social networks and health: a systematic review of sociocentric network studies in low- and middle-income countries.

PubMed

Perkins, Jessica M; Subramanian, S V; Christakis, Nicholas A

2015-01-01

In low- and middle-income countries (LMICs), naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various resources. Understanding how social network structure, and influential individuals within the network, may amplify the effects of interventions in LMICs, by creating, for example, cascade effects to non-targeted participants, presents an opportunity to improve the efficiency and effectiveness of public health interventions in such settings. We conducted a systematic review of PubMed, Econlit, Sociological Abstracts, and PsycINFO to identify a sample of 17 sociocentric network papers (arising from 10 studies) that specifically examined health issues in LMICs. We also separately selected to review 19 sociocentric network papers (arising from 10 other studies) on development topics related to wellbeing in LMICs. First, to provide a methodological resource, we discuss the sociocentric network study designs employed in the selected papers, and then provide a catalog of 105 name generator questions used to measure social ties across all the LMIC network papers (including both ego- and sociocentric network papers) cited in this review. Second, we show that network composition, individual network centrality, and network structure are associated with important health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, we highlight the opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. In summary, human health and wellbeing are connected through complex webs of dynamic social relationships. Harnessing such information may be especially important in contexts where resources are limited and people depend on their direct and indirect connections for support. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social Networks and Health: A Systematic Review of Sociocentric Network Studies in Low- and Middle-Income Countries

PubMed Central

Perkins, Jessica M; Subramanian, S V; Christakis, Nicholas A

2015-01-01

In low- and middle-income countries (LMICs), naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various resources. Understanding how social network structure, and influential individuals within the network, may amplify the effects of interventions in LMICs, by creating, for example, cascade effects to non-targeted participants, presents an opportunity to improve the efficiency and effectiveness of public health interventions in such settings. We conducted a systematic review of PubMed, Econlit, Sociological Abstracts, and PsycINFO to identify a sample of 17 sociocentric network papers (arising from 10 studies) that specifically examined health issues in LMICs. We also separately selected to review 19 sociocentric network papers (arising from 10 other studies) on development topics related to wellbeing in LMICs. First, to provide a methodological resource, we discuss the sociocentric network study designs employed in the selected papers, and then provide a catalog of 105 name generator questions used to measure social ties across all the LMIC network papers (including both ego- and sociocentric network papers) cited in this review. Second, we show that network composition, individual network centrality, and network structure are associated with important health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, we highlight the opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. In summary, human health and wellbeing are connected through complex webs of dynamic social relationships. Harnessing such information may be especially important in contexts where resources are limited and people depend on their direct and indirect connections for support. PMID:25442969

Allocation of Public Resources for Psychological Therapy between Types of Mental Health Condition: Towards Structural Balance

ERIC Educational Resources Information Center

Tustin, Don

2009-01-01

This paper addresses issues of allocating public resources efficiently between mental health conditions that are associated with different levels of disability, and presents an adaptation of an established framework to help decision-making in this area. The adapted framework refers to psychological interventions that are universal, indicated,…

Determining the optimal model for role-substitution in NHS dental services in the United Kingdom.

PubMed

Brocklehurst, Paul; Birch, Stephen; McDonald, Ruth; Tickle, Martin

2013-09-24

Role-substitution describes a model of dental care where Dental Care Professionals (DCPs) provide some of the clinical activity previously undertaken by General Dental Practitioners. This has the potential to increase technical efficiency, the capacity to care and reduce costs. Technical efficiency is defined as the production of the maximum amount of output from a given amount of input so that the service operates at the production frontier i.e. optimal level of productivity. Academic research into technical efficiency is becoming increasingly utilised in health care, although no studies have investigated the efficiency of NHS dentistry or role-substitution in high-street dental practices. The aim of this study is to examine the barriers and enablers that exist for role-substitution in general dental practices in the NHS and to determine the most technically efficient model for role-substitution. A screening questionnaire will be sent to DCPs to determine the type and location of role-substitutive models employed in NHS dental practices in the United Kingdom (UK). Semi-structured interviews will then be conducted with practice owners, DCPs and patients at selected sites identified by the questionnaire. Detail will be recorded about the organisational structure of the dental team, the number of NHS hours worked and the clinical activity undertaken. The interviews will continue until saturation and will record the views and attitudes of the members of the dental team. Final numbers of interviews will be determined by saturation.The second work-stream will examine the technical efficiency of the selected practices using Data Envelopment Analysis and Stochastic Frontier Modeling. The former is a non-parametric technique and is considered to be a highly flexible approach for applied health applications. The latter is parametric and is based on frontier regression models that estimate a conventional cost function. Maximising health for a given level and mix of resources is an ethical imperative for health service planners. This study will determine the technical efficiency of role-substitution and so address one of the key recommendations of the Independent Review of NHS dentistry in England.

Determining the optimal model for role-substitution in NHS dental services in the United Kingdom

PubMed Central

2013-01-01

Background Role-substitution describes a model of dental care where Dental Care Professionals (DCPs) provide some of the clinical activity previously undertaken by General Dental Practitioners. This has the potential to increase technical efficiency, the capacity to care and reduce costs. Technical efficiency is defined as the production of the maximum amount of output from a given amount of input so that the service operates at the production frontier i.e. optimal level of productivity. Academic research into technical efficiency is becoming increasingly utilised in health care, although no studies have investigated the efficiency of NHS dentistry or role-substitution in high-street dental practices. The aim of this study is to examine the barriers and enablers that exist for role-substitution in general dental practices in the NHS and to determine the most technically efficient model for role-substitution. Methods/design A screening questionnaire will be sent to DCPs to determine the type and location of role-substitutive models employed in NHS dental practices in the United Kingdom (UK). Semi-structured interviews will then be conducted with practice owners, DCPs and patients at selected sites identified by the questionnaire. Detail will be recorded about the organisational structure of the dental team, the number of NHS hours worked and the clinical activity undertaken. The interviews will continue until saturation and will record the views and attitudes of the members of the dental team. Final numbers of interviews will be determined by saturation. The second work-stream will examine the technical efficiency of the selected practices using Data Envelopment Analysis and Stochastic Frontier Modeling. The former is a non-parametric technique and is considered to be a highly flexible approach for applied health applications. The latter is parametric and is based on frontier regression models that estimate a conventional cost function. Discussion Maximising health for a given level and mix of resources is an ethical imperative for health service planners. This study will determine the technical efficiency of role-substitution and so address one of the key recommendations of the Independent Review of NHS dentistry in England. PMID:24063247

Emergy-based urban ecosystem health assessment: A case study of Baotou, China

NASA Astrophysics Data System (ADS)

Liu, G. Y.; Yang, Z. F.; Chen, B.; Zhang, Y.; Zhang, L. X.; Zhao, Y. W.; Jiang, M. M.

2009-03-01

Ecosystem health has been a hot topic of ecosystem management research for years. Considering the urban area as a complex ecosystem consisted of natural, societal and economic entities, urban ecosystem health assessment is necessary to be conducted for the scientific management and proper ecological restoration. Combining with the ecosystem service function of the urban ecosystem, theoretical framework and methodology of the urban ecosystem health assessment based on emergy are proposed and the temporal variation of the health level of the city are also outlined in this paper. Following the principle of ecosystem health assessment, four major factors, including vigor (V), organizational structure (O), resilience (R) and function maintenance (F), are integrated to construct a novel emergy-based urban ecosystem health index (EUEHI). Based on the EUEHI and comparing with those of five other typical Chinese cities, the case study of Baotou city shows that its urban ecosystem health level is steadily arising despite the year 2001 as a turning point. Due to the emphasis on the resource structure adjustment and utilization efficiency, Baotou has obtained a better organizational structure and service function for the total urban ecosystem.

Improving Quality and Reducing Waste in Allied Health Workplace Education Programs: A Pragmatic Operational Education Framework Approach.

PubMed

Golder, Janet; Farlie, Melanie K; Sevenhuysen, Samantha

2016-01-01

Efficient utilisation of education resources is required for the delivery of effective learning opportunities for allied health professionals. This study aimed to develop an education framework to support delivery of high-quality education within existing education resources. This study was conducted in a large metropolitan health service. Homogenous and purposive sampling methods were utilised in Phase 1 (n=43) and 2 (n=14) consultation stages. Participants included 25 allied health professionals, 22 managers, 1 educator, and 3 executives. Field notes taken during 43 semi-structured interviews and 4 focus groups were member-checked, and semantic thematic analysis methods were utilised. Framework design was informed by existing published framework development guides. The framework model contains governance, planning, delivery, and evaluation and research elements and identifies performance indicators, practice examples, and support tools for a range of stakeholders. Themes integrated into framework content include improving quality of education and training provided and delivery efficiency, greater understanding of education role requirements, and workforce support for education-specific knowledge and skill development. This framework supports efficient delivery of allied health workforce education and training to the highest standard, whilst pragmatically considering current allied health education workforce demands.

The Irish health system: developments in strategy, structure, funding and delivery since 1980.

PubMed

Wiley, Miriam M

2005-09-01

As the Irish health system embarks upon its first major structural reorganisation in over 30 years, developments within this system over the past two decades are assessed. Real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s. While successive statements of health strategy have prioritised the objectives of equity, efficiency and quality of care, questions arise regarding the return achieved with the increased investment. With higher levels of economic growth, more people have been buying private health insurance such that almost half the population are now privately insured. At the same time, the numbers with eligibility for health services without charge have decreased while those from lower socio-economic groups continue to have higher levels of utilisation. Equity issues arise, however, with regard to access to public hospitals as the rate of growth in admissions for private patients outstrips that for public patients. The establishment of a National Treatment Purchase Fund to purchase treatment in private facilities for public patients on waiting lists raises efficiency and equity questions as the treatment of private patients in public hospitals is heavily subsidised while the State pays full cost for the treatment of public patients in private facilities. Copyright (c) 2005 John Wiley & Sons, Ltd.

The need for strategic tax planning among nonprofit hospitals.

PubMed

Smith, Pamela C

2005-01-01

Strategic tax planning issues are important to the nonprofit health care sector, despite its philanthropic mission. The consolidation of the industry has led management to fight for resources and develop alternative strategies for raising money. When management evaluates alternative collaborative structures to increase efficiency, the impact on governance structures must also be considered. The increased governmental scrutiny of joint ventures within the health care sector warrants management's attention as well. The financial incentives must be considered, along with the various tax policy implications of cross-sector collaborations.

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

PubMed

Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

2015-01-01

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Testicular Self-Examination: A Test of the Health Belief Model and the Theory of Planned Behaviour

ERIC Educational Resources Information Center

McClenahan, Carol; Shevlin, Mark; Adamson, Gary; Bennett, Cara; O'Neill, Brenda

2007-01-01

The aim of this study was to test the utility and efficiency of the theory of planned behaviour (TPB) and the health belief model (HBM) in predicting testicular self-examination (TSE) behaviour. A questionnaire was administered to an opportunistic sample of 195 undergraduates aged 18-39 years. Structural equation modelling indicated that, on the…

Measuring self-rated productivity: factor structure and variance component analysis of the Health and Work Questionnaire.

PubMed

von Thiele Schwarz, Ulrica; Sjöberg, Anders; Hasson, Henna; Tafvelin, Susanne

2014-12-01

To test the factor structure and variance components of the productivity subscales of the Health and Work Questionnaire (HWQ). A total of 272 individuals from one company answered the HWQ scale, including three dimensions (efficiency, quality, and quantity) that the respondent rated from three perspectives: their own, their supervisor's, and their coworkers'. A confirmatory factor analysis was performed, and common and unique variance components evaluated. A common factor explained 81% of the variance (reliability 0.95). All dimensions and rater perspectives contributed with unique variance. The final model provided a perfect fit to the data. Efficiency, quality, and quantity and three rater perspectives are valid parts of the self-rated productivity measurement model, but with a large common factor. Thus, the HWQ can be analyzed either as one factor or by extracting the unique variance for each subdimension.

Structural health monitoring of plates with surface features using guided ultrasonic waves

NASA Astrophysics Data System (ADS)

Fromme, P.

2009-03-01

Distributed array systems for guided ultrasonic waves offer an efficient way for the long-term monitoring of the structural integrity of large plate-like structures. The measurement concept involving baseline subtraction has been demonstrated under laboratory conditions. For the application to real technical structures it needs to be shown that the methodology works equally well in the presence of structural and surface features. Problems employing this structural health monitoring concept can occur due to the presence of additional changes in the signal reflected at undamaged parts of the structure. The influence of the signal processing parameters and transducer placement on the damage detection and localization accuracy is discussed. The use of permanently attached, distributed sensors for the A0 Lamb wave mode has been investigated. Results are presented using experimental data obtained from laboratory measurements and Finite Element simulated signals for a large steel plate with a welded stiffener.

A ground-based method of assessing urban forest structure and ecosystem services

Treesearch

David J. Nowak; Daniel E. Crane; Jack C. Stevens; Robert E. Hoehn; Jeffrey T. Walton; Jerry Bond

2008-01-01

To properly manage urban forests, it is essential to have data on this important resource. An efficient means to obtain this information is to randomly sample urban areas. To help assess the urban forest structure (e.g., number of trees, species composition, tree sizes, health) and several functions (e.g., air pollution removal, carbon storage and sequestration), the...

Hospital quality choice and market structure in a regulated duopoly.

PubMed

Beitia, Arantza

2003-11-01

This paper analyzes the optimal structure of a regulated health care industry in a model in which the regulator cannot enforce what hospitals do (unverifiable quality of health) or does not know what hospitals know (incomplete information about production costs) or both. We show that if quality is unverifiable the choice between monopoly and duopoly does not change with respect to the verifiable case but, if there are fixed costs (assumed to be quality dependent) and the monopoly is the optimal market structure, the quality level of the operative hospital decreases. Asymmetry of information introduces informational rents that can be reduced by increasing the most efficient hospital's market share. A monopoly is chosen more often.

Does decentralization influence efficiency of health units? A study of opinion and perception of health workers in Odisha.

PubMed

Panda, Bhuputra; Thakur, Harshad P; Zodpey, Sanjay P

2016-10-31

Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS) was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction) of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU); examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance. Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR), one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD) and the latter, non-priority districts (NPD). Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work. A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of respondents from PD was highly satisfied with the current set of provisions and manners of functioning of the sample health units. Active community engagement, participation of elected representatives, selection of a pro-active Chairman, and training to RKS members were suggested as the immediate priority action points for the state government. Mean scores differed significantly between PD and NPD with regard to: influence of RKS on individual-centric, organizational-centric and patient-centric performance, and the responsibilities to be entrusted with RKS. Absenteeism was strongly associated with satisfaction and local self-governance. Work-related factors, systemic factors, local accountability and patients' involvement were found to be the key predictors of satisfaction of health workforce. The understanding on quality improvement strategies was found to be very poor among the health workers. Tailor-made capacity building measures at district and sub-district levels could be critical to equip the peripheral health units to achieve the universal health coverage goals. Work environment, systemic factors and accountability need to be addressed on priority for retention of health workforce. The hypothesized link between efficient local decision making, perception of health workers about efficiency of health units and the health status of population needs further investigation.

On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality

PubMed Central

2013-01-01

Background Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided. Methods For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES. Results On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively. Conclusions This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed. PMID:24359014

The German and Japanese health care systems: an international comparison using an input-output model.

PubMed

Rump, A; Schöffski, O

2016-12-01

The German and Japanese health care systems have common roots, but have evolved differently. Whereas the German system is often considered as expensive and poorly efficient, people in Japan are viewed as healthy and health care as comparatively cheap. In this study, we compared the quality, the effectiveness and efficiency of the German and Japanese health care systems. This study includes comparative health care data analysis. The quality and effectiveness of the German and Japanese health care systems were analyzed using an input-output model including 12 countries based on health indicators published by the OECD. Besides the invested resources, a risk-related input dimension was used for risk adjustment. The efficiency of the systems was assessed by relating the average output to the health expenses per capita. Health risks seem qualitatively different in Germany and Japan, but at the aggregate level, lifestyle does not seem to be an outstanding explanatory factor for health outcome differences between both countries. For investments in health resources, Germany is in a top position, whereas in the international comparison, the outcome is rather poor. The resources invested in Japan are also high, but slightly less than in Germany, whereas on average, the outcome is better. However, in the international comparison, resources as well as results in Japan show a very high variability. Relating the average output to the health expenses per capita indicates that on the average, the health care system in Japan is more efficient than in Germany. Germany and Japan have a quality problem with their health care systems. In Germany there is a transmission failure from structural to outcome quality that might be related to coordination problems between the outpatient and inpatient sector. Japan shows an unbalanced system that may be suspected to have a quality problem as a whole. As the development of the remuneration system including quality requirements is under the direct responsibility and guidance of the Ministry of Health in Japan, the issue might however be more easily solved in Japan than in Germany. Although on average, health care seems more efficient in Japan than in Germany, taking into account health as well as long-term care expenses and uncertainties related to exchange rate adjustments, the higher efficiency of the Japanese system becomes questionable. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Fundamentals of service lines and the necessity of physician leaders.

PubMed

Jain, Anshu K; Thompson, Jon M; Kelley, Scott M; Schwartz, Richard W

2006-06-01

In the demanding and unpredictable environment of the health care industry, hospitals and health systems continue to search for ways to improve the efficiency and quality of care provision and, thus, thrive. Service line organization in health care, a concept that was popularized in the past, has recently experienced a resurgence, spanning the gamut from small community hospitals to large academic medical centers. The modern service line has transformed into an organizational tool that provides hospitals and health systems with a novel approach to achieve the goals of efficient and effective care. Physician leaders can play an integral role in the management of service lines, using a combination of management skills and clinical expertise to provide the oversight and direction necessary for assuring excellence in clinical care and value in its delivery. This article presents an overview of service line structure, implementation, implications, and the role of the physician-leader.

Shape and Stress Sensing of Multilayered Composite and Sandwich Structures Using an Inverse Finite Element Method

NASA Technical Reports Server (NTRS)

Cerracchio, Priscilla; Gherlone, Marco; Di Sciuva, Marco; Tessler, Alexander

2013-01-01

The marked increase in the use of composite and sandwich material systems in aerospace, civil, and marine structures leads to the need for integrated Structural Health Management systems. A key capability to enable such systems is the real-time reconstruction of structural deformations, stresses, and failure criteria that are inferred from in-situ, discrete-location strain measurements. This technology is commonly referred to as shape- and stress-sensing. Presented herein is a computationally efficient shape- and stress-sensing methodology that is ideally suited for applications to laminated composite and sandwich structures. The new approach employs the inverse Finite Element Method (iFEM) as a general framework and the Refined Zigzag Theory (RZT) as the underlying plate theory. A three-node inverse plate finite element is formulated. The element formulation enables robust and efficient modeling of plate structures instrumented with strain sensors that have arbitrary positions. The methodology leads to a set of linear algebraic equations that are solved efficiently for the unknown nodal displacements. These displacements are then used at the finite element level to compute full-field strains, stresses, and failure criteria that are in turn used to assess structural integrity. Numerical results for multilayered, highly heterogeneous laminates demonstrate the unique capability of this new formulation for shape- and stress-sensing.

A reusable PZT transducer for monitoring initial hydration and structural health of concrete.

PubMed

Yang, Yaowen; Divsholi, Bahador Sabet; Soh, Chee Kiong

2010-01-01

During the construction of a concrete structure, strength monitoring is important to ensure the safety of both personnel and the structure. Furthermore, to increase the efficiency of in situ casting or precast of concrete, determining the optimal time of demolding is important for concrete suppliers. Surface bonded lead zirconate titanate (PZT) transducers have been used for damage detection and parameter identification for various engineering structures over the last two decades. In this work, a reusable PZT transducer setup for monitoring initial hydration of concrete and structural health is developed, where a piece of PZT is bonded to an enclosure with two bolts tightened inside the holes drilled in the enclosure. An impedance analyzer is used to acquire the admittance signatures of the PZT. Root mean square deviation (RMSD) is employed to associate the change in concrete strength with changes in the PZT admittance signatures. The results show that the reusable setup is able to effectively monitor the initial hydration of concrete and the structural health. It can also be detached from the concrete for future re-use.

A Reusable PZT Transducer for Monitoring Initial Hydration and Structural Health of Concrete

PubMed Central

Yang, Yaowen; Divsholi, Bahador Sabet; Soh, Chee Kiong

2010-01-01

During the construction of a concrete structure, strength monitoring is important to ensure the safety of both personnel and the structure. Furthermore, to increase the efficiency of in situ casting or precast of concrete, determining the optimal time of demolding is important for concrete suppliers. Surface bonded lead zirconate titanate (PZT) transducers have been used for damage detection and parameter identification for various engineering structures over the last two decades. In this work, a reusable PZT transducer setup for monitoring initial hydration of concrete and structural health is developed, where a piece of PZT is bonded to an enclosure with two bolts tightened inside the holes drilled in the enclosure. An impedance analyzer is used to acquire the admittance signatures of the PZT. Root mean square deviation (RMSD) is employed to associate the change in concrete strength with changes in the PZT admittance signatures. The results show that the reusable setup is able to effectively monitor the initial hydration of concrete and the structural health. It can also be detached from the concrete for future re-use. PMID:22399929

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

Technology support of the handover: promoting observability, flexibility and efficiency.

PubMed

Patterson, Emily S

2012-12-01

Efforts to standardise data elements and increase the comprehensiveness of information included in patient handovers have produced a growing interest in augmenting the verbal exchange of information with written communications conducted through health information technology (HIT). The aim of this perspective is to offer recommendations to optimise technology support of handovers, based on a review of the relevant scientific literature. Review of the literature on human factors and the study of communication produced three recommendations. The first entails making available "shared knowledge" relevant to the handover and subsequent clinical management with intended and unintended recipients. The second is to create a flexible narrative structure (unstructured text fields) for human-human communications facilitated by technology. The third recommendation is to avoid reliance on real-time data entry during busy periods. Implementing these recommendations is anticipated to increase the observability (the ability to readily determine current status), flexibility, and efficiency of HIT-supported patient handovers. Anticipated benefits of technology-supported handovers include reducing reliance on human memory, increasing the efficiency and structure of the verbal exchange, avoiding readbacks of numeric data, and aiding clinical management following the handover. In cases when verbal handovers are delayed, do not occur, or involve members of the health care team without first-hand access to critical information, making 'common ground' observable for all recipients, creating a flexible narrative structure for communication and avoiding reliance on real-time data entry during the busiest times has implications for HIT design and day to day data entry and management operations. Benefits include increased observability, flexibility, and efficiency of HIT-supported patient handovers.

Policy and system strategies in promoting child health information systems, including the role of Medicaid, the state children's health insurance program, and public financing.

PubMed

MacTaggart, Patricia; Bagley, Bruce

2009-01-01

Government, through its unique roles as regulator, purchaser, provider, and facilitator, has an opportunity and an obligation to play a major role in accelerating the implementation of electronic health record systems and electronic health information exchange. Providers, who are expected to deliver appropriate care at designated locations at an appropriate cost, are dependent on health information technology for efficient effective health care. As state and federal governments move forward with health care purchasing reforms, they must take the opportunity to leverage policy and structure and to align incentives that enhance the potential for provider engagement in electronic health record adoption.

Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran

PubMed Central

Yazdi-Feyzabadi, Vahid; Emami, Mozhgan; Mehrolhassani, Mohammad Hossein

2015-01-01

Background: Health information system (HIS) has been utilized for collecting, processing, storing, and transferring the required information for planning and decision-making at different levels of health sector to provide quality services. In this study, in order to provide high-quality HIS, primary health care (PHC) providers’ perspective on current challenges and barriers were investigated. Methods: This study was carried out with a qualitative approach using semi-structured audiotaped focus group discussions (FGDs). One FGD was conducted with 13 Behvarz and health technicians as front-line workers and the other with 16 personnel including physicians, statisticians, and health professionals working in health centers of the PHC network in KUMS. The discussions were transcribed and then analyzed using the framework analysis method. Results: The identified organizational challenges were categorized into two groups: HIS structure and the current model of PHC in urban areas. Furthermore, the structural challenges were classified into HIS management structure (information systems resources, including human, supplies, and organizational rules) and information process. Conclusions: The HIS works effectively and efficiently when there are a consistency and integrity between the human, supplies, and process aspects. Hence, multifaceted interventions including strengthening the organizational culture to use the information in decisions, eliminating infrastructural obstacles, appointing qualified staff and more investment for service delivery at urban areas are the most fundamental requirements of high-quality HIS in PHC. PMID:26236444

Predicting organ toxicity using in vitro bioactivity data and chemical structure

EPA Science Inventory

Animal testing alone cannot practically evaluate the health hazard posed by tens of thousands of environmental chemicals. Computational approaches together with high-throughput experimental data may provide more efficient means to predict chemical toxicity. Here, we use a superv...

Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

PubMed

Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

2018-04-01

To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination.

PubMed

Swift, Melanie D; Aliyu, Muktar H; Byrne, Daniel W; Qian, Keqin; McGown, Paula; Kinman, Patricia O; Hanson, Katherine Louise; Culpepper, Demoyne; Cooley, Tamara J; Yarbrough, Mary I

2017-09-01

To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011-2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the "Flulapalooza method" as a best practice model to enhance efficiency.

[Integral health provision by two Catalonian health providing entities (Spain)].

PubMed

Henao-Martínez, Diana; Vázquez-Navarrete, María L; Vargas-Lorenzo, Ingrid; Coderch-Lassaletta, Jordi; Llopart-López, Josep R

2008-01-01

Health policies aimed at promoting collaboration amongst providers have led to different initiatives, amongst them integrated healthcare delivery systems (IDS); these have been analysed mainly in the USA but hardly so in Colombia or Spain . This article thus analyses the experience of two IDS in Catalonia for identifying elements for improvement. This was a case-study carried out via individual semi-structured interviews and analysing documents. Two IDS were selected; a sample of documents and reports providing information on analysis variables were selected for each case. Content was analysed via mixed categories and segmentation by cases and topics. Both IDS are health-care providing organisations presenting backward vertical integration, having total internal service production and virtual integration of ownership. BSA is funded by providing services whilst SSIBE relies on shareholding via capitation pilot test. Both have closely coordinated multiple managing bodies and have defined overall strategies orientated towards coordination and efficiency; they differ regarding implementation time. BSA has a divisional structure and SSIBE a functional one, organised by transversal areas. Clinical coordination is based on standardising processes and abilities, having few mechanisms for mutual adaptation and disparity in the number of instruments implemented. Both organisations presented enabling and hindering factors for clinical coordination which would need changes in internal and external components in order to improve overall efficiency and health care continuity.

Reforming "developing" health systems: Tanzania, Mexico, and the United States.

PubMed

Chernichovsky, Dov; Martinez, Gabriel; Aguilera, Nelly

2009-01-01

Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as "developing": they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice. The chapter contrasts the nature of the developing health care system with the common goals', objectives, and principles of the Emerging Paradigm (EP) in developed, integrated--yet decentralized--systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined. In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, "silos" that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits--substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors. The situation can be rectified by (a) "centralizing"--at any level of development and resource availability--health system finance around a set package of core medical benefits that is made available to the entire population and (b) "decentralizing" consumption and provision of care. The first serves equity and cost containment and sustainability. The second supports efficiency and client satisfaction. The chapter views commonly discussed problems of the health care system--a lack of insurance coverage and income protection--as symptoms of a large problem: health system segregation.

Vertical integration models to prepare health systems for capitation.

PubMed

Cave, D G

1995-01-01

Health systems will profit most under capitation if their vertical integration strategy provides operational stability, a strong primary care physician base, efficient delivery of medical services, and geographic access to physicians. Staff- and equity-based systems best meet these characteristics for success because they have one governance structure and a defined mission statement. Moreover, physician bonds are strong because these systems maximize physicians' income potential and control the revenue stream.

[Indicators of communication and degree of professional integration in healthcare].

PubMed

Mola, Ernesto; Maggio, Anna; Vantaggiato, Lucia

2009-01-01

According to the chronic care model, improving the management of chronic illness requires efficient communication between health care professionals and the creation of a web of integrated healthcare The aim of this study was to identify an efficient methodology for evaluating the degree of professional integration through indicators related to communication between healthcare professionals. The following types of indicators were identified:-structure indicators to evaluate the presence of prerequisites necessary for implementing the procedures -functional indicators to quantitatively evaluate the use of communications instruments-performance indicators Defining specific indicators may be an appropriate methodology for evaluating the degree of integration and communication between health professionals, available for a bargaining system of incentives.

Sensor-Only System Identification for Structural Health Monitoring of Advanced Aircraft

NASA Technical Reports Server (NTRS)

Kukreja, Sunil L.; Bernstein, Dennis S.

2012-01-01

Environmental conditions, cyclic loading, and aging contribute to structural wear and degradation, and thus potentially catastrophic events. The challenge of health monitoring technology is to determine incipient changes accurately and efficiently. This project addresses this challenge by developing health monitoring techniques that depend only on sensor measurements. Since actively controlled excitation is not needed, sensor-to-sensor identification (S2SID) provides an in-flight diagnostic tool that exploits ambient excitation to provide advance warning of significant changes. S2SID can subsequently be followed up by ground testing to localize and quantify structural changes. The conceptual foundation of S2SID is the notion of a pseudo-transfer function, where one sensor is viewed as the pseudo-input and another is viewed as the pseudo-output, is approach is less restrictive than transmissibility identification and operational modal analysis since no assumption is made about the locations of the sensors relative to the excitation.

A new approach for structural health monitoring by applying anomaly detection on strain sensor data

NASA Astrophysics Data System (ADS)

Trichias, Konstantinos; Pijpers, Richard; Meeuwissen, Erik

2014-03-01

Structural Health Monitoring (SHM) systems help to monitor critical infrastructures (bridges, tunnels, etc.) remotely and provide up-to-date information about their physical condition. In addition, it helps to predict the structure's life and required maintenance in a cost-efficient way. Typically, inspection data gives insight in the structural health. The global structural behavior, and predominantly the structural loading, is generally measured with vibration and strain sensors. Acoustic emission sensors are more and more used for measuring global crack activity near critical locations. In this paper, we present a procedure for local structural health monitoring by applying Anomaly Detection (AD) on strain sensor data for sensors that are applied in expected crack path. Sensor data is analyzed by automatic anomaly detection in order to find crack activity at an early stage. This approach targets the monitoring of critical structural locations, such as welds, near which strain sensors can be applied during construction and/or locations with limited inspection possibilities during structural operation. We investigate several anomaly detection techniques to detect changes in statistical properties, indicating structural degradation. The most effective one is a novel polynomial fitting technique, which tracks slow changes in sensor data. Our approach has been tested on a representative test structure (bridge deck) in a lab environment, under constant and variable amplitude fatigue loading. In both cases, the evolving cracks at the monitored locations were successfully detected, autonomously, by our AD monitoring tool.

Structure-based drug discovery for botulinum neurotoxins.

PubMed

Swaminathan, Subramanyam

2013-01-01

Clostridium botulinum neurotoxin is the most poisonous substance known to humans. It is a potential biowarfare threat and a public health hazard. The only therapeutics available is antibody treatment which will not be effective for post-exposure therapy. There are no drugs available for post-intoxication treatment. Accordingly, it is imperative to develop effective drugs to counter botulism. Available structural information on botulinum neurotoxins both alone and in complex with their substrates offers an efficient method for designing structure-based drugs to treat botulism.

[Analysis of the effectiveness of the public health system with special reference to the health of children].

PubMed

Köhler, L; Brogren, P O

1990-01-01

A well structured, efficient health service is an important component of the welfare state, in Sweden for example. But its significance for the state of the nation's health is limited and will be affected, inter alia, by life styles and the environment. A progressive health policy must be based on cooperation between various sectors of society, and here the health service plays a central part. Therefore social policy must be well documented and subjected to continuous review. This is an important prerequisite for planning and correction at different levels. The analysis must take account of society as a whole, organization, and the individual! In so doing, greater significance should be attributed to the effectiveness and quality of the health service than to structures, capacity and statistics. With reference to the health of children in the Nordic countries, it is encouraging to see that this conception of evaluation has also gained greater acceptance in preventive care, firstly in the field of paediatric health care and more recently in the school health service as well.

A fuzzy logic approach toward solving the analytic enigma of health system financing.

PubMed

Chernichovsky, Dov; Bolotin, Arkady; de Leeuw, David

2003-09-01

Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

Ambulatory care pavilion takes its place out front by solving multiple needs.

PubMed

Saukaitis, C A

1994-09-01

In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century.

Strategic relatedness in mergers and financial performance: the case of the health maintenance organization industry in the United States.

PubMed

Weech-Maldonado, Robert

2002-11-01

Knowledge and identification of strategic factors associated with favourable post-acquisition performance can be of benefit to both managers and shareholders. From a management perspective, the identification of contextual factors that can influence postmerger performance is 'strategic' in nature, and should be considered in the analysis of future acquisitions. Within the context of the health maintenance organization (HMO) industry, this study examines the impact of strategic relatedness on postmerger financial performance. Strategic relatedness is conceptualized as similarity between the acquirer and target HMOs in terms of operational efficiency, marketing orientation, organizational structure and profit orientation. Regression analysis showed that similarity in operational efficiency and similarity in HMO structure were associated with better postmerger financial performance. However, marketing orientation similarity and profit orientation similarity were not significantly related to postmerger performance. This finding suggests that HMO mergers involving firms with similar strategic orientations and similar approaches to the delivery of care have greater strategic fit and experience better financial performance.

The structure of the pharmaceutical market in Iran using concentration indices

PubMed Central

Mohseni, Mohammad; Gorji, Hasan Abolghasem; Ahadinezhad, Bahman; Khosravizadeh, Omid; Keykaleh, Meysam Safi; Moosavi, Ahmad; Mohtashamzadeh, Bahareh

2017-01-01

Background and objective The efficiency and function of the pharmaceutical sector, as a vital portion of the health system, have a significant effect on intermediate and final indices of health. In this research, the structure of the pharmaceutical market in Iran was examined through the calculation of concentration indices in 2011. Methods In this cross-sectional study, the needed data was gathered from the Food and Drug Administration in the year 2011. Data were analyzed using SPSS software version 20 and Microsoft Office Excel software. Finally, two common measures of market concentration, the Concentration Ratio and the Herfindahl-Hirschman Index, were calculated. Results The largest and the smallest shares of the industry were 5.57% and 0.01%, respectively. The average industry share was 1.09%. The share range was calculated to be 5.56%. The Herfindahl-Hirschman Index was 248.5, which indicates a very low concentration of the pharmaceutical market in Iran. Also, based on the Concentration Ratio of 4 companies (18.39%), the concentration of the pharmaceutical market has been too low. Conclusion The pharmaceutical market in Iran has a very low concentration and it does not have an exclusive mode in terms of market structure. Therefore, it can be attributed to the competitive model. The policy makers in this area can use this characteristic as a leverage to improve efficiency, fairness, revenue and health indices. PMID:28607663

The structure of the pharmaceutical market in Iran using concentration indices.

PubMed

Mohseni, Mohammad; Gorji, Hasan Abolghasem; Ahadinezhad, Bahman; Khosravizadeh, Omid; Keykaleh, Meysam Safi; Moosavi, Ahmad; Mohtashamzadeh, Bahareh

2017-04-01

The efficiency and function of the pharmaceutical sector, as a vital portion of the health system, have a significant effect on intermediate and final indices of health. In this research, the structure of the pharmaceutical market in Iran was examined through the calculation of concentration indices in 2011. In this cross-sectional study, the needed data was gathered from the Food and Drug Administration in the year 2011. Data were analyzed using SPSS software version 20 and Microsoft Office Excel software. Finally, two common measures of market concentration, the Concentration Ratio and the Herfindahl-Hirschman Index, were calculated. The largest and the smallest shares of the industry were 5.57% and 0.01%, respectively. The average industry share was 1.09%. The share range was calculated to be 5.56%. The Herfindahl-Hirschman Index was 248.5, which indicates a very low concentration of the pharmaceutical market in Iran. Also, based on the Concentration Ratio of 4 companies (18.39%), the concentration of the pharmaceutical market has been too low. The pharmaceutical market in Iran has a very low concentration and it does not have an exclusive mode in terms of market structure. Therefore, it can be attributed to the competitive model. The policy makers in this area can use this characteristic as a leverage to improve efficiency, fairness, revenue and health indices.

Systems Thinking to Improve the Public’s Health

PubMed Central

Leischow, Scott J.; Best, Allan; Trochim, William M.; Clark, Pamela I.; Gallagher, Richard S.; Marcus, Stephen E.; Matthews, Eva

2014-01-01

Improving population health requires understanding and changing societal structures and functions, but countervailing forces sometimes undermine those changes, thus reflecting the adaptive complexity inherent in public health systems. The purpose of this paper is to propose systems thinking as a conceptual rubric for the practice of team science in public health, and transdisciplinary, translational research as a catalyst for promoting the functional efficiency of science. The paper lays a foundation for the conceptual understanding of systems thinking and transdisciplinary research, and will provide illustrative examples within and beyond public health. A set of recommendations for a systems-centric approach to translational science will be presented. PMID:18619400

Lean thinking in health and nursing: an integrative literature review 1

PubMed Central

Magalhães, Aline Lima Pestana; Erdmann, Alacoque Lorenzini; da Silva, Elza Lima; dos Santos, José Luís Guedes

2016-01-01

ABSTRACT Objectives: to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. Method: an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. Results: the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. Conclusion: this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient. PMID:27508906

Integration mechanisms and hospital efficiency in integrated health care delivery systems.

PubMed

Wan, Thomas T H; Lin, Blossom Yen-Ju; Ma, Allen

2002-04-01

This study analyzes integration mechanisms that affect system performances measured by indicators of efficiency in integrated delivery systems (IDSs) in the United States. The research question is, do integration mechanisms improve IDSs' efficiency in hospital care? American Hospital Association's Annual Survey (1998) and Dorenfest's Survey on Information Systems in Integrated Healthcare Delivery Systems (1998) were used to conduct the study, using IDS as the unit of analysis. A covariance structure equation model of the effects of system integration mechanisms on IDS performance was formulated and validated by an empirical examination of IDSs. The study sample includes 973 hospital-based integrated health care delivery systems operating in the United States, carried in the list of Dorenfests Survey on Information Systems in Integrated Health care Delivery Systems. The measurement indicators of system integration mechanisms are categorized into six related domains: informatic integration, case management, hybrid physician-hospital integration, forward integration, backward integration, and high tech medical services. The multivariate analysis reveals that integration mechanisms in system operation are positively correlated and positively affect IDSs' efficiency. The six domains of integration mechanisms account for 58.9% of the total variance in hospital performance. The service differentiation strategy such as having more high tech medical services have much stronger influences on efficiency than other integration mechanisms do. The beneficial effects of integration mechanisms have been realized in IDS performance. High efficiency in hospital care can be achieved by employing proper integration strategies in operations.

On modelling three-dimensional piezoelectric smart structures with boundary spectral element method

NASA Astrophysics Data System (ADS)

Zou, Fangxin; Aliabadi, M. H.

2017-05-01

The computational efficiency of the boundary element method in elastodynamic analysis can be significantly improved by employing high-order spectral elements for boundary discretisation. In this work, for the first time, the so-called boundary spectral element method is utilised to formulate the piezoelectric smart structures that are widely used in structural health monitoring (SHM) applications. The resultant boundary spectral element formulation has been validated by the finite element method (FEM) and physical experiments. The new formulation has demonstrated a lower demand on computational resources and a higher numerical stability than commercial FEM packages. Comparing to the conventional boundary element formulation, a significant reduction in computational expenses has been achieved. In summary, the boundary spectral element formulation presented in this paper provides a highly efficient and stable mathematical tool for the development of SHM applications.

Heuristic evaluation of eNote: an electronic notes system.

PubMed

Bright, Tiffani J; Bakken, Suzanne; Johnson, Stephen B

2006-01-01

eNote is an electronic health record (EHR) system based on semi-structured narrative documents. A heuristic evaluation was conducted with a sample of five usability experts. eNote performed highly in: 1)consistency with standards and 2)recognition rather than recall. eNote needs improvement in: 1)help and documentation, 2)aesthetic and minimalist design, 3)error prevention, 4)helping users recognize, diagnosis, and recover from errors, and 5)flexibility and efficiency of use. The heuristic evaluation was an efficient method of evaluating our interface.

High resolution, high sensitivity, dynamic distributed structural monitoring using optical frequency domain reflectometry

NASA Astrophysics Data System (ADS)

Kreger, Stephen T.; Sang, Alex K.; Garg, Naman; Michel, Julia

2013-05-01

Fiber-optic ultrasonic transducers are an important component of an active ultrasonic testing system for structural health monitoring. Fiber-optic transducers have several advantages such as small size, light weight, and immunity to electromagnetic interference that make them much more attractive than the current available piezoelectric transducers, especially as embedded and permanent transducers in active ultrasonic testing for structural health monitoring. In this paper, a distributed fiber-optic laser-ultrasound generation based on the ghost-mode of tilted fiber Bragg gratings is studied. The influences of the laser power and laser pulse duration on the laser-ultrasound generation are investigated. The results of this paper are helpful to understand the working principle of this laser-ultrasound method and improve the ultrasonic generation efficiency.

Metal-Organic Frameworks-Derived Hierarchical Co3O4 Structures as Efficient Sensing Materials for Acetone Detection.

PubMed

Zhang, Rui; Zhou, Tingting; Wang, Lili; Zhang, Tong

2018-03-21

Highly sensitive and stable gas sensors have attracted much attention because they are the key to innovations in the fields of environment, health, energy savings and security, etc. Sensing materials, which influence the practical sensing performance, are the crucial parts for gas sensors. Metal-organic frameworks (MOFs) are considered as alluring sensing materials for gas sensors because of the possession of high specific surface area, unique morphology, abundant metal sites, and functional linkers. Herein, four kinds of porous hierarchical Co 3 O 4 structures have been selectively controlled by optimizing the thermal decomposition (temperature, rate, and atmosphere) using ZIF-67 as precursor that was obtained from coprecipitation method with the co-assistance of cobalt salt and 2-methylimidazole in the solution of methanol. These hierarchical Co 3 O 4 structures, with controllable cross-linked channels, meso-/micropores, and adjustable surface area, are efficient catalytic materials for gas sensing. Benefits from structural advantages, core-shell, and porous core-shell Co 3 O 4 exhibit enhanced sensing performance compared to those of porous popcorn and nanoparticle Co 3 O 4 to acetone gas. These novel MOF-templated Co 3 O 4 hierarchical structures are so fantastic that they can be expected to be efficient sensing materials for development of low-temperature operating gas sensors.

Equity and efficiency in health status and health services utilization: a household perspective.

PubMed

Sirageldin, I; Diop, F

1991-01-01

Health economists examine the existing pattern of disease, the initial distributional structure of public policies, and the behavioral response of households in allocating resources towards health promoting activities to understand the health consequences of public fiscal and income policies. They hope that this analysis will guide health policymakers to minimize differentials in health service utilization and health outcomes. The household production of health serves as the general framework. The analysis reveals that the demand for health and the demand for health services depend on the organization of government fiscal and distribution policies. Further the demand for health services hinges on its own price as well as on the prices of other inputs including nutrition and environmental sanitation. The government basically subsidizes these inputs, but it does not equally distribute the subsidies. For people with the lower subsidy on other health inputs, the health benefit from using health services tend to be lower. Thus the fact that these households have a low demand for health and low use of health services may indicate a rational decision which reveals low perceived productivity of these inputs. Therefore policymakers should include the effect of public subsidies when examining the effect of public policies on health status. These policies may include structural adjustment or cost recovery schemes. In fact, as evidenced in a case study in the Ivory Coast, structural adjustments did not affect the rural poor and urban poor, but instead adversely affected middle class urban households. Hence policymakers should not limit their examinations to traditional income groups.

Modernizing UK health services: 'short-sharp-shock' reform, the NHS subsistence economy, and the spectre of health care famine.

PubMed

Charlton, Bruce G; Andras, Peter

2005-04-01

Modernization is the trend for societies to grow functionally more complex, efficient and productive. Modernization usually occurs by increased specialization of function (e.g. division of labour, such as the proliferation of specialists in medicine), combined with increased organization in order to co-ordinate the numerous specialized functions (e.g. the increased size of hospitals and specialist teams, including the management of these large groups). There have been many attempts to modernize the National Health Service (NHS) over recent decades, but it seems that none have significantly enhanced either the efficiency or output of the health care system. The reason may be that reforms have been applied as a 'drip-drip' of central regulation, with the consequence that health care has become increasingly dominated by the political system. In contrast, a 'short-sharp-shock' of radical and rapid modernization seems to be a more successful strategy for reforming social systems - in-between waves of structural change the system is left to re-orientate towards its client group. An example was the Flexner-initiated reform of US medical education which resulted in the closure of nearly half the medical colleges, an immediate enhancement in quality and efficiency of the system and future growth based on best institutional practices. However, short-sharp-shock reforms would probably initiate an NHS 'health care famine' with acute shortages and a health care crisis, because the NHS constitutes a 'subsistence economy' without any significant surplus of health services. The UK health care system must grow to generate a surplus before it can adequately be modernized. Efficient and rapid growth in health services could most easily be generated by stimulating provision outside the NHS, using mainly staff trained abroad and needs-subsidized 'item-of-service'-type payment schemes. Once there is a surplus of critically vital health services (e.g. acute and emergency provision), then radical modernization should rapidly improve the health service by a cull of low-quality and inefficient health care providers.

Public Policy and Health Informatics.

PubMed

Bell, Katherine

2018-05-01

To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. US Department of Health and Human Services. The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology. Copyright © 2018 Elsevier Inc. All rights reserved.

Mathematical support for surveying measurements in order to obtain the draft tube three-dimensional model

NASA Astrophysics Data System (ADS)

Gridan, Maria-Roberta; Herban, Sorin; Grecea, Oana

2017-07-01

Nowadays, the engineering companies and contractors are facing challenges never experienced before. They are being charged with - and being held liable for - the health of the structures they create and maintain. To surmount these challenges, engineers need to be able to measure structural movements up to millimetre level accuracy. Accurate and timely information on the status of a structure is highly valuable to engineers. It enables them to compare the real world behaviour of a structure against the design and theoretical models. When empowered by such data, engineers can effectively and cost efficiently measure and maintain the health of vital infrastructure. This paper presents the interpretation of the draft tube topographical measurements in order to obtain its 3D model. Based on the documents made available by the beneficiary and the data obtained in situ, the modernization conclusions were presented.

An Embedded Wireless Sensor Network with Wireless Power Transmission Capability for the Structural Health Monitoring of Reinforced Concrete Structures.

PubMed

Gallucci, Luca; Menna, Costantino; Angrisani, Leopoldo; Asprone, Domenico; Moriello, Rosario Schiano Lo; Bonavolontà, Francesco; Fabbrocino, Francesco

2017-11-07

Maintenance strategies based on structural health monitoring can provide effective support in the optimization of scheduled repair of existing structures, thus enabling their lifetime to be extended. With specific regard to reinforced concrete (RC) structures, the state of the art seems to still be lacking an efficient and cost-effective technique capable of monitoring material properties continuously over the lifetime of a structure. Current solutions can typically only measure the required mechanical variables in an indirect, but economic, manner, or directly, but expensively. Moreover, most of the proposed solutions can only be implemented by means of manual activation, making the monitoring very inefficient and then poorly supported. This paper proposes a structural health monitoring system based on a wireless sensor network (WSN) that enables the automatic monitoring of a complete structure. The network includes wireless distributed sensors embedded in the structure itself, and follows the monitoring-based maintenance (MBM) approach, with its ABCDE paradigm, namely: accuracy, benefit, compactness, durability, and easiness of operations. The system is structured in a node level and has a network architecture that enables all the node data to converge in a central unit. Human control is completely unnecessary until the periodic evaluation of the collected data. Several tests are conducted in order to characterize the system from a metrological point of view and assess its performance and effectiveness in real RC conditions.

Comparative analysis of different weight matrices in subspace system identification for structural health monitoring

NASA Astrophysics Data System (ADS)

Shokravi, H.; Bakhary, NH

2017-11-01

Subspace System Identification (SSI) is considered as one of the most reliable tools for identification of system parameters. Performance of a SSI scheme is considerably affected by the structure of the associated identification algorithm. Weight matrix is a variable in SSI that is used to reduce the dimensionality of the state-space equation. Generally one of the weight matrices of Principle Component (PC), Unweighted Principle Component (UPC) and Canonical Variate Analysis (CVA) are used in the structure of a SSI algorithm. An increasing number of studies in the field of structural health monitoring are using SSI for damage identification. However, studies that evaluate the performance of the weight matrices particularly in association with accuracy, noise resistance, and time complexity properties are very limited. In this study, the accuracy, noise-robustness, and time-efficiency of the weight matrices are compared using different qualitative and quantitative metrics. Three evaluation metrics of pole analysis, fit values and elapsed time are used in the assessment process. A numerical model of a mass-spring-dashpot and operational data is used in this research paper. It is observed that the principal components obtained using PC algorithms are more robust against noise uncertainty and give more stable results for the pole distribution. Furthermore, higher estimation accuracy is achieved using UPC algorithm. CVA had the worst performance for pole analysis and time efficiency analysis. The superior performance of the UPC algorithm in the elapsed time is attributed to using unit weight matrices. The obtained results demonstrated that the process of reducing dimensionality in CVA and PC has not enhanced the time efficiency but yield an improved modal identification in PC.

Performance of private sector health care: implications for universal health coverage.

PubMed

Morgan, Rosemary; Ensor, Tim; Waters, Hugh

2016-08-06

Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole. Copyright © 2016 Elsevier Ltd. All rights reserved.

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination

PubMed Central

Aliyu, Muktar H.; Byrne, Daniel W.; Qian, Keqin; McGown, Paula; Kinman, Patricia O.; Hanson, Katherine Louise; Culpepper, Demoyne; Cooley, Tamara J.; Yarbrough, Mary I.

2017-01-01

Objectives. To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. Methods. We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011–2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. Results. A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. Conclusions. Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the “Flulapalooza method” as a best practice model to enhance efficiency. PMID:28892449

Comparisons of Health Care Systems in the United States, Germany and Canada

PubMed Central

Ridic, Goran; Gleason, Suzanne; Ridic, Ognjen

2012-01-01

The purpose of this research paper is to compare health care systems in three highly advanced industrialized countries: The United States of America, Canada and Germany. The first part of the research paper will focus on the description of health care systems in the above-mentioned countries while the second part will analyze, evaluate and compare the three systems regarding equity and efficiency. Finally, an overview of recent changes and proposed future reforms in these countries will be provided as well. We start by providing a general description and comparison of the structure of health care systems in Canada, Germany and the United States. PMID:23678317

Self-actuating and self-diagnosing plastically deforming piezo-composite flapping wing MAV

NASA Astrophysics Data System (ADS)

Harish, Ajay B.; Harursampath, Dineshkumar; Mahapatra, D. Roy

2011-04-01

In this work, we propose a constitutive model to describe the behavior of Piezoelectric Fiber Reinforced Composite (PFRC) material consisting of elasto-plastic matrix reinforced by strong elastic piezoelectric fibers. Computational efficiency is achieved using analytical solutions for elastic stifness matrix derived from Variational Asymptotic Methods (VAM). This is extended to provide Structural Health Monitoring (SHM) based on plasticity induced degradation of flapping frequency of PFRC. Overall this work provides an effective mathematical tool that can be used for structural self-health monitoring of plasticity induced flapping degradation of PFRC flapping wing MAVs. The developed tool can be re-calibrated to also provide SHM for other forms of failures like fatigue, matrix cracking etc.

Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries.

PubMed

Sun, Daxin; Ahn, Haksoon; Lievens, Tomas; Zeng, Wu

2017-01-01

In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.

Acoustic Techniques for Structural Health Monitoring

NASA Astrophysics Data System (ADS)

Frankenstein, B.; Augustin, J.; Hentschel, D.; Schubert, F.; Köhler, B.; Meyendorf, N.

2008-02-01

Future safety and maintenance strategies for industrial components and vehicles are based on combinations of monitoring systems that are permanently attached to or embedded in the structure, and periodic inspections. The latter belongs to conventional nondestructive evaluation (NDE) and can be enhanced or partially replaced by structural health monitoring systems. However, the main benefit of this technology for the future will consist of systems that can be differently designed based on improved safety philosophies, including continuous monitoring. This approach will increase the efficiency of inspection procedures at reduced inspection times. The Fraunhofer IZFP Dresden Branch has developed network nodes, miniaturized transmitter and receiver systems for active and passive acoustical techniques and sensor systems that can be attached to or embedded into components or structures. These systems have been used to demonstrate intelligent sensor networks for the monitoring of aerospace structures, railway systems, wind energy generators, piping system and other components. Material discontinuities and flaws have been detected and monitored during full scale fatigue testing. This paper will discuss opportunities and future trends in nondestructive evaluation and health monitoring based on new sensor principles and advanced microelectronics. It will outline various application examples of monitoring systems based on acoustic techniques and will indicate further needs for research and development.

High-efficiency integrated piezoelectric energy harvesting systems

NASA Astrophysics Data System (ADS)

Hande, Abhiman; Shah, Pradeep

2010-04-01

This paper describes hierarchically architectured development of an energy harvesting (EH) system that consists of micro and/or macro-scale harvesters matched to multiple components of remote wireless sensor and communication nodes. The micro-scale harvesters consist of thin-film MEMS piezoelectric cantilever arrays and power generation modules in IC-like form to allow efficient EH from vibrations. The design uses new high conversion efficiency thin-film processes combined with novel cantilever structures tuned to multiple resonant frequencies as broadband arrays. The macro-scale harvesters are used to power the collector nodes that have higher power specifications. These bulk harvesters can be integrated with efficient adaptive power management circuits that match transducer impedance and maximize power harvested from multiple scavenging sources with very low intrinsic power consumption. Texas MicroPower, Inc. is developing process based on a composition that has the highest reported energy density as compared to other commercially available bulk PZT-based sensor/actuator ceramic materials and extending it to thin-film materials and miniature conversion transducer structures. The multiform factor harvesters can be deployed for several military and commercial applications such as underground unattended sensors, sensors in oil rigs, structural health monitoring, supply chain management, and battlefield applications such as sensors on soldier apparel, equipment, and wearable electronics.

Interprofessional team meetings: Opportunities for informal interprofessional learning.

PubMed

Nisbet, Gillian; Dunn, Stewart; Lincoln, Michelle

2015-01-01

This study explores the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals as part of their attendance at their regular interprofessional team meetings. While most interprofessional learning research to date has focused on formal structured education programs, this study adds to our understanding of the complexities of the learning processes occurring between health professionals as part of everyday practice. Through observations of team meetings and semi-structured interviews, we found that the interprofessional team meeting provided a practical, time-efficient, and relevant means for interprofessional learning, resulting in perceived benefits to individuals, teams, and patients. The learning process, however, was influenced by members' conceptions of learning, participation within the meeting, and medical presence. This study provides a basis for further research to assist health professionals capitalize on informal learning opportunities within the interprofessional meeting.

Capturing structured, pulmonary disease-specific data elements in electronic health records.

PubMed

Gronkiewicz, Cynthia; Diamond, Edward J; French, Kim D; Christodouleas, John; Gabriel, Peter E

2015-04-01

Electronic health records (EHRs) have the potential to improve health-care quality by allowing providers to make better decisions at the point of care based on electronically aggregated data and by facilitating clinical research. These goals are easier to achieve when key, disease-specific clinical information is documented as structured data elements (SDEs) that computers can understand and process, rather than as free-text/natural-language narrative. This article reviews the benefits of capturing disease-specific SDEs. It highlights several design and implementation considerations, including the impact on efficiency and expressivity of clinical documentation and the importance of adhering to data standards when available. Pulmonary disease-specific examples of collection instruments are provided from two commonly used commercial EHRs. Future developments that can leverage SDEs to improve clinical quality and research are discussed.

A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned from a HIV Prevention Mobilization Study

PubMed Central

Chutuape, Kate S.; Willard, Nancy; Walker, Bendu C.; Boyer, Cherrie B.; Ellen, Jonathan

2014-01-01

Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment and access to healthcare. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This paper describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures, such as building distributed coalition leadership, to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions and recommendations for public health practitioners that are seeking to start a similar coalition. PMID:26785397

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency.

PubMed

Hanna, Timothy P; Kangolle, Alfred C T

2010-10-13

Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) PROCESS: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) OUTCOME: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important.

Indoor Residual Spraying Delivery Models to Prevent Malaria: Comparison of Community- and District-Based Approaches in Ethiopia

PubMed Central

Johns, Benjamin; Yihdego, Yemane Yeebiyo; Kolyada, Lena; Dengela, Dereje; Chibsa, Sheleme; Dissanayake, Gunawardena; George, Kristen; Taffese, Hiwot Solomon; Lucas, Bradford

2016-01-01

ABSTRACT Background: Indoor residual spraying (IRS) for malaria prevention has traditionally been implemented in Ethiopia by the district health office with technical and operational inputs from regional, zonal, and central health offices. The United States President's Malaria Initiative (PMI) in collaboration with the Government of Ethiopia tested the effectiveness and efficiency of integrating IRS into the government-funded community-based rural health services program. Methods: Between 2012 and 2014, PMI conducted a mixed-methods study in 11 districts of Oromia region to compare district-based IRS (DB IRS) and community-based IRS (CB IRS) models. In the DB IRS model, each district included 2 centrally located operational sites where spray teams camped during the IRS campaign and from which they traveled to the villages to conduct spraying. In the CB IRS model, spray team members were hired from the communities in which they operated, thus eliminating the need for transport and camping facilities. The study team evaluated spray coverage, the quality of spraying, compliance with environmental and safety standards, and cost and performance efficiency. Results: The average number of eligible structures found and sprayed in the CB IRS districts increased by 19.6% and 20.3%, respectively, between 2012 (before CB IRS) and 2013 (during CB IRS). Between 2013 and 2014, the numbers increased by about 14%. In contrast, in the DB IRS districts the number of eligible structures found increased by only 8.1% between 2012 and 2013 and by 0.4% between 2013 and 2014. The quality of CB IRS operations was good and comparable to that in the DB IRS model, according to wall bioassay tests. Some compliance issues in the first year of CB IRS implementation were corrected in the second year, bringing compliance up to the level of the DB IRS model. The CB IRS model had, on average, higher amortized costs per district than the DB IRS model but lower unit costs per structure sprayed and per person protected because the community-based model found and sprayed more structures. Conclusion: Established community-based service delivery systems can be adapted to include a seasonal IRS campaign alongside the community-based health workers' routine activities to improve performance efficiency. Further modifications of the community-based IRS model may reduce the total cost of the intervention and increase its financial sustainability. PMID:27965266

Particle Collection Efficiency of a Lens-Liquid Filtration System

NASA Astrophysics Data System (ADS)

Wong, Ross Y. M.; Ng, Moses L. F.; Chao, Christopher Y. H.; Li, Z. G.

2011-09-01

Clinical and epidemiological studies have shown that indoor air quality has substantial impact on the health of building occupants [1]. Possible sources of indoor air contamination include hazardous gases as well as particulate matters (PMs) [2]. Experimental studies show that the size distribution of PMs in indoor air ranges from tens of nanometers to a few hundreds of micrometers [3]. Vacuum cleaners can be used as a major tool to collect PMs from floor/carpets, which are the main sources of indoor PMs. However, the particle collection efficiency of typical cyclonic filters in the vacuums drops significantly for particles of diameter below 10 μm. In this work, we propose a lens-liquid filtration system (see Figure 1), where the flow channel is formed by a liquid free surface and a planar plate with fin/lens structures. Computational fluid dynamics simulations are performed by using FLUENT to optimize the structure of the proposed system toward high particle collection efficiency and satisfactory pressure drop. Numerical simulations show that the system can collect 250 nm diameter particles with collection efficiency of 50%.

Human resource development in rural health care facilities.

PubMed

Johnson, L

1991-01-01

In this paper, human resource development problems facing rural health care facilities are identified and it is recognised that, particularly in the face of escalating demands for training arising from environmental pressures such as implementation of the structural efficiency principle, a coordinated approach to meet these problems is desirable. Such coordination is often sought via a regional staff development service. Accordingly, using the organisational life cycle as a conceptual framework, staff development services in five NSW health regions are examined. Ranging from a cafeteria style to a results-orientation, a diversity of strategic approaches to staff development is reflected.

Characterizing the Conductivity and Enhancing the Piezoresistivity of Carbon Nanotube-Polymeric Thin Films

PubMed Central

Zhao, Yingjun; Schagerl, Martin; Viechtbauer, Christoph

2017-01-01

The concept of lightweight design is widely employed for designing and constructing aerospace structures that can sustain extreme loads while also being fuel-efficient. Popular lightweight materials such as aluminum alloy and fiber-reinforced polymers (FRPs) possess outstanding mechanical properties, but their structural integrity requires constant assessment to ensure structural safety. Next-generation structural health monitoring systems for aerospace structures should be lightweight and integrated with the structure itself. In this study, a multi-walled carbon nanotube (MWCNT)-based polymer paint was developed to detect distributed damage in lightweight structures. The thin film’s electromechanical properties were characterized via cyclic loading tests. Moreover, the thin film’s bulk conductivity was characterized by finite element modeling. PMID:28773084

[Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model].

PubMed

Kim, Miji; Ryu, Eunjung

2015-12-01

The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. The goodness-of-fit statistics of the final modified hypothetical model are as follows: χ²=586.03, χ²/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.

A structural model decomposition framework for systems health management

NASA Astrophysics Data System (ADS)

Roychoudhury, I.; Daigle, M.; Bregon, A.; Pulido, B.

Systems health management (SHM) is an important set of technologies aimed at increasing system safety and reliability by detecting, isolating, and identifying faults; and predicting when the system reaches end of life (EOL), so that appropriate fault mitigation and recovery actions can be taken. Model-based SHM approaches typically make use of global, monolithic system models for online analysis, which results in a loss of scalability and efficiency for large-scale systems. Improvement in scalability and efficiency can be achieved by decomposing the system model into smaller local submodels and operating on these submodels instead. In this paper, the global system model is analyzed offline and structurally decomposed into local submodels. We define a common model decomposition framework for extracting submodels from the global model. This framework is then used to develop algorithms for solving model decomposition problems for the design of three separate SHM technologies, namely, estimation (which is useful for fault detection and identification), fault isolation, and EOL prediction. We solve these model decomposition problems using a three-tank system as a case study.

A Structural Model Decomposition Framework for Systems Health Management

NASA Technical Reports Server (NTRS)

Roychoudhury, Indranil; Daigle, Matthew J.; Bregon, Anibal; Pulido, Belamino

2013-01-01

Systems health management (SHM) is an important set of technologies aimed at increasing system safety and reliability by detecting, isolating, and identifying faults; and predicting when the system reaches end of life (EOL), so that appropriate fault mitigation and recovery actions can be taken. Model-based SHM approaches typically make use of global, monolithic system models for online analysis, which results in a loss of scalability and efficiency for large-scale systems. Improvement in scalability and efficiency can be achieved by decomposing the system model into smaller local submodels and operating on these submodels instead. In this paper, the global system model is analyzed offline and structurally decomposed into local submodels. We define a common model decomposition framework for extracting submodels from the global model. This framework is then used to develop algorithms for solving model decomposition problems for the design of three separate SHM technologies, namely, estimation (which is useful for fault detection and identification), fault isolation, and EOL prediction. We solve these model decomposition problems using a three-tank system as a case study.

An Automatic Method for Geometric Segmentation of Masonry Arch Bridges for Structural Engineering Purposes

NASA Astrophysics Data System (ADS)

Riveiro, B.; DeJong, M.; Conde, B.

2016-06-01

Despite the tremendous advantages of the laser scanning technology for the geometric characterization of built constructions, there are important limitations preventing more widespread implementation in the structural engineering domain. Even though the technology provides extensive and accurate information to perform structural assessment and health monitoring, many people are resistant to the technology due to the processing times involved. Thus, new methods that can automatically process LiDAR data and subsequently provide an automatic and organized interpretation are required. This paper presents a new method for fully automated point cloud segmentation of masonry arch bridges. The method efficiently creates segmented, spatially related and organized point clouds, which each contain the relevant geometric data for a particular component (pier, arch, spandrel wall, etc.) of the structure. The segmentation procedure comprises a heuristic approach for the separation of different vertical walls, and later image processing tools adapted to voxel structures allows the efficient segmentation of the main structural elements of the bridge. The proposed methodology provides the essential processed data required for structural assessment of masonry arch bridges based on geometric anomalies. The method is validated using a representative sample of masonry arch bridges in Spain.

Federal, provincial and territorial public health response plan for biological events.

PubMed

McNeill, R; Topping, J

2018-01-04

The Federal/Provincial/Territorial (FPT) Public Health Response Plan for Biological Events was developed for the Public Health Network Council (PHNC). This plan outlines how the national response to public health events caused by biological agents will be conducted and coordinated, with a focus on implementation of responses led by senior-level FPT public health decision-makers. The plan was developed by an expert task group and was approved by PHNC in October, 2017. The plan describes roles, responsibilities and authorities of FPT governments for public health and emergency management, a concept of operations outlining four scalable response levels and a governance structure that aims to facilitate an efficient, timely, evidence-informed and consistent approach across jurisdictions. Improving effective engagement amongst public health, health care delivery and health emergency management authorities is a key objective of the plan.

Federal, provincial and territorial public health response plan for biological events

PubMed Central

McNeill, R; Topping, J

2018-01-01

The Federal/Provincial/Territorial (FPT) Public Health Response Plan for Biological Events was developed for the Public Health Network Council (PHNC). This plan outlines how the national response to public health events caused by biological agents will be conducted and coordinated, with a focus on implementation of responses led by senior-level FPT public health decision-makers. The plan was developed by an expert task group and was approved by PHNC in October, 2017. The plan describes roles, responsibilities and authorities of FPT governments for public health and emergency management, a concept of operations outlining four scalable response levels and a governance structure that aims to facilitate an efficient, timely, evidence-informed and consistent approach across jurisdictions. Improving effective engagement amongst public health, health care delivery and health emergency management authorities is a key objective of the plan. PMID:29770090

The medicine that might kill the patient: Structural Adjustment and its impacts on health care in Bangladesh.

PubMed

Hossen, Md Abul; Westhues, Anne

2012-01-01

Over the past decade, reforms of the health sector have evolved as a global phenomenon. There is, by now, a fair literature on the relationship between globalization and health. Within this literature, however, there is relatively little attention given to the Structural Adjustment Program (SAP), one aspect of globalization, and its impact on health. It can be observed that the SAP has had a dramatic impact on the status of education, health, the environment, and women and children in many developing countries. The restructuring of the health sector has led to the collapse of preventive and curative care due to the lack of medical equipment, supplies, poor working conditions, low pay of medical personnel, and the resulting low morale in Ghana, Philippines, and Zimbabwe. User fees in primary health care have led to the exclusion of a large section of the population from accessing health services as they are unable to pay. This article discusses the health specific impact of the SAP and the economic reforms initiated under it in Bangladesh. In particular, it will analyze how these policies affect the health care delivery system in Bangladesh in relation to geographic accessibility, affordability, quality of services, administrative efficiency, the rural urban service gap, public provision of health care, and donor influence on health policy.

How to design a horizontal patient-focused hospital.

PubMed

Murphy, E C; Ruflin, P

1993-05-01

Work Imaging is an executive information system for analyzing the cost effectiveness and efficiency of work processes and structures in health care. Advanced Work Imaging relational database technology allows managers and employees to take a sample work activities profile organization-wide. This is married to financial and organizational data to produce images of work within and across all functions, departments, and levels. The images are benchmarked against best practice data to provide insight on the quality and cost efficiency of work practice patterns, from individual roles to departmental skill mix to organization-wide service processes.

Applications of Electronic Health Information in Public Health: Uses, Opportunities & Barriers

PubMed Central

Tomines, Alan; Readhead, Heather; Readhead, Adam; Teutsch, Steven

2013-01-01

Electronic health information systems can reshape the practice of public health including public health surveillance, disease and injury investigation and control, decision making, quality assurance, and policy development. While these opportunities are potentially transformative, and the federal program for the Meaningful Use (MU) of electronic health records (EHRs) has included important public health components, significant barriers remain. Unlike incentives in the clinical care system, scant funding is available to public health departments to develop the necessary information infrastructure and workforce capacity to capitalize on EHRs, personal health records, or Big Data. Current EHR systems are primarily built to serve clinical systems and practice rather than being structured for public health use. In addition, there are policy issues concerning how broadly the data can be used by public health officials. As these issues are resolved and workable solutions emerge, they should yield a more efficient and effective public health system. PMID:25848571

Bureaucracy, institutional theory and institutionaucracy: applications to the hospital industry.

PubMed

Bolon, D S

1998-01-01

The health care industry is experiencing rapid change and uncertainty. Hospitals, in particular, are redesigning structures and processes in order to maximize efficiencies and remain economically viable. This article uses two organizational theory perspectives (bureaucracy and institutional theory) to examine many of the trends and transitions which are occurring throughout the hospital industry. It suggests that many of the key tenets of bureaucracy (rationality, efficiency, productivity, control, etc.) have been incorporated into the institutional environment as normative expectations. This synthesis or blending of these two perspectives is labeled institutionaucracy, implying that, as productivity and efficiency considerations become institutionalized, hospitals conforming to such operational standards will gain legitimacy and additional resources from their environment.

What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

PubMed

Mackintosh, Maureen; Channon, Amos; Karan, Anup; Selvaraj, Sakthivel; Cavagnero, Eleonora; Zhao, Hongwen

2016-08-06

Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa. Copyright © 2016 Elsevier Ltd. All rights reserved.

Perspectives on utilization of community based health information systems in Western Kenya.

PubMed

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.

An Embedded Wireless Sensor Network with Wireless Power Transmission Capability for the Structural Health Monitoring of Reinforced Concrete Structures

PubMed Central

Gallucci, Luca; Menna, Costantino; Angrisani, Leopoldo; Asprone, Domenico

2017-01-01

Maintenance strategies based on structural health monitoring can provide effective support in the optimization of scheduled repair of existing structures, thus enabling their lifetime to be extended. With specific regard to reinforced concrete (RC) structures, the state of the art seems to still be lacking an efficient and cost-effective technique capable of monitoring material properties continuously over the lifetime of a structure. Current solutions can typically only measure the required mechanical variables in an indirect, but economic, manner, or directly, but expensively. Moreover, most of the proposed solutions can only be implemented by means of manual activation, making the monitoring very inefficient and then poorly supported. This paper proposes a structural health monitoring system based on a wireless sensor network (WSN) that enables the automatic monitoring of a complete structure. The network includes wireless distributed sensors embedded in the structure itself, and follows the monitoring-based maintenance (MBM) approach, with its ABCDE paradigm, namely: accuracy, benefit, compactness, durability, and easiness of operations. The system is structured in a node level and has a network architecture that enables all the node data to converge in a central unit. Human control is completely unnecessary until the periodic evaluation of the collected data. Several tests are conducted in order to characterize the system from a metrological point of view and assess its performance and effectiveness in real RC conditions. PMID:29112128

Electronic health records and cardiac implantable electronic devices: new paradigms and efficiencies.

PubMed

Slotwiner, David J

2016-10-01

The anticipated advantages of electronic health records (EHRs)-improved efficiency and the ability to share information across the healthcare enterprise-have so far failed to materialize. There is growing recognition that interoperability holds the key to unlocking the greatest value of EHRs. Health information technology (HIT) systems including EHRs must be able to share data and be able to interpret the shared data. This requires a controlled vocabulary with explicit definitions (data elements) as well as protocols to communicate the context in which each data element is being used (syntactic structure). Cardiac implantable electronic devices (CIEDs) provide a clear example of the challenges faced by clinicians when data is not interoperable. The proprietary data formats created by each CIED manufacturer, as well as the multiple sources of data generated by CIEDs (hospital, office, remote monitoring, acute care setting), make it challenging to aggregate even a single patient's data into an EHR. The Heart Rhythm Society and CIED manufacturers have collaborated to develop and implement international standard-based specifications for interoperability that provide an end-to-end solution, enabling structured data to be communicated from CIED to a report generation system, EHR, research database, referring physician, registry, patient portal, and beyond. EHR and other health information technology vendors have been slow to implement these tools, in large part, because there have been no financial incentives for them to do so. It is incumbent upon us, as clinicians, to insist that the tools of interoperability be a prerequisite for the purchase of any and all health information technology systems.

Health reform in Mexico: the promotion of inequality.

PubMed

Laurell, A C

2001-01-01

The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the government's commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.

De-identification of unstructured paper-based health records for privacy-preserving secondary use.

PubMed

Fenz, Stefan; Heurix, Johannes; Neubauer, Thomas; Rella, Antonio

2014-07-01

Abstract Whenever personal data is processed, privacy is a serious issue. Especially in the document-centric e-health area, the patients' privacy must be preserved in order to prevent any negative repercussions for the patient. Clinical research, for example, demands structured health records to carry out efficient clinical trials, whereas legislation (e.g. HIPAA) regulates that only de-identified health records may be used for research. However, unstructured and often paper-based data dominates information technology, especially in the healthcare sector. Existing approaches are geared towards data in English-language documents only and have not been designed to handle the recognition of erroneous personal data which is the result of the OCR-based digitization of paper-based health records.

A Framework for Developing the Structure of Public Health Economic Models.

PubMed

Squires, Hazel; Chilcott, James; Akehurst, Ronald; Burr, Jennifer; Kelly, Michael P

2016-01-01

A conceptual modeling framework is a methodology that assists modelers through the process of developing a model structure. Public health interventions tend to operate in dynamically complex systems. Modeling public health interventions requires broader considerations than clinical ones. Inappropriately simple models may lead to poor validity and credibility, resulting in suboptimal allocation of resources. This article presents the first conceptual modeling framework for public health economic evaluation. The framework presented here was informed by literature reviews of the key challenges in public health economic modeling and existing conceptual modeling frameworks; qualitative research to understand the experiences of modelers when developing public health economic models; and piloting a draft version of the framework. The conceptual modeling framework comprises four key principles of good practice and a proposed methodology. The key principles are that 1) a systems approach to modeling should be taken; 2) a documented understanding of the problem is imperative before and alongside developing and justifying the model structure; 3) strong communication with stakeholders and members of the team throughout model development is essential; and 4) a systematic consideration of the determinants of health is central to identifying the key impacts of public health interventions. The methodology consists of four phases: phase A, aligning the framework with the decision-making process; phase B, identifying relevant stakeholders; phase C, understanding the problem; and phase D, developing and justifying the model structure. Key areas for further research involve evaluation of the framework in diverse case studies and the development of methods for modeling individual and social behavior. This approach could improve the quality of Public Health economic models, supporting efficient allocation of scarce resources. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Open source cardiology electronic health record development for DIGICARDIAC implementation

NASA Astrophysics Data System (ADS)

Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

2015-12-01

This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

An intelligent stand-alone ultrasonic device for monitoring local structural damage: implementation and preliminary experiments

NASA Astrophysics Data System (ADS)

Pertsch, Alexander; Kim, Jin-Yeon; Wang, Yang; Jacobs, Laurence J.

2011-01-01

Continuous structural health monitoring has the potential to significantly improve the safety management of aged, in-service civil structures. In particular, monitoring of local damage growth at hot-spot areas can help to prevent disastrous structural failures. Although ultrasonic nondestructive evaluation (NDE) has proved to be effective in monitoring local damage growth, conventional equipment and devices are usually bulky and only suitable for scheduled human inspections. The objective of this research is to harness the latest developments in embedded hardware and wireless communication for developing a stand-alone, compact ultrasonic device. The device is directed at the continuous structural health monitoring of civil structures. Relying on battery power, the device possesses the functionalities of high-speed actuation, sensing, signal processing, and wireless communication. Integrated with contact ultrasonic transducers, the device can generate 1 MHz Rayleigh surface waves in a steel specimen and measure response waves. An envelope detection algorithm based on the Hilbert transform is presented for efficiently determining the peak values of the response signals, from which small surface cracks are successfully identified.

Drivers and challenges of personal health systems in workplace health promotion.

PubMed

Ilvesmäki, Antti

2007-01-01

Novel technologies such as wearable sensors, electronic health diaries and personalized web services are thought to have the potential to improve population health in a cost- efficient manner. The use of personal health systems in workplace health promotion is of particular interest, since the workplace often provides an excellent setting and infrastructure to support health- related interventions. Compared to the elderly or those already debilitated by disease, working people are also generally more capable of taking advantage of information technology. Extant research on the use of ICT in health promotion has recognized several functional and technological requirements, but relatively little is known about other factors that affect the commercialization and adoption of such systems. This paper attempts to identify some economic and structural drivers and challenges that may be relevant to the success of personal health systems in workplace health promotion.

A clinical information systems strategy for a large integrated delivery network.

PubMed Central

Kuperman, G. J.; Spurr, C.; Flammini, S.; Bates, D.; Glaser, J.

2000-01-01

Integrated delivery networks (IDNs) are an emerging class of health care institutions. IDNs are formed from the affiliation of individual health care institutions and are intended to be more efficient in the current fiscal health care environment. To realize efficiencies and support their strategic visions, IDNs rely critically on excellent information technology (IT). Because of its importance to the mission of the IDN, strategic decisions about IT are made by the top leadership of the IDN. At Partners HealthCare System, a large IDN in Boston, MA, a clinical information systems strategy has been created to support the Partners clinical vision. In this paper, we discuss the Partners' structure, clinical vision, and current IT initiatives in place to address the clinical vision. The initiatives are: a clinical data repository, inpatient process support, electronic medical records, a portal strategy, referral applications, knowledge resources, support for product lines, patient computing, confidentiality, and clinical decision support. We address several of the issues encountered in trying to bring excellent information technology to a large IDN. PMID:11079921

Active Control Technology at NASA Langley Research Center

NASA Technical Reports Server (NTRS)

Antcliff, Richard R.; McGowan, Anna-Marie R.

2000-01-01

NASA Langley has a long history of attacking important technical opportunities from a broad base of supporting disciplines. The research and development at Langley in this subject area range from the test tube to the test flight. The information covered here will range from the development of innovative new materials, sensors and actuators, to the incorporation of smart sensors and actuators in practical devices, to the optimization of the location of these devices, to, finally, a wide variety of applications of these devices utilizing Langley's facilities and expertise. Advanced materials are being developed for sensors and actuators, as well as polymers for integrating smart devices into composite structures. Contributions reside in three key areas: computational materials; advanced piezoelectric materials; and integrated composite structures. The computational materials effort is focused on developing predictive tools for the efficient design of new materials with the appropriate combination of properties for next generation smart airframe systems. Research in the area of advanced piezoelectrics includes optimizing the efficiency, force output, use temperature, and energy transfer between the structure and device for both ceramic and polymeric materials. For structural health monitoring, advanced non-destructive techniques including fiber optics are being developed for detection of delaminations, cracks and environmental deterioration in aircraft structures. The computational materials effort is focused on developing predictive tools for the efficient design of new materials with the appropriate combination of properties for next generation smart airframe system. Innovative fabrication techniques processing structural composites with sensor and actuator integration are being developed.

[Healthy Cities projects].

PubMed

Takano, Takehito

2002-05-01

This is a review article on "Healthy Cities". The Healthy Cities programme has been developed by the World Health Organization (WHO) to tackle urban health and environmental issues in a broad way. It is a kind of comprehensive policy package to carry out individual projects and activities effectively and efficiently. Its key aspects include healthy public policy, vision sharing, high political commitment, establishment of structural organization, strategic health planning, intersectoral collaboration, community participation, setting approach, development of supportive environment for health, formation of city health profile, national and international networking, participatory research, periodic monitoring and evaluation, and mechanisms for sustainability of projects. The present paper covered the Healthy Cities concept and approaches, rapid urbanization in the world, developments of WHO Healthy Cities, Healthy Cities developments in the Western Pacific Region, the health promotion viewpoint, and roles of research.

Virtual Environments for Visualizing Structural Health Monitoring Sensor Networks, Data, and Metadata.

PubMed

Napolitano, Rebecca; Blyth, Anna; Glisic, Branko

2018-01-16

Visualization of sensor networks, data, and metadata is becoming one of the most pivotal aspects of the structural health monitoring (SHM) process. Without the ability to communicate efficiently and effectively between disparate groups working on a project, an SHM system can be underused, misunderstood, or even abandoned. For this reason, this work seeks to evaluate visualization techniques in the field, identify flaws in current practices, and devise a new method for visualizing and accessing SHM data and metadata in 3D. More precisely, the work presented here reflects a method and digital workflow for integrating SHM sensor networks, data, and metadata into a virtual reality environment by combining spherical imaging and informational modeling. Both intuitive and interactive, this method fosters communication on a project enabling diverse practitioners of SHM to efficiently consult and use the sensor networks, data, and metadata. The method is presented through its implementation on a case study, Streicker Bridge at Princeton University campus. To illustrate the efficiency of the new method, the time and data file size were compared to other potential methods used for visualizing and accessing SHM sensor networks, data, and metadata in 3D. Additionally, feedback from civil engineering students familiar with SHM is used for validation. Recommendations on how different groups working together on an SHM project can create SHM virtual environment and convey data to proper audiences, are also included.

Virtual Environments for Visualizing Structural Health Monitoring Sensor Networks, Data, and Metadata

PubMed Central

Napolitano, Rebecca; Blyth, Anna; Glisic, Branko

2018-01-01

Visualization of sensor networks, data, and metadata is becoming one of the most pivotal aspects of the structural health monitoring (SHM) process. Without the ability to communicate efficiently and effectively between disparate groups working on a project, an SHM system can be underused, misunderstood, or even abandoned. For this reason, this work seeks to evaluate visualization techniques in the field, identify flaws in current practices, and devise a new method for visualizing and accessing SHM data and metadata in 3D. More precisely, the work presented here reflects a method and digital workflow for integrating SHM sensor networks, data, and metadata into a virtual reality environment by combining spherical imaging and informational modeling. Both intuitive and interactive, this method fosters communication on a project enabling diverse practitioners of SHM to efficiently consult and use the sensor networks, data, and metadata. The method is presented through its implementation on a case study, Streicker Bridge at Princeton University campus. To illustrate the efficiency of the new method, the time and data file size were compared to other potential methods used for visualizing and accessing SHM sensor networks, data, and metadata in 3D. Additionally, feedback from civil engineering students familiar with SHM is used for validation. Recommendations on how different groups working together on an SHM project can create SHM virtual environment and convey data to proper audiences, are also included. PMID:29337877

Measuring Efficiency of Knowledge Production in Health Research Centers Using Data Envelopment Analysis (DEA): A Case Study in Iran.

PubMed

Amiri, Mohammad Meskarpour; Nasiri, Taha; Saadat, Seyed Hassan; Anabad, Hosein Amini; Ardakan, Payman Mahboobi

2016-11-01

Efficiency analysis is necessary in order to avoid waste of materials, energy, effort, money, and time during scientific research. Therefore, analyzing efficiency of knowledge production in health areas is necessary, especially for developing and in-transition countries. As the first step in this field, the aim of this study was the analysis of selected health research center efficiency using data envelopment analysis (DEA). This retrospective and applied study was conducted in 2015 using input and output data of 16 health research centers affiliated with a health sciences university in Iran during 2010-2014. The technical efficiency of health research centers was evaluated based on three basic data envelopment analysis (DEA) models: input-oriented, output-oriented, and hyperbolic-oriented. The input and output data of each health research center for years 2010-2014 were collected from the Iran Ministry of Health and Medical Education (MOHE) profile and analyzed by R software. The mean efficiency score in input-oriented, output-oriented, and hyperbolic-oriented models was 0.781, 0.671, and 0.798, respectively. Based on results of the study, half of the health research centers are operating below full efficiency, and about one-third of them are operating under the average efficiency level. There is also a large gap between health research center efficiency relative to each other. It is necessary for health research centers to improve their efficiency in knowledge production through better management of available resources. The higher level of efficiency in a significant number of health research centers is achievable through more efficient management of human resources and capital. Further research is needed to measure and follow the efficiency of knowledge production by health research centers around the world and over a period of time.

House bat management

USGS Publications Warehouse

Greenhall, Arthur M.

1982-01-01

The soundest long-term solution for the management of bats that enter buildings and cause a nuisance problem or present a public health hazard is by batproofing the structure. Chemical toxicants do not solve house bat problems and may create worse ones. This manual describes batproofing techniques that will provide effective and acceptable alternatives for dealing with house bat problems and hazards. Recent declines in bat populations and greater appreciation of the ecological importance of bats have identified the need for sound management strategies that will encourage bat conservation while protecting human health and solving nuisance problems. One of the best deterrents against house bats is to improve the energy efficiency of the structure since bats may enter holes through which heat is lost. Heat conservation methods used for batproofing will also be eligible for Federal residential energy tax credits. The manual should be useful to homeowners, public health officials, physicians, veterinarians, conservationists, and others interested or concerned about bat interactions with humans.

Early experience of a safety net provider reorganizing into an accountable care organization.

PubMed

Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

2014-08-01

Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. Copyright © 2014 by Duke University Press.

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

PubMed Central

ROBBINS, JACOB A.

2015-01-01

The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

The policy implications of the cost structure of home health agencies.

PubMed

Mukamel, Dana B; Fortinsky, Richard H; White, Alan; Harrington, Charlene; White, Laura M; Ngo-Metzger, Quyen

2014-01-01

To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.

Optimization of PZT ceramic IDT sensors for health monitoring of structures.

PubMed

Takpara, Rafatou; Duquennoy, Marc; Ouaftouh, Mohammadi; Courtois, Christian; Jenot, Frédéric; Rguiti, Mohamed

2017-08-01

Surface acoustic waves (SAW) are particularly suited to effectively monitoring and characterizing structural surfaces (condition of the surface, coating, thin layer, micro-cracks…) as their energy is localized on the surface, within approximately one wavelength. Conventionally, in non-destructive testing, wedge sensors are used to the generation guided waves but they are especially suited to flat surfaces and sized for a given type material (angle of refraction). Additionally, these sensors are quite expensive so it is quite difficult to leave the sensors permanently on the structure for its health monitoring. Therefore we are considering in this study, another type of ultrasonic sensors, able to generate SAW. These sensors are interdigital sensors or IDT sensors for InterDigital Transducer. This paper focuses on optimization of IDT sensors for non-destructive structural testing by using PZT ceramics. The challenge was to optimize the dimensional parameters of the IDT sensors in order to efficiently generate surface waves. Acoustic tests then confirmed these parameters. Copyright © 2017 Elsevier B.V. All rights reserved.

Structural Health Monitoring for a Z-Type Special Vehicle

PubMed Central

Yuan, Chaolin; Ren, Liang; Li, Hongnan

2017-01-01

Nowadays there exist various kinds of special vehicles designed for some purposes, which are different from regular vehicles in overall dimension and design. In that case, accidents such as overturning will lead to large economical loss and casualties. There are still no technical specifications to follow to ensure the safe operation and driving of these special vehicles. Owing to the poor efficiency of regular maintenance, it is more feasible and effective to apply real-time monitoring during the operation and driving process. In this paper, the fiber Bragg grating (FBG) sensors are used to monitor the safety of a z-type special vehicle. Based on the structural features and force distribution, a reasonable structural health monitoring (SHM) scheme is presented. Comparing the monitoring results with the finite element simulation results guarantees the accuracy and reliability of the monitoring results. Large amounts of data are collected during the operation and driving progress to evaluate the structural safety condition and provide reference for SHM systems developed for other special vehicles. PMID:28587161

Managed competition in health care and the unfinished agenda

PubMed Central

Enthoven, Alain C.

1986-01-01

A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent active agents on the demand side, called sponsors, that contract with the competing health care plans and continuously structure and adjust the market to overcome its tendencies to failure. A great deal remains to be done to achieve the goals envisioned by the “procompetition reformers.” PMID:10311922

What have health care reforms achieved in Turkey? An appraisal of the "Health Transformation Programme".

PubMed

Ökem, Zeynep Güldem; Çakar, Mehmet

2015-09-01

Poor health status indicators, low quality care, inequity in the access to health services and inefficiency due to fragmented health financing and provision have long been problems in Turkey's health system. To address these problems a radical reform process known as the Health Transformation Programme (HTP) was initiated in 2003. The health sector reforms in Turkey are considered to have been among the most successful of middle-income countries undergoing reform. Numerous articles have been published that review these reforms in terms of, variously, financial sustainability, efficiency, equity and quality. Evidence suggests that Turkey has indeed made significant progress, yet these achievements are uneven among its regions, and their long-term financial sustainability is unresolved due to structural problems in employment. As yet, there is no comprehensive evidence-based analysis of how far the stated reform objectives have been achieved. This article reviews the empirical evidence regarding the outcomes of the HTP during 10 years of its implementation. Strengthening the strategic purchasing function of the Social Security Institution (SSI) should be a priority. Overall performance can be improved by linking resource allocation to provider performance. More emphasis on prevention rather than treatment, with an effective referral chain, can also bring better outcomes, greater efficiency gains and contribute to sustainability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Benefit or burden? Perceptions of energy efficiency efforts among low-income housing residents in New York City.

PubMed

Hernández, Diana; Phillips, Douglas

2015-07-01

Low-income households contend with high energy costs and poor thermal comfort due to poor structural conditions and energy inefficiencies in their homes. Energy efficiency upgrades can potentially reduce energy expenses and improve thermal comfort, while also addressing problematic issues in the home environment. The present mixed method pilot study explored the impacts of energy efficiency upgrades in 20 households in a low-income community in New York City. Surveys and interviews were administered to the heads of household in a variety of housing types. Interviews were also conducted with landlords of buildings that had recently undergone upgrades. Findings indicate that energy efficiency measures resulted in improved thermal comfort, enhanced health and safety and reduced energy costs. Participants reported largely positive experiences with the upgrades, resulting in direct and indirect benefits. However, results also indicate negative consequences associated with the upgrades and further illustrate that weatherization alone was insufficient to address all of the issues facing low-income households. Moreover, qualitative results revealed differing experiences of low-income renters compared to homeowners. Overall, energy efficiency upgrades are a promising intervention to mitigate the energy and structurally related challenges facing low-income households, but larger scale research is needed to capture the long-term implications of these upgrades.

Benefit or burden? Perceptions of energy efficiency efforts among low-income housing residents in New York City☆

PubMed Central

Hernández, Diana; Phillips, Douglas

2016-01-01

Low-income households contend with high energy costs and poor thermal comfort due to poor structural conditions and energy inefficiencies in their homes. Energy efficiency upgrades can potentially reduce energy expenses and improve thermal comfort, while also addressing problematic issues in the home environment. The present mixed method pilot study explored the impacts of energy efficiency upgrades in 20 households in a low-income community in New York City. Surveys and interviews were administered to the heads of household in a variety of housing types. Interviews were also conducted with landlords of buildings that had recently undergone upgrades. Findings indicate that energy efficiency measures resulted in improved thermal comfort, enhanced health and safety and reduced energy costs. Participants reported largely positive experiences with the upgrades, resulting in direct and indirect benefits. However, results also indicate negative consequences associated with the upgrades and further illustrate that weatherization alone was insufficient to address all of the issues facing low-income households. Moreover, qualitative results revealed differing experiences of low-income renters compared to homeowners. Overall, energy efficiency upgrades are a promising intervention to mitigate the energy and structurally related challenges facing low-income households, but larger scale research is needed to capture the long-term implications of these upgrades. PMID:27054092

Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction.

PubMed

Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

2015-01-01

Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

[The influence of the organizational structure on the internal controls of a foundation for cancer research, prevention and care in the interior of the state of São Paulo, Brazil].

PubMed

Bonacim, Carlos Alberto Grespam; Salgado, André Luís; Girioli, Lumila Souza; de Araujo, Adriana Maria Procópio

2011-05-01

This work focuses on a discussion about the extent to which the level of organizational structure interferes in the internal control practices of non-governmental organizations (NGOs), especially those related to health. The objective of this work was to observe the efficiency of the internal control tests applied within the organizational structure of the Foundation for Cancer Research, Prevention and Care, checking the reliability of the accounting records and operational controls. A case study in a third sector health organization was the chosen methodology. The case study involved company interviews and the analysis of confidential reports. After an evaluation of the organizational structure (of the relations between officials and volunteers) and the application of evaluation proceedings on the quality of the internal controls, the extent to which the organizational structure interferes with the internal control practices of the hospital was assessed. It was revealed that there are structured mechanisms of control in the institution, however the implementation of these controls is inadequately performed. It was further detected that the level of the organizational structure does indeed interfere in internal control practices at the entity.

Measuring Efficiency of Knowledge Production in Health Research Centers Using Data Envelopment Analysis (DEA): A Case Study in Iran

PubMed Central

Amiri, Mohammad Meskarpour; Nasiri, Taha; Saadat, Seyed Hassan; Anabad, Hosein Amini; Ardakan, Payman Mahboobi

2016-01-01

Introduction Efficiency analysis is necessary in order to avoid waste of materials, energy, effort, money, and time during scientific research. Therefore, analyzing efficiency of knowledge production in health areas is necessary, especially for developing and in-transition countries. As the first step in this field, the aim of this study was the analysis of selected health research center efficiency using data envelopment analysis (DEA). Methods This retrospective and applied study was conducted in 2015 using input and output data of 16 health research centers affiliated with a health sciences university in Iran during 2010–2014. The technical efficiency of health research centers was evaluated based on three basic data envelopment analysis (DEA) models: input-oriented, output-oriented, and hyperbolic-oriented. The input and output data of each health research center for years 2010–2014 were collected from the Iran Ministry of Health and Medical Education (MOHE) profile and analyzed by R software. Results The mean efficiency score in input-oriented, output-oriented, and hyperbolic-oriented models was 0.781, 0.671, and 0.798, respectively. Based on results of the study, half of the health research centers are operating below full efficiency, and about one-third of them are operating under the average efficiency level. There is also a large gap between health research center efficiency relative to each other. Conclusion It is necessary for health research centers to improve their efficiency in knowledge production through better management of available resources. The higher level of efficiency in a significant number of health research centers is achievable through more efficient management of human resources and capital. Further research is needed to measure and follow the efficiency of knowledge production by health research centers around the world and over a period of time. PMID:28344756

The Hungarian country profile: inequalities in health and health care in Hungary.

PubMed

Orosz, E

1990-01-01

Analysis of occupational, educational, urban/rural and regional data over several decades demonstrate large disparities in the availability of health care and in infant and adult mortality. Life expectancy increased in the immediate post-war period but in the late sixties improvement ceased and life expectancy at age 40 began to fall. Mortality has been particularly high for middle-aged males. Analysis by cause of death suggests the persistence of older poverty-type diseases co-existing with the newer lifestyle diseases. Reasons for system dysfunctioning are discussed--lack of health resources, rigid institutional structures, lack of integrated health policies, failure to adjust the distribution of resources to changing needs etc. The analysis raises the question of how to achieve a balance between equity and efficiency.

Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

PubMed

Novignon, Jacob; Nonvignon, Justice

2017-06-12

Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private and public facilities. There is need for primary health facility managers to improve productivity via effective and efficient resource use. Efforts to improve efficiency should focus on training health workers and improving facility environment alongside effective monitoring and evaluation exercises.

Perspectives on utilization of community based health information systems in Western Kenya

PubMed Central

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Introduction Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Methods Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Results Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. Conclusion The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers. PMID:28904707

New approaches to health promotion and informatics education using Internet in the Czech Republic.

PubMed

Zvárová, J

2005-01-01

The paper describes nowadays information technology skills in the Czech Republic. It focuses on informatics education using Internet, ECDL concept and the links between computer literacy among health care professionals and quality of health care. Everyone understands that the main source of wealth of any nation is information management and the efficient transformation of information into knowledge. There appear completely new decisive factors for the economics of the near future based on circulation and exchange information. It is clear that modern health care cannot be built without information and communication technologies. We discuss several approaches how to contribute to some topics of information society in health care, namely the role of electronic health record, structured information, extraction of information from free medical texts and sharing knowledge stored in medical guidelines.

Information Technology in Complex Health Services

PubMed Central

Southon, Frank Charles Gray; Sauer, Chris; Dampney, Christopher Noel Grant (Kit)

1997-01-01

Abstract Objective: To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. Design: A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. Measurements: Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. Results: Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. Conclusion: The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case. PMID:9067877

Information technology in complex health services: organizational impediments to successful technology transfer and diffusion.

PubMed

Southon, F C; Sauer, C; Grant, C N

1997-01-01

To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case.

Quality management in Irish health care.

PubMed

Ennis, K; Harrington, D

1999-01-01

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

Classification of damage in structural systems using time series analysis and supervised and unsupervised pattern recognition techniques

NASA Astrophysics Data System (ADS)

Omenzetter, Piotr; de Lautour, Oliver R.

2010-04-01

Developed for studying long, periodic records of various measured quantities, time series analysis methods are inherently suited and offer interesting possibilities for Structural Health Monitoring (SHM) applications. However, their use in SHM can still be regarded as an emerging application and deserves more studies. In this research, Autoregressive (AR) models were used to fit experimental acceleration time histories from two experimental structural systems, a 3- storey bookshelf-type laboratory structure and the ASCE Phase II SHM Benchmark Structure, in healthy and several damaged states. The coefficients of the AR models were chosen as damage sensitive features. Preliminary visual inspection of the large, multidimensional sets of AR coefficients to check the presence of clusters corresponding to different damage severities was achieved using Sammon mapping - an efficient nonlinear data compression technique. Systematic classification of damage into states based on the analysis of the AR coefficients was achieved using two supervised classification techniques: Nearest Neighbor Classification (NNC) and Learning Vector Quantization (LVQ), and one unsupervised technique: Self-organizing Maps (SOM). This paper discusses the performance of AR coefficients as damage sensitive features and compares the efficiency of the three classification techniques using experimental data.

Design for perception management system on offshore reef based on integrated management

NASA Astrophysics Data System (ADS)

Peng, Li; Qiankun, Wang

2017-06-01

According to an analysis of actual monitoring demands using integrated management and information technology, a quad monitoring system is proposed to provide intelligent perception of offshore reefs, including indoor building environments, architectural structures, and facilities and perimeter integrity. This will strengthen the ability to analyse and evaluate offshore reef operation and health, promoting efficiency in decision making.

On-line Bayesian model updating for structural health monitoring

NASA Astrophysics Data System (ADS)

Rocchetta, Roberto; Broggi, Matteo; Huchet, Quentin; Patelli, Edoardo

2018-03-01

Fatigue induced cracks is a dangerous failure mechanism which affects mechanical components subject to alternating load cycles. System health monitoring should be adopted to identify cracks which can jeopardise the structure. Real-time damage detection may fail in the identification of the cracks due to different sources of uncertainty which have been poorly assessed or even fully neglected. In this paper, a novel efficient and robust procedure is used for the detection of cracks locations and lengths in mechanical components. A Bayesian model updating framework is employed, which allows accounting for relevant sources of uncertainty. The idea underpinning the approach is to identify the most probable crack consistent with the experimental measurements. To tackle the computational cost of the Bayesian approach an emulator is adopted for replacing the computationally costly Finite Element model. To improve the overall robustness of the procedure, different numerical likelihoods, measurement noises and imprecision in the value of model parameters are analysed and their effects quantified. The accuracy of the stochastic updating and the efficiency of the numerical procedure are discussed. An experimental aluminium frame and on a numerical model of a typical car suspension arm are used to demonstrate the applicability of the approach.

In vitro cell transformation assays for an integrated, alternative assessment of carcinogenicity: a data-based analysis.

PubMed

Benigni, Romualdo; Bossa, Cecilia; Tcheremenskaia, Olga

2013-01-01

The study of the chemical carcinogenesis mechanisms and the design of efficient prevention strategies and measures are of crucial importance to protect human health. The long-term carcinogenesis bioassays have played a central role in protecting human health, but for ethical and practical reasons their use is dramatically diminishing, and the genotoxicity short-term tests have taken the pivotal role in the pre-screening of carcinogenicity. However, there is evidence that this strategy is not sensitive enough to detect all genotoxic carcinogens and it cannot detect nongenotoxic carcinogens. In a previous article, we have shown that an integrated strategy consisting of the in vitro Ames and Syrian Hamster Embryo cells transformation assays, combined with structure-activity relationships, is a valid alternative to the present pre-screening strategies. Here, we expand the previous investigation by (i) including results of cell transformation assays on inorganics, together with an additional assay (Bhas 42), and (ii) considering new structural alerts for nongenotoxic carcinogenicity. We also present a new analysis on global relationships between toxicological endpoints. The new results confirm that the previously proposed integrated, alternative strategy is an efficient tool to identify both genotoxic and nongenotoxic carcinogens, with an estimated 90-95% sensitivity.

Study of distributed fiber-optic laser-ultrasound generation based on ghost-mode of tilted fiber Bragg gratings

NASA Astrophysics Data System (ADS)

Tian, Jiajun; Zhang, Qi; Han, Ming

2013-05-01

Fiber-optic ultrasonic transducers are an important component of an active ultrasonic testing system for structural health monitoring. Fiber-optic transducers have several advantages such as small size, light weight, and immunity to electromagnetic interference that make them much more attractive than the current available piezoelectric transducers, especially as embedded and permanent transducers in active ultrasonic testing for structural health monitoring. In this paper, a distributed fiber-optic laser-ultrasound generation based on the ghost-mode of tilted fiber Bragg gratings is studied. The influences of the laser power and laser pulse duration on the laser-ultrasound generation are investigated. The results of this paper are helpful to understand the working principle of this laser-ultrasound method and improve the ultrasonic generation efficiency.

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

PubMed

Soliman, Bishoy A B; Stanton, Raymond; Sowter, Steven; Rozen, Warren Matthew; Shahbaz, Shekib

2013-07-01

Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

PubMed Central

2010-01-01

Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. PMID:20942937

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

PubMed Central

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-01-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. PMID:26803655

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures.

PubMed

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-02-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework.

PubMed

Alqubaisi, Mai; Tonna, Antonella; Strath, Alison; Stewart, Derek

2016-07-01

Effective and efficient medication reporting processes are essential in promoting patient safety. Few qualitative studies have explored reporting of medication errors by health professionals, and none have made reference to behavioural theories. The objective was to describe and understand the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE). This was a qualitative study comprising face-to-face, semi-structured interviews within three major medical/surgical hospitals of Abu Dhabi, the UAE. Health professionals were sampled purposively in strata of profession and years of experience. The semi-structured interview schedule focused on behavioural determinants around medication error reporting, facilitators, barriers and experiences. The Theoretical Domains Framework (TDF; a framework of theories of behaviour change) was used as a coding framework. Ethical approval was obtained from a UK university and all participating hospital ethics committees. Data saturation was achieved after interviewing ten nurses, ten pharmacists and nine physicians. Whilst it appeared that patient safety and organisational improvement goals and intentions were behavioural determinants which facilitated reporting, there were key determinants which deterred reporting. These included the beliefs of the consequences of reporting (lack of any feedback following reporting and impacting professional reputation, relationships and career progression), emotions (fear and worry) and issues related to the environmental context (time taken to report). These key behavioural determinants which negatively impact error reporting can facilitate the development of an intervention, centring on organisational safety and reporting culture, to enhance reporting effectiveness and efficiency.

Green buildings need good ergonomics.

PubMed

Hedge, A; Dorsey, J A

2013-01-01

A retrospective post-occupancy evaluation survey of 44 occupants in two Leadership in Energy and Environmental Design (LEED) Platinum buildings on a US college campus is reported. The Internet survey covered a range of indoor environment and ergonomics issues. Results show that working in these buildings were a generally positive experience for their health, performance and satisfaction. However, in one building there were persistent issues of variability in air temperature, air freshness, air quality and noise that affected the perceived health and performance of the occupants. Although the buildings were energy-efficient and sustainable structures, ergonomics design issues were identified. Implications for the role of ergonomics in green buildings and in the US LEED rating system are discussed. This survey identified a number of ergonomics design issues present in the LEED Platinum energy-efficient and sustainable buildings that were studied. These results highlight the importance of integrating ergonomics design into green buildings as a component in the US LEED rating system.

Design of a Recommendation System for Adding Support in the Treatment of Chronic Patients.

PubMed

Torkar, Simon; Benedik, Peter; Rajkovič, Uroš; Šušteršič, Olga; Rajkovič, Vladislav

2016-01-01

Rapid growth of chronic disease cases around the world is adding pressure on healthcare providers to ensure a structured patent follow-up during chronic disease management process. In response to the increasing demand for better chronic disease management and improved health care efficiency, nursing roles have been specialized or enhanced in the primary health care setting. Nurses become key players in chronic disease management process. Study describes a system to help nurses manage the care process of patient with chronic disease. It supports focusing nurse's attention on those resources/solutions that are likely to be most relevant to their particular situation/problem in nursing domain. System is based on multi-relational property graph representing a flexible modeling construct. Graph allows modeling a nursing ontology and the indices that partition domain into an efficient, searchable space where the solution to a problem is seen as abstractly defined traversals through its vertices and edges.

Regulating a health insurance exchange: implications for individuals with mental illness.

PubMed

McGuire, Thomas G; Sinaiko, Anna D

2010-11-01

Under the newly enacted health reform law, millions of lower- and middle-income Americans will purchase individual or family health insurance through state-based markets for private health insurance called insurance "exchanges," which consolidate and regulate the market for individual and small-group health insurance. The authors consider options for structuring choice and pricing of health insurance in an exchange from the perspective of efficiently and fairly serving persons with mental illness. Exchanges are intended to foster choice and competition. However, certain features-open enrollment, individual choice, and imperfect risk adjusters-create incentives for "adverse selection," especially in providing coverage for persons with mental illness, who have higher overall health care costs. The authors review the experience of persons with mental illness in insurance markets similar to the exchanges, such as the Massachusetts Connector and the Federal Employees Health Benefit Program, and note that competition among health plans for enrollees who are "good risks" can undermine coverage and efficiency. They review the possible approaches for contending with selection-related incentives, such as carving out all or part of mental health benefits, providing reinsurance for some mental health care costs, or their preferred option, running the exchange in the same way that an employer runs its employee benefits and addressing selection and cost control issues by choice of contractor. The authors also consider approaches an exchange could use to promote effective consumer choice, such as passive and active roles for the exchange authority. Regulation will be necessary to establish a foundation for success of the exchanges.

Operational Efficiency of an Immunization Clinic Attached to Rural Health Training Centre in Delhi, India: A Time and Motion Study

PubMed Central

Kumar, Varun; Mangal, Abha; Panesar, Sanjeet; Yadav, Geeta; Talwar, Richa; Raut, Deepak; Singh, Saudan

2014-01-01

Background. Obtaining baseline data about current patterns of work is important for assessing the effects of interventions designed to improve care delivery. Time and motion studies allow for the most accurate measurement of structured components. Therefore, the present study was conducted to study the operational efficiency of an immunization clinic in Delhi, India. Methods. An observational cross-sectional study was conducted at the immunization clinic of Rural Health Training Centre in Delhi, India, from January 2014 to March 2014. The study composed two stage evaluations, a passive observation and a time and motion study. Systemic random sampling method was used to select 863 mothers/caregivers attending the immunization clinic. Results. At the immunization clinic, the study participants spent 64.1% of their total time in waiting. For new cases, the mean time taken for initial registration and receiving postvaccination advice was found to be significantly longer than old cases. Delivering health care services took more time during Mondays and also during the first hour of the day. Conclusion. Results of this study will guide public health decision-makers at all government levels in planning and implementation of immunization programs in developing countries. PMID:25431679

Methamphetamine residue dermal transfer efficiencies from household surfaces.

PubMed

Van Dyke, Mike; Martyny, John W; Serrano, Kate A

2014-01-01

Methamphetamine contamination from illegal production operations poses a potential health concern for emergency responders, child protective services, law enforcement, and children living in contaminated structures. The objective of this study was to evaluate dermal transfer efficiencies of methamphetamine from contaminated household surfaces. These transfer efficiencies are lacking for methamphetamine, and would be beneficial for use in exposure models. Surfaces were contaminated using a simulated smoking method in a stainless steel chamber. Household surfaces were carpet, painted drywall, and linoleum. Dermal transfer efficiencies were obtained using cotton gloves for two hand conditions, dry or saliva moistened (wet). In addition, three contact scenarios were evaluated for both hand conditions: one, two, or three contacts with contaminated surfaces. Dermal transfer efficiencies were calculated for both hand conditions and used as inputs in a Stochastic Human Exposure and Dose Simulation model (SHEDS-Multimedia, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, N.C.). Results of this study showed that average dermal transfer efficiencies of methamphetamine ranged from 11% for dry hands to 26% for wet hands. There was a significantly higher wet transfer as compared to dry transfer for all surfaces. For wet hands, dermal transfer depended on surface type with higher transfer from carpet and linoleum as compared to drywall. Based on our estimates of dermal transfer efficiency, a surface contamination clearance level of 1.5 μg/100 cm(2) may not ensure absorbed doses remain below the level associated with adverse health effects in all cases. Additional dermal transfer studies should be performed using skin surrogates that may better predict actual skin transfer.

[Plansalud: Decentralized and agreed sector plan for the capacity development in health, Peru 2010-2014].

PubMed

Huamán-Angulo, Lizardo; Liendo-Lucano, Lindaura; Nuñez-Vergara, Manuel

2011-06-01

Human resources are the backbone of health sector actions; however, they are not necessarily the area with the greatest attention, therefore, the Ministry of Health of Peru (MINSA) together with regional governments, led the Decentralized and Agreed Sector Plan for the Capacity Development in Health 2010-2014 (PLANSALUD) with the aim of strengthening the capacities of Human Resources for Health (HRH) and contribute to health care efficient development, quality, relevance, equity and multiculturalism, in the context of descentralization, the Universal Health Insurance (AUS) and health policies. To achieve this goal, they have proposed three components (technical assistance, joint training and education - health articulation) that bring together an important set of interventions, which are planned and defined according to the national, regional and local levels, thus contributing to improve the government capacity, capability management and delivery of health services. This paper presents a first approach of PLANSALUD, including aspects related to planning, management, financing, structure and functioning, as well as monitoring and evaluation measures.

[Control of health care by the economist?].

PubMed

Henke, K D

2000-12-01

Although the health care system has to deal with huge financial problems one cannot neglect that this labour-intensive service branch creates the most jobs with social security obligations. Corrective strategies will have to increase the orientation of health care to patients' needs which requires better information and more decision-making autonomy for the insured people as well as a maximising of efficiency. Competition needs to be strengthened in order to improve quality and reduce costs. This requires more contractual freedom for insurance funds and a dismantling of the current monopolistic structures. Finally, adequate remuneration schedules and patients' individual responsibility play a major role to meet the future challenges in the European internal market.

Health authority: the Italian experience.

PubMed

Vannelli, Alberto; Buongiorno, Massimo; Battaglia, Luigi; Poiasina, Elia; Boati, Paolo; Mario, Rampa; Leo, Ermanno

2009-01-01

The healthcare reform, introduced in Italy in 1992, has completely changed the structure of the national healthcare system (NHS) , including the introduction of the concept of "business firm" applied to public health service providers. The aim of this study was to outline the history of healthcare "firms" (azienda sanitaria) and evaluate the impact of this change on the NHS in terms of health expenditure, and corporate effectiveness and efficiency. Self regulation and correction are the abilities to which the success of healthcare companies can be attributed. The benefits of creating healthcare firms include preventing those problems associated with healthcare models based on the principles of the private insurance type model and preferring instead a cost-effectiveness approach.

Approach for Structurally Clearing an Adaptive Compliant Trailing Edge Flap for Flight

NASA Technical Reports Server (NTRS)

Miller, Eric J.; Lokos, William A.; Cruz, Josue; Crampton, Glen; Stephens, Craig A.; Kota, Sridhar; Ervin, Gregory; Flick, Pete

2015-01-01

The Adaptive Compliant Trailing Edge (ACTE) flap was flown on the National Aeronautics and Space Administration (NASA) Gulfstream GIII testbed at the NASA Armstrong Flight Research Center. This smoothly curving flap replaced the existing Fowler flaps creating a seamless control surface. This compliant structure, developed by FlexSys Inc. in partnership with the Air Force Research Laboratory, supported NASA objectives for airframe structural noise reduction, aerodynamic efficiency, and wing weight reduction through gust load alleviation. A thorough structures airworthiness approach was developed to move this project safely to flight. A combination of industry and NASA standard practice require various structural analyses, ground testing, and health monitoring techniques for showing an airworthy structure. This paper provides an overview of compliant structures design, the structural ground testing leading up to flight, and the flight envelope expansion and monitoring strategy. Flight data will be presented, and lessons learned along the way will be highlighted.

76 FR 70831 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-15

... of Veteran Enrollees (Quality and Efficiency of VA Health Care)) Activity; Comment Request AGENCY... of Veteran Enrollees (Quality and Efficiency of VA Health Care), VA Form 10-21088. OMB Control Number... will be used to collect data that is necessary to promote quality and efficient delivery of health care...

77 FR 3841 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-25

... of Veteran Enrollees (Quality and Efficiency of VA Health Care)) Activities Under OMB Review AGENCY... of Veteran Enrollees (Quality and Efficiency of VA Health Care), VA Form 10-21088. OMB Control Number... will be used to collect data that is necessary to promote quality and efficient delivery of health care...

Ambient Vibration Testing for Story Stiffness Estimation of a Heritage Timber Building

PubMed Central

Min, Kyung-Won; Kim, Junhee; Park, Sung-Ah; Park, Chan-Soo

2013-01-01

This paper investigates dynamic characteristics of a historic wooden structure by ambient vibration testing, presenting a novel estimation methodology of story stiffness for the purpose of vibration-based structural health monitoring. As for the ambient vibration testing, measured structural responses are analyzed by two output-only system identification methods (i.e., frequency domain decomposition and stochastic subspace identification) to estimate modal parameters. The proposed methodology of story stiffness is estimation based on an eigenvalue problem derived from a vibratory rigid body model. Using the identified natural frequencies, the eigenvalue problem is efficiently solved and uniquely yields story stiffness. It is noteworthy that application of the proposed methodology is not necessarily confined to the wooden structure exampled in the paper. PMID:24227999

Production cost structure in US outpatient physical therapy health care.

PubMed

Lubiani, Gregory G; Okunade, Albert A

2013-02-01

This paper investigates the technology cost structure in US physical therapy care. We exploit formal economic theories and a rich national data of providers to tease out implications for operational cost efficiencies. The 2008-2009 dataset comprising over 19 000 bi-weekly, site-specific physical therapy center observations across 28 US states and Occupational Employment Statistics data (Bureau of Labor Statistics) includes measures of output, three labor types (clinical, support, and administrative), and facilities (capital). We discuss findings from the iterative seemingly unrelated regression estimation system model. The generalized translog cost estimates indicate a well-behaved underlying technology structure. We also find the following: (i) factor demands are downwardly sloped; (ii) pair-wise factor relationships largely reflect substitutions; (iii) factor demand for physical therapists is more inelastic compared with that for administrative staff; and (iv) diminishing scale economies exist at the 25%, 50%, and 75% output (patient visits) levels. Our findings advance the timely economic understanding of operations in an increasingly important segment of the medical care sector that has, up-to-now (because of data paucity), been missing from healthcare efficiency analysis. Our work further provides baseline estimates for comparing operational efficiencies in physical therapy care after implementations of the 2010 US healthcare reforms. Copyright © 2012 John Wiley & Sons, Ltd.

Effects of Economic Conditions and Organizational Structure on Local Health Jurisdiction Revenue Streams and Personnel Levels in Connecticut, 2005-2012.

PubMed

Pallas, Sarah Wood; Kertanis, Jennifer; O'Keefe, Elaine; Humphries, Debbie L

2015-01-01

We investigated whether or not changes in economic conditions during the 2008-2010 U.S. recession were associated with changes in Connecticut local health jurisdictions' (LHJs') revenue or personnel levels. We analyzed Connecticut Department of Public Health 2005-2012 annual report data from 91 Connecticut LHJs, as well as publicly available data on economic conditions. We used fixed- and random-effect regression models to test whether or not LHJ per capita revenues and full-time equivalent (FTE) personnel differed during and post-recession compared with pre-recession, or varied with recession intensity, as measured by unemployment rates and housing permits. On average, total revenue per capita was significantly lower during and post-recession compared with pre-recession, with two-thirds of LHJs experiencing per capita revenue reductions. FTE personnel per capita were significantly lower post-recession. Changes in LHJ-level unemployment rates and housing permits did not explain the variation in revenue or FTE personnel per capita. Revenue and personnel differed significantly by LHJ organizational structure across all time periods. Economic downturns can substantially reduce resources available for local public health. LHJ organizational structure influences revenue levels and sources, with implications for the scope, quality, and efficiency of services delivered.

Effects of Economic Conditions and Organizational Structure on Local Health Jurisdiction Revenue Streams and Personnel Levels in Connecticut, 2005–2012

PubMed Central

Pallas, Sarah Wood; Kertanis, Jennifer; O'Keefe, Elaine

2015-01-01

Objective We investigated whether or not changes in economic conditions during the 2008–2010 U.S. recession were associated with changes in Connecticut local health jurisdictions' (LHJs') revenue or personnel levels. Methods We analyzed Connecticut Department of Public Health 2005–2012 annual report data from 91 Connecticut LHJs, as well as publicly available data on economic conditions. We used fixed- and random-effect regression models to test whether or not LHJ per capita revenues and full-time equivalent (FTE) personnel differed during and post-recession compared with pre-recession, or varied with recession intensity, as measured by unemployment rates and housing permits. Results On average, total revenue per capita was significantly lower during and post-recession compared with pre-recession, with two-thirds of LHJs experiencing per capita revenue reductions. FTE personnel per capita were significantly lower post-recession. Changes in LHJ-level unemployment rates and housing permits did not explain the variation in revenue or FTE personnel per capita. Revenue and personnel differed significantly by LHJ organizational structure across all time periods. Conclusion Economic downturns can substantially reduce resources available for local public health. LHJ organizational structure influences revenue levels and sources, with implications for the scope, quality, and efficiency of services delivered. PMID:26556942

The Policy Implications of the Cost Structure of Home Health Agencies

PubMed Central

Mukamel, Dana B; Fortinsky, Richard H; White, Alan; Harrington, Charlene; White, Laura M; Ngo-Metzger, Quyen

2014-01-01

Purpose To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. Design and Methods 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. Results The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. Implications Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study. PMID:24949224

Should dentistry be part of the National Health Information Infrastructure?

PubMed

Schleyer, Titus K L

2004-12-01

The National Health Information Infrastructure, or NHII, proposes to improve the effectiveness, efficiency and overall quality of health in the United States by establishing a national, electronic information network for health care. To date, dentistry's integration into this network has not been discussed widely. The author reviews the NHII and its goals and structure through published reports and background literature. The author evaluates the advantages and disadvantages of the NHII regarding their implications for the dental care system. The NHII proposes to implement computer-based patient records, or CPRs, for most Americans by 2014, connect personal health information with other clinical and public health information, and enable different types of care providers to access CPRs. Advantages of the NHII include transparency of health information across health care providers, potentially increased involvement of patients in their care, better clinical decision making through connecting patient-specific information with the best clinical evidence, increased efficiency, enhanced bioterrorism defense and potential cost savings. Challenges in the implementation of the NHII in dentistry include limited use of CPRs, required investments in information technology, limited availability and adoption of standards, and perceived threats to privacy and confidentiality. The implementation of the NHII is making rapid strides. Dentistry should become an active participant in the NHII and work to ensure that the needs of dental patients and the profession are met. Practice Implications. The NHII has far-reaching implications on dental practice by making it easier to access relevant patient information and by helping to improve clinical decision making.

Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

PubMed Central

Duckett, Stephen J

2008-01-01

Background Hospital policy involves multiple objectives: efficiency of service delivery, pursuit of high quality care, promoting access. Funding policy based on hospital casemix has traditionally been considered to be only about promoting efficiency. Discussion Formula-based funding policy can be (and has been) used to pursue a range of policy objectives, not only efficiency. These are termed 'adjunct' goals. Strategies to incorporate adjunct goals into funding design must, implicitly or explicitly, address key decision choices outlined in this paper. Summary Policy must be clear and explicit about the behaviour to be rewarded; incentives must be designed so that all facilities with an opportunity to improve have an opportunity to benefit; the reward structure is stable and meaningful; and the funder monitors performance and gaming. PMID:18384694

Damage classification and estimation in experimental structures using time series analysis and pattern recognition

NASA Astrophysics Data System (ADS)

de Lautour, Oliver R.; Omenzetter, Piotr

2010-07-01

Developed for studying long sequences of regularly sampled data, time series analysis methods are being increasingly investigated for the use of Structural Health Monitoring (SHM). In this research, Autoregressive (AR) models were used to fit the acceleration time histories obtained from two experimental structures: a 3-storey bookshelf structure and the ASCE Phase II Experimental SHM Benchmark Structure, in undamaged and limited number of damaged states. The coefficients of the AR models were considered to be damage-sensitive features and used as input into an Artificial Neural Network (ANN). The ANN was trained to classify damage cases or estimate remaining structural stiffness. The results showed that the combination of AR models and ANNs are efficient tools for damage classification and estimation, and perform well using small number of damage-sensitive features and limited sensors.

Many-level multilevel structural equation modeling: An efficient evaluation strategy.

PubMed

Pritikin, Joshua N; Hunter, Michael D; von Oertzen, Timo; Brick, Timothy R; Boker, Steven M

2017-01-01

Structural equation models are increasingly used for clustered or multilevel data in cases where mixed regression is too inflexible. However, when there are many levels of nesting, these models can become difficult to estimate. We introduce a novel evaluation strategy, Rampart, that applies an orthogonal rotation to the parts of a model that conform to commonly met requirements. This rotation dramatically simplifies fit evaluation in a way that becomes more potent as the size of the data set increases. We validate and evaluate the implementation using a 3-level latent regression simulation study. Then we analyze data from a state-wide child behavioral health measure administered by the Oklahoma Department of Human Services. We demonstrate the efficiency of Rampart compared to other similar software using a latent factor model with a 5-level decomposition of latent variance. Rampart is implemented in OpenMx, a free and open source software.

A human body model for efficient numerical characterization of UWB signal propagation in wireless body area networks.

PubMed

Lim, Hooi Been; Baumann, Dirk; Li, Er-Ping

2011-03-01

Wireless body area network (WBAN) is a new enabling system with promising applications in areas such as remote health monitoring and interpersonal communication. Reliable and optimum design of a WBAN system relies on a good understanding and in-depth studies of the wave propagation around a human body. However, the human body is a very complex structure and is computationally demanding to model. This paper aims to investigate the effects of the numerical model's structure complexity and feature details on the simulation results. Depending on the application, a simplified numerical model that meets desired simulation accuracy can be employed for efficient simulations. Measurements of ultra wideband (UWB) signal propagation along a human arm are performed and compared to the simulation results obtained with numerical arm models of different complexity levels. The influence of the arm shape and size, as well as tissue composition and complexity is investigated.

Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs.

PubMed

Sterrett-Hong, Emma M; Karam, Eli; Kiaer, Lynn

2017-09-01

Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.

Fast and Efficient Feature Engineering for Multi-Cohort Analysis of EHR Data.

PubMed

Ozery-Flato, Michal; Yanover, Chen; Gottlieb, Assaf; Weissbrod, Omer; Parush Shear-Yashuv, Naama; Goldschmidt, Yaara

2017-01-01

We present a framework for feature engineering, tailored for longitudinal structured data, such as electronic health records (EHRs). To fast-track feature engineering and extraction, the framework combines general-use plug-in extractors, a multi-cohort management mechanism, and modular memoization. Using this framework, we rapidly extracted thousands of features from diverse and large healthcare data sources in multiple projects.

Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.

PubMed

Fischman, Daniel

2010-01-01

Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care. Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other. This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

User recommendation in healthcare social media by assessing user similarity in heterogeneous network.

PubMed

Jiang, Ling; Yang, Christopher C

2017-09-01

The rapid growth of online health social websites has captured a vast amount of healthcare information and made the information easy to access for health consumers. E-patients often use these social websites for informational and emotional support. However, health consumers could be easily overwhelmed by the overloaded information. Healthcare information searching can be very difficult for consumers, not to mention most of them are not skilled information searcher. In this work, we investigate the approaches for measuring user similarity in online health social websites. By recommending similar users to consumers, we can help them to seek informational and emotional support in a more efficient way. We propose to represent the healthcare social media data as a heterogeneous healthcare information network and introduce the local and global structural approaches for measuring user similarity in a heterogeneous network. We compare the proposed structural approaches with the content-based approach. Experiments were conducted on a dataset collected from a popular online health social website, and the results showed that content-based approach performed better for inactive users, while structural approaches performed better for active users. Moreover, global structural approach outperformed local structural approach for all user groups. In addition, we conducted experiments on local and global structural approaches using different weight schemas for the edges in the network. Leverage performed the best for both local and global approaches. Finally, we integrated different approaches and demonstrated that hybrid method yielded better performance than the individual approach. The results indicate that content-based methods can effectively capture the similarity of inactive users who usually have focused interests, while structural methods can achieve better performance when rich structural information is available. Local structural approach only considers direct connections between nodes in the network, while global structural approach takes the indirect connections into account. Therefore, the global similarity approach can deal with sparse networks and capture the implicit similarity between two users. Different approaches may capture different aspects of the similarity relationship between two users. When we combine different methods together, we could achieve a better performance than using each individual method. Copyright © 2017 Elsevier B.V. All rights reserved.

Health Monitoring System for Composite Structures

NASA Technical Reports Server (NTRS)

Tang, S. S.; Riccardella, P. C.; Andrews, R. J.; Grady, J. E.; Mucciaradi, A. N.

1996-01-01

An automated system was developed to monitor the health status of composites. It uses the vibration characteristics of composites to identify a component's damage condition. The vibration responses are characterized by a set of signal features defined in the time, frequency and spatial domains. The identification of these changes in the vibration characteristics corresponding to different health conditions was performed using pattern recognition principles. This allows efficient data reduction and interpretation of vast amounts of information. Test components were manufactured from isogrid panels to evaluate performance of the monitoring system. The components were damaged by impact to simulate different health conditions. Free vibration response was induced by a tap test on the test components. The monitoring system was trained using these free vibration responses to identify three different health conditions. They are undamaged vs. damaged, damage location and damage zone size. High reliability in identifying the correct component health condition was achieved by the monitoring system.

Development of Self-Powered Wireless Structural Health Monitoring (SHM) for Wind Turbine Blades

NASA Astrophysics Data System (ADS)

Lim, Dong-Won

Wind turbine blade failure can lead to unexpected power interruptions. Monitoring wind turbine blades is important to ensure seamless electricity delivery from power generation to consumers. Structural health monitoring (SHM) enables early recognition of structural problems so that the safety and reliability of operation can be enhanced. This dissertation focuses on the development of a wireless SHM system for wind turbine blades. The sensor is comprised of a piezoelectric energy harvester (EH) and a telemetry unit. The sensor node is mounted on the blade surface. As the blade rotates, the blade flexes, and the energy harvester captures the strain energy on the blade surface. Once sufficient electricity is captured, a pulse is sent from the sensing node to a gateway. Then, a central monitoring algorithm processes a series of pulses received from all three blades. This wireless SHM, which uses commercially available components, can be retrofitted to existing turbines. The harvested energy for sensing can be estimated in terms of two factors: the available strain energy and conversion efficiency. The available strain energy was evaluated using the FAST (Fatigue, Aerodynamics, Structures, and Turbulence) simulator. The conversion efficiency was studied analytically and experimentally. An experimental set-up was designed to mimic the expected strain frequency and amplitude for rotor blades. From a series of experiments, the efficiency of a piezoelectric EH at a typical rotor speed (0.2 Hz) was approximately 0.5%. The power requirement for sending one measurement (280 muJ) can be achieved in 10 minutes. Designing a detection algorithm is challenging due to this low sampling rate. A new sensing approach-the timing of pulses from the transmitter-was introduced. This pulse timing, which is tied to the charging time, is indicative of the structural health. The SHM system exploits the inherent triple redundancy of the three blades. The timing data of the three blades are compared to discern an outlier, corresponding to a damaged blade. Two types of post-processing of pulses were investigated: (1) comparing the ratios of signal timings (i.e. transmission ratio); and (2) comparing the difference between signal timings (i.e. residuals). For either method, damage is indicated when the energy ratio or residual exceeds a threshold level. When residuals are used to detect damage, performance measures such as the false alarm rate and detection probability can also be imposed. The SHM algorithms were evaluated using strain energy data from a 2.5 MW wind turbine.

Using qualitative mixed methods to study small health care organizations while maximising trustworthiness and authenticity.

PubMed

Phillips, Christine B; Dwan, Kathryn; Hepworth, Julie; Pearce, Christopher; Hall, Sally

2014-11-19

The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA-Qualitative Rapid Appraisal, Rigorous Analysis-to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector.

The role of information and communication technology in planning the digital hospital.

PubMed

Lacanna, Giuseppe

2013-01-01

Hospital structure is undergoing radical changes, forced by contemporary market trends, new demands from different stakeholders and a common interest in innovation. Health care expenditure around the globe continues to rise at unsustainable levels. In this context efficiency and optimization become the keywords of the process aimed at lowering costs and increasing the quality of care services. Efficiency and optimization leads to innovation, and innovation in the contemporary age leads to the power of information and communication technology (ICT). This paper discusses how ICT became the new shaping tool for hospital environments and highlights one of the best examples of its implementation.

Chapter 5: Organizational structures suited to ISPRM's evolving role as an international non-governmental organization in official relation with the world health organization.

PubMed

von Groote, Per M; Reinhardt, Jan D; Gutenbrunner, Christoph; DeLisa, Joel A; Melvin, John L; Bickenbach, Jerome E; Stucki, Gerold

2009-09-01

International non-governmental organizations (NGOs) in official relation with the World Health Organization (WHO) face organizational challenges against the background of legitimate representation of their membership and accountable procedures within the organization. Moreover, challenges arise in the light of such an international NGO's civil societal mandate to help reach the "health-for-all" goals as defined by WHO and to facilitate the implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities. The objective of this paper is to examine how such an international NGO using the International Society of Physical and Rehabilitation Medicine (ISPRM) as a case in point can address these challenges. The specific aims are to analyse ISPRM's structures and procedures of internal organs and external relations and to develop solutions. These possible solutions will be presented as internal organizational scenarios and a yearly schedule of meetings closely aligned to that of WHO to facilitate an efficient internal and external interaction.

[Balance of power in hospitals].

PubMed

Lameyer, A

2000-08-01

It is known that there is a large extent of working dissatisfaction within some professional groups of the health service system. Especially in the hospital sector, many "struggles for power" take place. Unfortunately, these struggles are often only examined with regard to individual points of view without considering the system-oriented background. The following text will reflect the discussion in social sciences as to the distribution of power within the health service system. The double meaning of the distribution of power will be explained and, by means of decisive phenomenons, the development of cost and efficiency structures on the one hand as well as the development of health political processes in decision-making on the other hand will be described. In the section "The Hospital in the 20th Century", the structures that still can be widely found nowadays will be specified and examined as to aspects in behavioural sciences. Finally, as a logical consequence, an urgently needed reorientation from administration towards management will be pointed out.

Machine Learning for Knowledge Extraction from PHR Big Data.

PubMed

Poulymenopoulou, Michaela; Malamateniou, Flora; Vassilacopoulos, George

2014-01-01

Cloud computing, Internet of things (IOT) and NoSQL database technologies can support a new generation of cloud-based PHR services that contain heterogeneous (unstructured, semi-structured and structured) patient data (health, social and lifestyle) from various sources, including automatically transmitted data from Internet connected devices of patient living space (e.g. medical devices connected to patients at home care). The patient data stored in such PHR systems constitute big data whose analysis with the use of appropriate machine learning algorithms is expected to improve diagnosis and treatment accuracy, to cut healthcare costs and, hence, to improve the overall quality and efficiency of healthcare provided. This paper describes a health data analytics engine which uses machine learning algorithms for analyzing cloud based PHR big health data towards knowledge extraction to support better healthcare delivery as regards disease diagnosis and prognosis. This engine comprises of the data preparation, the model generation and the data analysis modules and runs on the cloud taking advantage from the map/reduce paradigm provided by Apache Hadoop.

Achieving value for money in health: a comparative analysis of OECD countries and regional countries.

PubMed

Çelik, Yusuf; Khan, Mahmud; Hikmet, Neşet

2017-10-01

To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Damage Detection in Flexible Plates through Reduced-Order Modeling and Hybrid Particle-Kalman Filtering

PubMed Central

Capellari, Giovanni; Eftekhar Azam, Saeed; Mariani, Stefano

2015-01-01

Health monitoring of lightweight structures, like thin flexible plates, is of interest in several engineering fields. In this paper, a recursive Bayesian procedure is proposed to monitor the health of such structures through data collected by a network of optimally placed inertial sensors. As a main drawback of standard monitoring procedures is linked to the computational costs, two remedies are jointly considered: first, an order-reduction of the numerical model used to track the structural dynamics, enforced with proper orthogonal decomposition; and, second, an improved particle filter, which features an extended Kalman updating of each evolving particle before the resampling stage. The former remedy can reduce the number of effective degrees-of-freedom of the structural model to a few only (depending on the excitation), whereas the latter one allows to track the evolution of damage and to locate it thanks to an intricate formulation. To assess the effectiveness of the proposed procedure, the case of a plate subject to bending is investigated; it is shown that, when the procedure is appropriately fed by measurements, damage is efficiently and accurately estimated. PMID:26703615

Cross-Validation of the Implementation Leadership Scale (ILS) in Child Welfare Service Organizations.

PubMed

Finn, Natalie K; Torres, Elisa M; Ehrhart, Mark G; Roesch, Scott C; Aarons, Gregory A

2016-08-01

The Implementation Leadership Scale (ILS) is a brief, pragmatic, and efficient measure that can be used for research or organizational development to assess leader behaviors and actions that actively support effective implementation of evidence-based practices (EBPs). The ILS was originally validated with mental health clinicians. This study validates the ILS factor structure with providers in community-based organizations (CBOs) providing child welfare services. Participants were 214 service providers working in 12 CBOs that provide child welfare services. All participants completed the ILS, reporting on their immediate supervisor. Confirmatory factor analyses were conducted to examine the factor structure of the ILS. Internal consistency reliability and measurement invariance were also examined. Confirmatory factor analyses showed acceptable fit to the hypothesized first- and second-order factor structure. Internal consistency reliability was strong and there was partial measurement invariance for the first-order factor structure when comparing child welfare and mental health samples. The results support the use of the ILS to assess leadership for implementation of EBPs in child welfare organizations. © The Author(s) 2016.

Efficiency in mental health practice and research.

PubMed

Lagomasino, Isabel T; Zatzick, Douglas F; Chambers, David A

2010-01-01

Limited financial resources, escalating mental health-related costs and opportunities for capitalizing on advances in health information technologies have brought the theme of efficiency to the forefront of mental health services research and clinical practice. In this introductory article to the journal series stemming from the 20th NIMH Mental Health Services Research Conference, we first delineate the need for a new focus on efficiency in both research and clinical practice. Second, we provide preliminary definitions of efficiency for the field and discuss issues related to measurement. Finally, we explore the interface between efficiency in mental health services research and practice and the NIMH strategic objectives of developing improved interventions for diverse populations and enhancing the public health impact of research. Case examples illustrate how perspectives from dissemination and implementation research may be used to maximize efficiencies in the development and implementation of new service delivery models. Allowing findings from the dissemination and implementation field to permeate and inform clinical practice and research may facilitate more efficient development of interventions and enhance the public health impact of research. Copyright © 2010 Elsevier Inc. All rights reserved.

Pixel-wise deblurring imaging system based on active vision for structural health monitoring at a speed of 100 km/h

NASA Astrophysics Data System (ADS)

Hayakawa, Tomohiko; Moko, Yushi; Morishita, Kenta; Ishikawa, Masatoshi

2018-04-01

In this paper, we propose a pixel-wise deblurring imaging (PDI) system based on active vision for compensation of the blur caused by high-speed one-dimensional motion between a camera and a target. The optical axis is controlled by back-and-forth motion of a galvanometer mirror to compensate the motion. High-spatial-resolution image captured by our system in high-speed motion is useful for efficient and precise visual inspection, such as visually judging abnormal parts of a tunnel surface to prevent accidents; hence, we applied the PDI system for structural health monitoring. By mounting the system onto a vehicle in a tunnel, we confirmed significant improvement in image quality for submillimeter black-and-white stripes and real tunnel-surface cracks at a speed of 100 km/h.

[Primary care: decentralization and efficiency].

PubMed

Pinillos, M; Antoñanzas, F

2002-01-01

The purpose of this study was to evaluate whether the productive behavior of health centers in autonomous communities with competence in health is more efficient than that among centers belonging to Spanish public health system (INSALUD). The technical efficiency of 66 health centers in Alava, Navarre and La Rioja was analyzed. Centers in autonomous communities that in 1997 had been granted complete authority from the central government to manage their healthcare services were compared with centers whose administration, in the same year, was still in the hands of INSALUD. The method used to measure and quantify the efficiency of these centers was data envelopment analysis. Nonparametric contrast of the health centers' mean efficiency rates revealed no significant differences in the (in)efficiency of centers from La Rioja, Navarre and Alava. The results obtained from the model of efficiency measurement used did not indicate that decentralization improves the productive efficiency of primary care centers.

Creating an integrated clinical enterprise at the University of Kentucky: the emergence of UK HealthCare.

PubMed

Karpf, Michael; Perman, Jay; Lofgren, Richard; Melgar, Sergio; Butler, Frank; Day, Zed; Clark, Murray; Claypool, Joseph O; Gilbert, Peter; Gombeski, William; Higdon, Courtney M

2007-12-01

If the medical system in the United States is to change, as has been recommended, academic medical centers must, in fact, lead this change process. To prepare for the future, the University of Kentucky decided to move aggressively toward developing an integrated clinical enterprise branded as UK HealthCare, where leadership of the various components of the academic medical center make strategic and financial decisions together to achieve common organizational goals. The authors discuss senior leadership's development of the vision for the enterprise and the governance structure that was established to engage board members and faculty of the institution. They examine the rigorous strategic, facilities, financial, and academic planning that ensued, and the early successes achieved. The authors introduce some of the lessons learned by the organization during the emergence of UK HealthCare and describe the corporate structure and senior management team that was established to support the quick and efficient implementation of the planning strategies. It was this corporate structure and senior management team which has proven to be an effective agent of change and a key to the successful development of a truly integrated clinical enterprise.

[Ethics versus economics in public health? On the integration of economic rationality in a discourse of public health ethics].

PubMed

Rothgang, H; Staber, J

2009-05-01

In the course of establishing the discourse of public health ethics in Germany, we discuss whether economic efficiency should be part of public health ethics and, if necessary, how efficiency should be conceptualized. Based on the welfare economics theory, we build a theoretical framework that demands an integration of economic rationality in public health ethics. Furthermore, we consider the possible implementation of welfare efficiency against the background of current practice in an economic evaluation of health care in Germany. The indifference of the welfare efficiency criterion with respect to distribution leads to the conclusion that efficiency must not be the only criteria of public health ethics. Therefore, an ethical approach of principles should be chosen for public health ethics. Possible conflicts between principles of such an approach are outlined.

Technical efficiency of public district hospitals and health centres in Ghana: a pilot study

PubMed Central

Osei, Daniel; d'Almeida, Selassi; George, Melvill O; Kirigia, Joses M; Mensah, Ayayi Omar; Kainyu, Lenity H

2005-01-01

Background The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination) in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i) to estimate the relative technical efficiency (TE) and scale efficiency (SE) of a sample of public hospitals and health centres in Ghana; and (ii) to demonstrate policy implications for health sector policy-makers. Methods The Data Envelopment Analysis (DEA) approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. Results Eight (47%) hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD) of 12%. Ten (59%) hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%). Out of the 17 health centres, 3 (18%) were technically inefficient, with a mean TE score of 49% (STD = 27%). Eight health centres (47%) were scale inefficient, with an average SE score of 84% (STD = 16%). Conclusion This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres) in the course of the implementation of health sector reforms. PMID:16188021

Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer’s Quality of Life Questionnaire C30: a confirmatory versus exploratory approach

PubMed Central

Costa, Daniel SJ; Aaronson, Neil K; Fayers, Peter M; Grimison, Peter S; Janda, Monika; Pallant, Julie F; Rowen, Donna; Velikova, Galina; Viney, Rosalie; Young, Tracey A; King, Madeleine T

2014-01-01

Background Multi attribute utility instruments (MAUIs) are preference-based measures that comprise a health state classification system (HSCS) and a scoring algorithm that assigns a utility value to each health state in the HSCS. When developing a MAUI from a health-related quality of life (HRQOL) questionnaire, first a HSCS must be derived. This typically involves selecting a subset of domains and items because HRQOL questionnaires typically have too many items to be amendable to the valuation task required to develop the scoring algorithm for a MAUI. Currently, exploratory factor analysis (EFA) followed by Rasch analysis is recommended for deriving a MAUI from a HRQOL measure. Aim To determine whether confirmatory factor analysis (CFA) is more appropriate and efficient than EFA to derive a HSCS from the European Organisation for the Research and Treatment of Cancer’s core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30), given its well-established domain structure. Methods QLQ-C30 (Version 3) data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQ-C30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis. Results CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04). EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA. Conclusion CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest that CFA should be recommended generally when deriving a preference-based measure from a HRQOL measure that has an established domain structure. PMID:25395875

The value of structured data elements from electronic health records for identifying subjects for primary care clinical trials.

PubMed

Ateya, Mohammad B; Delaney, Brendan C; Speedie, Stuart M

2016-01-11

An increasing number of clinical trials are conducted in primary care settings. Making better use of existing data in the electronic health records to identify eligible subjects can improve efficiency of such studies. Our study aims to quantify the proportion of eligibility criteria that can be addressed with data in electronic health records and to compare the content of eligibility criteria in primary care with previous work. Eligibility criteria were extracted from primary care studies downloaded from the UK Clinical Research Network Study Portfolio. Criteria were broken into elemental statements. Two expert independent raters classified each statement based on whether or not structured data items in the electronic health record can be used to determine if the statement was true for a specific patient. Disagreements in classification were discussed until 100 % agreement was reached. Statements were also classified based on content and the percentages of each category were compared to two similar studies reported in the literature. Eligibility criteria were retrieved from 228 studies and decomposed into 2619 criteria elemental statements. 74 % of the criteria elemental statements were considered likely associated with structured data in an electronic health record. 79 % of the studies had at least 60 % of their criteria statements addressable with structured data likely to be present in an electronic health record. Based on clinical content, most frequent categories were: "disease, symptom, and sign", "therapy or surgery", and "medication" (36 %, 13 %, and 10 % of total criteria statements respectively). We also identified new criteria categories related to provider and caregiver attributes (2.6 % and 1 % of total criteria statements respectively). Electronic health records readily contain much of the data needed to assess patients' eligibility for clinical trials enrollment. Eligibility criteria content categories identified by our study can be incorporated as data elements in electronic health records to facilitate their integration with clinical trial management systems.

Exploring the influence of context and policy on health district productivity in Cambodia.

PubMed

Ensor, Tim; So, Sovannarith; Witter, Sophie

2016-01-01

Cambodia has been reconstructing its economy and health sector since the end of conflict in the 1990s. There have been gains in life expectancy and increased health expenditure, but Cambodia still lags behind neighbours One factor which may contribute is the efficiency of public health services. This article aims to understand variations in efficiency and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade. The analysis makes use of data envelopment analysis (DEA) to measure relative efficiency and changes in productivity and regression analysis to assess the association with the implementation of health policies. Data on 28 operational districts were obtained for 2008-11, focussing on the five provinces selected to represent a range of conditions in Cambodia. DEA was used to calculate efficiency scores assuming constant and variable returns to scale and Malmquist indices to measure productivity changes over time. This analysis was combined with qualitative findings from 17 key informant interviews and 19 in-depth interviews with managers and staff in the same provinces. The DEA results suggest great variation in the efficiency scores and trends of scores of public health services in the five provinces. Starting points were significantly different, but three of the five provinces have improved efficiency considerably over the period. Higher efficiency is associated with more densely populated areas. Areas with health equity funds in Special Operating Agency (SOA) and non-SOA areas are associated with higher efficiency. The same effect is not found in areas only operating voucher schemes. We find that the efficiency score increased by 0.12 the year any of the policies was introduced. This is the first study published on health district productivity in Cambodia. It is one of the few studies in the region to consider the impact of health policy changes on health sector efficiency. The results suggest that the recent health financing reforms have been effective, singly and in combination. This analysis could be extended nationwide and used for targeting of new initiatives. The finding of an association between recent policy interventions and improved productivity of public health services is relevant for other countries planning similar health sector reforms.

Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study.

PubMed

Dizon, J M; Grimmer, K; Louw, Q; Machingaidze, S; Parker, H; Pillen, H

2017-09-15

The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC. Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes. CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice. CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.

NATO Advanced Research Workshop: Optics of Biological Particles. Held in Novosibirsk, Russia on 3-6 Oct 2005

DTIC Science & Technology

2005-01-01

acterization of health relevant bacteria should be critically discussed, and experimentally further evidenced. References [1] D. Naumann, « Infrared spectroscopy ...application of conventional meth- ods for characterizing protein conformational transformations. Raman spectroscopy has been proven to be an efficient...appli- cation of deep ultraviolet res- onance Raman spectroscopy for structural characteriza- tion of a protein at all stages of fibrillation process

Sell your practice to grow and compete--the synergism of vertical integration.

PubMed

Robison, D L

1988-01-01

There are many advantages for selling a group practice to achieve vertical integration with a larger entity, including shared medical and management services, and greater efficiency, which results in greater profits. Health care in the 1990s will have a more formalized, structured system, greatly reducing freedoms enjoyed by both physicians and patients. An attractive option for smaller groups or solo practitioners is vertical integration.

Assessing the technical efficiency of health posts in rural Guatemala: a data envelopment analysis.

PubMed

Hernández, Alison R; San Sebastián, Miguel

2014-01-01

Strengthening health service delivery to the rural poor is an important means of redressing inequities. Meso-level managers can help enhance efficiency in the utilization of existing resources through the application of practical tools to analyze routinely collected data reflecting inputs and outputs. This study aimed to assess the efficiency and change in productivity of health posts over two years in a rural department of Guatemala. Data envelopment analysis was used to measure health posts' technical efficiency and productivity change for 2008 and 2009. Input/output data were collected from the regional health office of Alta Verapaz for 34 health posts from the 19 districts comprising the health region. Technical efficiency varied widely across health posts, with mean scores of 0.78 (SD=0.24) and 0.75 (SD=0.21) in 2008 and 2009, respectively. Overall, productivity increased by 4%, though 47% of health posts experienced a decline in productivity. Results were combined on a bivariate plot to identify health posts at the high and low extremes of efficiency, which should be followed up to determine how and why their production processes are operating differently. Assessing efficiency using the data that are available at the meso-level can serve as a first step in strengthening performance. Further work is required to support managers in the routine application of efficiency analysis and putting the results to use in guiding efforts to improve service delivery and increase utilization.

Assessing the technical efficiency of health posts in rural Guatemala: a data envelopment analysis

PubMed Central

Hernández, Alison R.; Sebastián, Miguel San

2014-01-01

Introduction Strengthening health service delivery to the rural poor is an important means of redressing inequities. Meso-level managers can help enhance efficiency in the utilization of existing resources through the application of practical tools to analyze routinely collected data reflecting inputs and outputs. This study aimed to assess the efficiency and change in productivity of health posts over two years in a rural department of Guatemala. Methods Data envelopment analysis was used to measure health posts’ technical efficiency and productivity change for 2008 and 2009. Input/output data were collected from the regional health office of Alta Verapaz for 34 health posts from the 19 districts comprising the health region. Results Technical efficiency varied widely across health posts, with mean scores of 0.78 (SD=0.24) and 0.75 (SD=0.21) in 2008 and 2009, respectively. Overall, productivity increased by 4%, though 47% of health posts experienced a decline in productivity. Results were combined on a bivariate plot to identify health posts at the high and low extremes of efficiency, which should be followed up to determine how and why their production processes are operating differently. Conclusions Assessing efficiency using the data that are available at the meso-level can serve as a first step in strengthening performance. Further work is required to support managers in the routine application of efficiency analysis and putting the results to use in guiding efforts to improve service delivery and increase utilization. PMID:24461356

Military health system efficiency: a review of history and recommendations for the future.

PubMed

Coppola, Nicholas; Satterwhite, Robin; Fulton, Lawrence V; Shanderson, Laurie L; Pasupathy, Rubini

2012-06-01

This article reviews the history of measuring military medical health care efficiency. No single approved definition or uniform framework has ever been offered or suggested defining military medical treatment facility efficiency over the last 225 years within the Department of Defense. The purpose of this article is to consolidate much of the existing research on the latent variable of military medical efficiency over the last two centuries, and to provide health care leaders a framework for understanding past and current practices in measuring efficiency in the military health care setting.

New Zealand's post-2008 health system reforms: toward re-centralization of organizational arrangements.

PubMed

Gauld, Robin

2012-07-01

The election of a centre-right government in 2008 has spawned a series of ongoing reforms to the structures for governing New Zealand's health system. These mainly involve creation of a series of new national agencies designed to stimulate national coordination and centralization of some planning and service delivery functions along with performance improvements in specific areas, namely quality, information technology, service efficiency, reduction of administrative costs, and comparative-effectiveness research. This brief article provides an overview of the post-2008 reforms. It notes that, while there appears to be agreement within the health system that the reforms are moving in the right direction, the new institutional arrangements are perhaps overly complicated. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Considerations and benefits of implementing an online database tool for business continuity.

PubMed

Mackinnon, Susanne; Pinette, Jennifer

2016-01-01

In today's challenging climate of ongoing fiscal restraints, limited resources and complex organisational structures there is an acute need to investigate opportunities to facilitate enhanced delivery of business continuity programmes while maintaining or increasing acceptable levels of service delivery. In 2013, Health Emergency Management British Columbia (HEMBC), responsible for emergency management and business continuity activities across British Columbia's health sector, transitioned its business continuity programme from a manual to automated process with the development of a customised online database, known as the Health Emergency Management Assessment Tool (HEMAT). Key benefits to date include a more efficient business continuity input process, immediate situational awareness for use in emergency response and/or advanced planning and streamlined analyses for generation of reports.

Optical fiber curvature sensor based on MMF-SCF-MMF structure

NASA Astrophysics Data System (ADS)

Wang, Qi; Liu, Yu

2018-07-01

A sensitive curvature sensor based on MMF-SCF-MMF (MMF: multimode fiber; SCF: seven core fiber) structure is proposed. The multimode fiber (MMF) are used to improve the light coupling efficiency between the input singlemode fiber (SMF) and the seven-core fiber (SCF), and the seven-core fiber is used as the main element for curvature measurement. Experimental results show that the best curvature sensitivity reaches 41.46453 nm/m-1 in the range of 0.094 m-1-0.567 m-1. The temperature sensitivity is up to 59.02 pm/°C in the range of 20 °C-55 °C. The optical curvature sensors are widely used for buildings structure health monitoring and mechanical engineering due to the advantages of compact structure, anti-electromagnetic interference, and low cost.

Transition to adult-oriented health care: perspectives of youth and adults with complex physical disabilities.

PubMed

Young, Nancy L; Barden, Wendy S; Mills, Wendy A; Burke, Tricia A; Law, Mary; Boydell, Katherine

2009-01-01

The transition to adulthood is extremely difficult for individuals with disabilities. We sought to explore the specific issue of transition to adult-oriented health care in a Canadian context. We conducted semi-structured individual interviews with 15 youth and 15 adults with cerebral palsy, spina bifida, and acquired brain injuries of childhood, and their parents (n = 30). Respondents discussed their health care services, their experience with clinical transition, and contributing factors. We analyzed the transcripts using qualitative methods. All participants identified challenges in transition, including: lack of access to health care; lack of professionals' knowledge; lack of information and uncertainty regarding the transition process. Two solutions were identified: early provision of detailed information and more extensive support throughout the clinical transition process. The challenges of clinical transition were universal. More extensive information and support is needed during transition to ensure an efficient move to appropriate adult-oriented health care.

Smart health community: the hidden value of health information exchange.

PubMed

Ciriello, James N; Kulatilaka, Nalin

2010-12-01

Investments in health information technology are accelerating the digitization of medicine. The value from these investments, however, can grow beyond efficiencies by filling the information gaps between the various stakeholders. New work processes, governance structures, and relationships are needed for the coevolution of healthcare markets and business models. But coevolution is slow, hindered by the scarcity of incentives for legacy delivery systems and constrained by the prevailing patient-healthcare paradigm. The greater opportunity lies in wellness for individuals, families, communities, and society at large: a consumer-community paradigm. Capturing new value from this opportunity can start with investment in health information exchange and the creation of Smart Health Communities. By shifting the focus of exchange from public servant to value-added service provider, these communities can serve as a platform for a wider array of wellness services from consumer care, traditional healthcare, and research.

Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform.

PubMed

Shen, Gordon C; Snowden, Lonnie R

2014-01-01

Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.

Creating a high-value delivery system for health care.

PubMed

Teisberg, Elizabeth O; Wallace, Scott

2009-01-01

Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clusters of medical circumstances; and (3) enabling reimbursement tied to value rather than to quantity of services. Many of these changes require physician leadership. We discuss steps on the journey to value-based care delivery.

Electronic health records: postadoption physician satisfaction and continued use.

PubMed

Wright, Edward; Marvel, Jon

2012-01-01

One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record (EHR) systems throughout the health care industry. Consequently, this investigation focused on the effects of known antecedents of technology adoption on physician satisfaction with EHR technology and the continued use of such systems. The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience. A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling. Results indicate that effort expectancy (ease of use) has the most substantive effect on physician satisfaction and the continued use of EHR systems. As such, health care managers should be especially sensitive to the user and computer interface of prospective EHR systems to avoid costly and disruptive system selection mistakes.

Getting from here to there: health IT needs for population health.

PubMed

Vest, Joshua R; Harle, Christopher A; Schleyer, Titus; Dixon, Brian E; Grannis, Shaun J; Halverson, Paul K; Menachemi, Nir

2016-12-01

The United States' decade-long transition from a paper- to technology-based information infrastructure has always been recognized as an initial step-a laying of the foundation-for future changes to the delivery of care. An increasingly important focal area for improvement is population health. Numerous policies and programs now require healthcare organizations to manage the risks, outcomes, utilization, and health of entire groups of individuals. Nonetheless, current health information technology (IT) systems are not ready to support population health improvements effectively and efficiently. Existing health IT systems were designed for organizations that are structurally, operationally, and culturally focused on individual care delivery, rather than improving health for a population. Opportunities exist to align health IT resources and population health management strategies to fill the gaps among technological capabilities, use and the emerging demands of population health. To realize this alignment, healthcare leaders must think differently about the types of data their organizations need, the types of partners with whom they share information, and how they can leverage new information and partnerships for evidence-based action.

Options for diabetes management in sub-Saharan Africa with an electronic medical record system.

PubMed

Kouematchoua Tchuitcheu, G; Rienhoff, O

2011-01-01

An increase of diabetes prevalence of up to 80% is predicted in sub-Saharan Africa (SSA) by 2025 exceeding the worldwide 55%. Mortality rates of diabetes and HIV/AIDS are similar. Diabetes shares several common factors with HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). The latter two health problems have been efficiently managed by an open source electronic medical record system (EMRS) in Latin America. Therefore a similar solution for diabetes in SSA could be extremely helpful. The aim was to design and validate a conceptual model for an EMRS to improve diabetes management in SSA making use of the HIV and TB experience. A review of the literature addressed diabetes care and management in SSA as well as existing examples of information and communication technology (ICT) use in SSA. Based on a need assessment conducted in SSA a conceptual model based on the traditionally structured healthcare system in SSA was mapped into a three-layer structure. Application modules were derived and a demonstrator programmed based on an open source EMRS. Then the approach was validated by SSA experts. A conceptual model could be specified and validated which enhances a problem-oriented approach to diabetes management processes. The prototyp EMRS demonstrates options for a patient portal and simulation tools for education of health professional and patients in SSA. It is possible to find IT solutions for diabetes care in SSA which follow the same efficiency concepts as HIV or TB modules in Latin America. The local efficiency and sustainability of the solution will, however, depend on training and changes in work behavior.

Identifying and managing inappropriate hospital utilization: a policy synthesis.

PubMed Central

Payne, S M

1987-01-01

Utilization review, the assessment of the appropriateness and efficiency of hospital care through review of the medical record, and utilization management, deliberate action by payers or hospital administrators to influence providers of hospital services to increase the efficiency and effectiveness with which services are provided, are valuable but relatively unfamiliar strategies for containing hospital costs. The purpose of this synthesis is to increase awareness of the scope of and potential for these approaches among health services managers and administrators, third-party payers, policy analysts, and health services researchers. The synthesis will assist the reader to trace the conceptual context and the historical development of utilization review from unstructured methods using individual physicians' professional judgment to structured methods using explicit criteria; to establish the context of utilization review and clarify its uses; to understand the concepts and tools used in assessing the efficiency of hospital use; and to select, design, and evaluate utilization review and utilization management programs. The extent of inappropriate (medical unnecessary) hospital utilization and the factors associated with it are described. Implications for managers, providers, and third-party payers in targeting utilization review and in designing and evaluating utilization management programs are discussed. PMID:3121538

Some aspects of the reform of the health care systems in Austria, Germany and Switzerland.

PubMed

Theurl, E

1999-01-01

The health care systems in Austria, Germany and Switzerland owe their institutional structure to different historical developments. While Austria and Germany voted for the Bismarck-Model of social health insurance, Switzerland adopted a voluntary system of health insurance. In all three countries, until very recently, the different challenges which the health care sector faced were met by piecemeal approaches and by stop and go policies, which, in the long run were not very successful either in containing costs or in improving efficacy and efficiency. During the 1990 more fundamental reforms in the health care systems of all three countries took place. Germany and Switzerland chose the path of deregulation of the health insurance system, which consequently strengthened the competition between the insurance companies, and, to some extent between the suppliers of medical services. While this can be seen as an essential part of the reform process for these two countries. Austria favors a state-oriented and interventionist approach in order to meet the challenges.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries.

PubMed

Tambo, Ernest; Ugwu, Chidiebere E; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity.

[Mental health of children, adolescents and young adults--part 2: burden of illness, deficits of the German health care system and efficacy and effectiveness of early intervention services].

PubMed

Karow, A; Bock, T; Naber, D; Löwe, B; Schulte-Markwort, M; Schäfer, I; Gumz, A; Degkwitz, P; Schulte, B; König, H H; Konnopka, A; Bauer, M; Bechdolf, A; Correll, C; Juckel, G; Klosterkötter, J; Leopold, K; Pfennig, A; Lambert, M

2013-11-01

Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services. © Georg Thieme Verlag KG Stuttgart · New York.

Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Akazili, James; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F

2015-01-01

Despite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament. This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factors that account for differences in efficiency and determine the association between quality care and efficiency levels. The study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regions in southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilities while Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation test was performed to determine the association between quality care and efficiency. Overall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the 20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilities and 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9; p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % technical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant association was found between technical efficiency scores of health facilities and many technical quality care proxies, except in overall quality score per the NHIS accreditation data (Coef. = -0.3158; p < 0.05) and SafeCare Essentials quality score on environmental safety for staff and patients (Coef. = -0.2764; p < 0.05) where the association was negative. The findings suggest some level of wastage of health resources in many healthcare facilities, especially those located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective need analysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limited resources without compromising quality care standards.

Political decision-making in health care: the Dutch case.

PubMed

Elsinga, E

1989-01-01

In many western countries health care is a subject of increasing importance on the political agenda. Issues such as aging, development of medical technologies, equity and efficiency of care, increasing costs, market elements, etc. are leading to a review of existing health care systems. In The Netherlands the government has proposed fundamental changes in the structure and financing of care, based on a report by the so-called Dekker Committee. The final result of a step-wise process of change should be the introduction of a new insurance scheme and the strengthening of market elements. After a short description of the government proposals, this article gives an analysis of the process of decision-making for a restructuring of health care in the Netherlands. The analysis is based on a bureaupolitical model, as originally described by Allison.

European health policy challenges.

PubMed

Maynard, Alan

2005-09-01

Few countries are immune to the international health care 'virus' of reform, with many countries regularly re-cycling changes that shift costs and benefits in ways that are arbitrary, inefficient and offer short term political palliation. Much of this activity has little evidence base and reveals lack of clarity in defining public policy goals, establishing trade-offs and aligning incentive structures with these objectives. Well established failures in health care delivery systems such as variations in medical practice and continuing absence of systematic outcome measurement, have persisted for decades as nations grapple inefficiently with recurring problems of expenditure inflation and waiting times. The lack of emphasis on evidence to inform the efficient management of chronic disease and the reduction of health inequalities is a product of perverse incentives and managerial inertia that maintains the incomes of powerful interest groups. Copyright (c) 2005 John Wiley & Sons, Ltd.

National health insurance policy in Nepal: challenges for implementation.

PubMed

Mishra, Shiva Raj; Khanal, Pratik; Karki, Deepak Kumar; Kallestrup, Per; Enemark, Ulrika

2015-01-01

The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.

Perceived organizational problems in health care: a pilot test of the structured problem and success inventory.

PubMed

Nyström, Monica E; Terris, Darcey D; Sparring, Vibeke; Tolf, Sara; Brown, Claire R

2012-01-01

Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.

Supporting health systems in Europe: added value of EU actions?

PubMed

Clemens, Timo; Michelsen, Kai; Brand, Helmut

2014-01-01

Since the start of the economic crisis, the European Union's (EU's) predominant discourse has been austerity and fiscal consolidation. The detrimental effects on Europe's health systems and the health status of its citizens are well described. However, little is known about the emerging EU-level initiatives to support national health systems handle the challenges of efficient care provision and system reorganisation aimed to meet their future needs. This review analyses the manner, conditions and prospects of such EU support. First, health system objectives are increasingly entering the EU health policy agenda. Second, professional and patient mobility provisions may support member states (MS) in copying with crisis related health challenges but can potentially acerbate them at the same time. Third, in recent initiatives health system goals are more closely tied to the EU's economic growth narrative. And fourth, health system issues are taken up in existing EU-level structures for debate and exchange between MS. In addition, the design of some policies may have the potential to intensify socioeconomic and health inequalities rather than ameliorate them.

[Methods in health services research. The example of the evaluation of the German disease management programmes].

PubMed

Morfeld, M; Wirtz, M

2006-02-01

According to the established definition of Pfaff, health services research analyses patients' path through the institutions of the health care system. The focus is on development, evaluation and implementation of innovative measures of health care. By increasing its quality health services research strives for an improvement of efficacy and efficiency of the health care system. In order to allow for an appropriate evaluation it is essential to differentiate between structure, process and outcome quality referring to (1) the health care system in its entirety, (2) specific health care units as well as (3) processes of communication in different settings. Health services research comprises a large array of scientific disciplines like public health, medicine, social sciences and social care. For the purpose of managing its tasks adequately a special combination of instruments and methodological procedures is needed. Thus, diverse techniques of evaluation research as well as special requirements for study designs and assessment procedures are of vital importance. The example of the German disease management programmes illustrates the methodical requirements for a scientific evaluation.

Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation.

PubMed

Patrick, Rebecca; Kingsley, Jonathan

2017-08-01

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

Role of information systems in public health services.

PubMed

Hartshorne, J E; Carstens, I L

1990-07-01

The purpose of this review is to establish a conceptual framework on the role of information systems in public health care. Information is indispensable for effective management and development of health services and therefore considered as an important operational asset or resource. A Health Information System is mainly required to support management and operations at four levels: namely transactional and functional; operational control; management planning and control; and strategic planning. To provide the necessary information needs of users at these levels of management in the health care system, a structured information system coupled with appropriate information technology is required. Adequate and relevant information is needed regarding population characteristics, resources available and expended, output and outcome of health care activities. Additionally information needs to be reliable, accurate, timely, easily accessible and presented in a compact and meaningful form. With a well-planned health information system health authorities would be in a position to provide a quality, cost-effective and efficient health service for as many people as need it, optimal utilisation of resources and to maintain and improve the community's health status.

How efficient are New Zealand's District Health Boards at producing life expectancy gains for Māori and Europeans?

PubMed

Sandiford, Peter; Consuelo, David Juan José Vivas; Rouse, Paul

2017-04-01

Use data envelopment analysis (DEA) to measure the efficiency of New Zealand's District Health Boards (DHBs) at achieving gains in Māori and European life expectancy (LE). Using life tables for 2006 and 2013, a two-output DEA model established the production possibility frontier for Māori and European LE gain. Confidence limits were generated from a 10,000 replicate Monte Carlo simulation. Results support the use of LE change as an indicator of DHB efficiency. DHB mean income and education were related to initial LE but not to its rate of change. LE gains were unrelated to either the initial level of life expectancy or to the proportion of Māori in the population. DHB efficiency ranged from 79% to 100%. Efficiency was significantly correlated with DHB financial performance. Changes in LE did not depend on the social characteristics of the DHB. The statistically significant association between efficiency and financial performance supports its use as an indicator of managerial effectiveness. Implications for public health: Efficient health systems achieve better population health outcomes. DEA can be used to measure the relative efficiency of sub-national health authorities at achieving health gain and equity outcomes. © 2016 The Authors.

A vibration-based health monitoring program for a large and seismically vulnerable masonry dome

NASA Astrophysics Data System (ADS)

Pecorelli, M. L.; Ceravolo, R.; De Lucia, G.; Epicoco, R.

2017-05-01

Vibration-based health monitoring of monumental structures must rely on efficient and, as far as possible, automatic modal analysis procedures. Relatively low excitation energy provided by traffic, wind and other sources is usually sufficient to detect structural changes, as those produced by earthquakes and extreme events. Above all, in-operation modal analysis is a non-invasive diagnostic technique that can support optimal strategies for the preservation of architectural heritage, especially if complemented by model-driven procedures. In this paper, the preliminary steps towards a fully automated vibration-based monitoring of the world’s largest masonry oval dome (internal axes of 37.23 by 24.89 m) are presented. More specifically, the paper reports on signal treatment operations conducted to set up the permanent dynamic monitoring system of the dome and to realise a robust automatic identification procedure. Preliminary considerations on the effects of temperature on dynamic parameters are finally reported.

Ortho-perio integrated approach in periodontally compromised patients

PubMed Central

Ramachandra, C. S.; Shetty, Pradeep Chandra; Rege, Sanyukta; Shah, Chitrang

2011-01-01

It is an undisputed fact that sound and strong periodontal health is a must in patients seeking orthodontic treatment. Does this mean that we are going to deny orthodontic treatment for those adults whose number is rising, more often secondary to periodontal deterioration and pathological migration of teeth resulting in aesthetic and functional problems? Need of the hour is to have an integrated approach where in periodontal treatment precedes orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this article is to familiarize the practicing clinicians both in the field of orthodontics and periodontics with current thoughts and successful clinical techniques used in the field of periodontology to regenerate lost periodontal structures. Furthermore, it aims to integrate such techniques into the orthodontic treatment of patients with severe bone loss. PMID:22368371

The benefit of 3D laser scanning technology in the generation and calibration of FEM models for health assessment of concrete structures.

PubMed

Yang, Hao; Xu, Xiangyang; Neumann, Ingo

2014-11-19

Terrestrial laser scanning technology (TLS) is a new technique for quickly getting three-dimensional information. In this paper we research the health assessment of concrete structures with a Finite Element Method (FEM) model based on TLS. The goal focuses on the benefits of 3D TLS in the generation and calibration of FEM models, in order to build a convenient, efficient and intelligent model which can be widely used for the detection and assessment of bridges, buildings, subways and other objects. After comparing the finite element simulation with surface-based measurement data from TLS, the FEM model is determined to be acceptable with an error of less than 5%. The benefit of TLS lies mainly in the possibility of a surface-based validation of results predicted by the FEM model.

The Metro Firm System: meeting the challenges of a changing health care environment.

PubMed

Dawson, N V

Changes in the health care system and especially in reimbursement systems are creating new challenges for all hospitals. These challenges are particularly critical for academic medical centers. The traditional (inpatient) teaching base is threatened by changes in the case mix of patients entering hospitals and by the associated decreasing lengths of stay. The effects of the new financial pressures are intensified in academic centers which have been shown to be less efficient and more costly than community hospitals. This paper describes the formation and evolution of the Metro Firm System, an organizational structure which is adapting to the changing demands placed on an academic medical center. Inherent in its structure is the ability to evaluate easily and rigorously changes that have been suggested in the system prior to implementing them. Operational details essential for understanding functions of and interrelationships within the system are included.

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

PubMed Central

Davey, Sanjeev; Raghav, Santosh Kumar; Singh, Jai Vir; Davey, Anuradha; Singh, Nirankar

2015-01-01

Background: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. Materials and Methods: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1st Jan 2014 to 1st July 2014 was taken for deciding their efficiency scores. Results: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). Conclusions: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future. PMID:26435598

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

PubMed Central

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-01

Objective Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting The study focused on all 72 health districts of Zambia. Methods We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. PMID:28057650

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application

PubMed Central

Renner, Ade; Kirigia, Joses M; Zere, Eyob A; Barry, Saidou P; Kirigia, Doris G; Kamara, Clifford; Muthuri, Lenity HK

2005-01-01

Background The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone. Methods This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone. Results Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%). Conclusion It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about US$7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalise health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter. PMID:16354299

Graphene based strain sensor with LCP substrate

NASA Astrophysics Data System (ADS)

Nie, M.; Yang, H. S.; Xia, Y. H.

2018-02-01

A flexible strain sensor constructed by an efficient, low-cost fabrication strategy is presented in this paper. It is assembled by adhering grid-like graphene on LCP substrate. Kinds of measurement setup have been designed to verify that the proposed flexible sensor device is suitable to be used in health monitoring system. From the experiment results, it can be proved that the sensor exhibits the following features: ultra-light, relatively good sensitivity, high reversibility, superior physical robustness, easy fabrication. With the great performance of this flexible strain sensor, it is considered to play an important role in body monitoring, structural health monitoring system, fatigue detection and healthcare systems in the near future.

The application of data mining and cloud computing techniques in data-driven models for structural health monitoring

NASA Astrophysics Data System (ADS)

Khazaeli, S.; Ravandi, A. G.; Banerji, S.; Bagchi, A.

2016-04-01

Recently, data-driven models for Structural Health Monitoring (SHM) have been of great interest among many researchers. In data-driven models, the sensed data are processed to determine the structural performance and evaluate the damages of an instrumented structure without necessitating the mathematical modeling of the structure. A framework of data-driven models for online assessment of the condition of a structure has been developed here. The developed framework is intended for automated evaluation of the monitoring data and structural performance by the Internet technology and resources. The main challenges in developing such framework include: (a) utilizing the sensor measurements to estimate and localize the induced damage in a structure by means of signal processing and data mining techniques, and (b) optimizing the computing and storage resources with the aid of cloud services. The main focus in this paper is to demonstrate the efficiency of the proposed framework for real-time damage detection of a multi-story shear-building structure in two damage scenarios (change in mass and stiffness) in various locations. Several features are extracted from the sensed data by signal processing techniques and statistical methods. Machine learning algorithms are deployed to select damage-sensitive features as well as classifying the data to trace the anomaly in the response of the structure. Here, the cloud computing resources from Amazon Web Services (AWS) have been used to implement the proposed framework.

[Group preventive consultation of the population concerning nutrition. Experience of School of the balanced nutrition founded on the basis of the Health center].

PubMed

Lobykina, E N; Tatarnikova, I S; Rusaev, Yu W; Naydenova, N E; Maklakova, T P

2015-01-01

The development of the program of group preventive consultation of visitors of the centers of health concerning nutrition and assessment of its efficiency was the purpose of the work. The analysis of the results of inspection of 2569 visitors of the Health сenter at the age of 18–78 years and randomized, open, cross research of 242 women (27–72 years old) who passed group preventive consultation in the Center of health at «School of a balanced nutrition » were carried out. Anthropometrical data and the actual nutrition with use of the computer program «Analysis of the Person Nutrition» were studied. The study of nutritional status of 242 women with different body mass revealed an excess consumption of fats and carbohydrates, dietary energy supply in obese. Basing on the structural features of patient’s nutrition the School nutrition program was developed. Сomparing of laboratory, diagnostic and resource capabilities of Health сenter with algorithm of overweight and obesity patients treatment has shown wide opportunities of Health сenter, not only in the diagnosis (the study of nutrient, metabolic status), but also in the complex treatment of patients with different body mass. Due to group preventive counseling in the School of a balanced nutrition the efficiency of such an approach contributed 1-month weight loss (2.18±1.28 kg) in 64.4% of the participants.

Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system.

PubMed

Gok, Mehmet Sahin; Altındağ, Erkut

2015-06-01

This paper analyzes the effects of the pay for performance (PFP) system on the efficiencies of public and private hospitals in Turkey. In order to evaluate these effects, we examine the relationship between hospital efficiency and health care costs in Turkey, and address the impact of the PFP system on the efficiencies of public and private hospitals. In an effort to analyze the efficiencies of public and private hospitals, this study uses data envelopment analysis. The Malmquist Productivity Index is also used to analyze the patterns of efficiency change for the study years from 2001 to 2008. This study shows that health care costs and hospital efficiency are negatively correlated for private hospitals, while they are positively correlated for public hospitals. In other words, increased health care costs might reduce efficiency in private hospitals in contrast to public hospitals. Our findings also indicate that average efficiencies of public hospitals tend to increase, particularly during the implementation period of PFP system. The efficiency trend of private hospitals, conversely, decreased in the latter periods of the PFP system. Suggestions for improvement are provided to the health care policy makers regarding the impact of health care reforms on public and private hospitals.

A review of medical terminology standards and structured reporting.

PubMed

Awaysheh, Abdullah; Wilcke, Jeffrey; Elvinger, François; Rees, Loren; Fan, Weiguo; Zimmerman, Kurt

2018-01-01

Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies. The impact of standardization and structured reporting is not limited to secondary activities; standardization has been shown to have a direct impact on patient healthcare.

Analysis and determination the efficiency of the European health systems.

PubMed

Del Rocío Moreno-Enguix, María; Gómez-Gallego, Juan Cándido; Gómez Gallego, María

2018-01-01

The current economic crisis has increased the interest in analyzing the efficiency of health care systems, as their funding is a very important part of the budgets for different countries. In this work determines the efficiency in the health services in European countries applying data envelopment analysis. In addition, the combined application of data envelopment analysis methods and ACP can provide an evaluation of the efficiency with respect to differently oriented productive health systems in the different countries. The results show that models with a lower level of efficiency are those whose input is beds, followed by the models whose input is physicians. Finally, we apply the AD to select a few simple indicators that facilitate control of the level of operational efficiency of a health system. Copyright © 2017 John Wiley & Sons, Ltd.

Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

PubMed

Sun, Jian; Luo, Hongye

2017-07-14

China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource investments for different provinces.

Efficient and mechanically robust stretchable organic light-emitting devices by a laser-programmable buckling process

PubMed Central

Yin, Da; Feng, Jing; Ma, Rui; Liu, Yue-Feng; Zhang, Yong-Lai; Zhang, Xu-Lin; Bi, Yan-Gang; Chen, Qi-Dai; Sun, Hong-Bo

2016-01-01

Stretchable organic light-emitting devices are becoming increasingly important in the fast-growing fields of wearable displays, biomedical devices and health-monitoring technology. Although highly stretchable devices have been demonstrated, their luminous efficiency and mechanical stability remain impractical for the purposes of real-life applications. This is due to significant challenges arising from the high strain-induced limitations on the structure design of the device, the materials used and the difficulty of controlling the stretch-release process. Here we have developed a laser-programmable buckling process to overcome these obstacles and realize a highly stretchable organic light-emitting diode with unprecedented efficiency and mechanical robustness. The strained device luminous efficiency −70 cd A−1 under 70% strain - is the largest to date and the device can accommodate 100% strain while exhibiting only small fluctuations in performance over 15,000 stretch-release cycles. This work paves the way towards fully stretchable organic light-emitting diodes that can be used in wearable electronic devices. PMID:27187936

Role of innovative institutional structures in integrated governance. A case study of integrating health and nutrition programs in Chhattisgarh, India.

PubMed

Kalita, Anuska; Mondal, Shinjini

2012-01-01

The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities. The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource-poor state of Chhattisgarh, India, at different levels of governance structures--hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods--i.e. document analysis, interviews, discussions and quantitative data from facilities surveys--to present a case study analyzing the process and outcome of integration. The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self-governance, community monitoring of government programs, and therefore, better services. As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance. This paper is one of the few to investigate innovative public institutions of a and community mobilisation to explore this important, and under-researched, topic.

[Evaluating the efficiency of basic public health service project in Beijing rural areas based on data envelopment analysis].

PubMed

Zhang, Gui-lin; Pan, Xi-long

2013-04-18

To measure the efficiency changes of basic public health service in Beijing rural areas and to provide some suggestions for the basic public health service project throughout China. In the study, stratified random samples from 32 township health centers (THCs) were measured by data envelopment analysis (DEA) model with the panel data from 2007 to 2009. (1) The average total efficiency score of samples was 0.972. The TE non-efficient THCs were with excess in all input indicators and insufficient outputs in technology management, health promotion and chronic disease management. (2) The total factor productivity (TFP) from 2007 to 2008 increased 8.8%, which was attributed to technology change. The TFP decreased by 6.6% from 2008 to 2009, but the technical efficiency increased by 3.3%. There is room for improvemrnt in the basic public health service project in Beijing rural areas. Scale efficiency should be improved and the common development of technical efficiency and technology progress promoted in order to increase the project outputs.

Acoustic Emission of Large PRSEUS Structures (Pultruded Rod Stitched Efficient Unitized Structure)

NASA Technical Reports Server (NTRS)

Horne, Michael R.; Juarez, Peter D.

2016-01-01

In the role of structural health monitoring (SHM), Acoustic Emission (AE) analysis is being investigated as an effective method for tracking damage development in large composite structures under load. Structures made using Pultruded Rod Stitched Efficient Unitized Structure (PRSEUS) for damage tolerant, light, and economical airframe construction are being pursued by The Boeing Company and NASA under the Environmentally Responsible Aircraft initiative (ERA). The failure tests of two PRSEUS substructures based on the Boeing Hybrid Wing Body fuselage concept were conducted during third quarter 2011 and second quarter 2015. One fundamental concern of these tests was determining the effectiveness of the stitched integral stiffeners to inhibit damage progression. By design, severe degradation of load carrying capability should not occur prior to Design Ultimate Load (DUL). While minor damage prior to DUL was anticipated, the integral stitching should not fail since this would allow a stiffener-skin delamination to progress rapidly and alter the transfer of load into the stiffeners. In addition, the stiffeners should not fracture because they are fundamental to structural integrity. Getting the best information from each AE sensor is a primary consideration because a sparse network of sensors is implemented. Sensitivity to stiffener-contiguous degradation is supported by sensors near the stiffeners, which increases the coverage per sensor via AE waveguide actions. Some sensors are located near potentially critical areas or "critical zones" as identified by numerical analyses. The approach is compared with the damage progression monitored by other techniques (e.g. ultrasonic C-scan).

Does restructuring hospitals result in greater efficiency?--An empirical test using diachronic data.

PubMed

Braithwaite, Jeffrey; Westbrook, Mary T; Hindle, Donald; Iedema, Rick A; Black, Deborah A

2006-02-01

Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical-divisional (CD), or clinical-institute (CI). In all, 12 hospitals changed structure during the study period. There was slight evidence that CD structures were more efficient than TP structures but this was not supported by other evidence. There were no significant differences in efficiency in the first or second years following changes from either TP to CD or TP to CI structures. All four hospitals changing from CD to CI structure became significantly less efficient. This may be due to frequency rather than type of change as they were the only hospitals that implemented two structural changes. Hospitals that changed or did not change structure were similar in efficiency at the beginning and at the end of the study period, in overall efficiency during the period, and in trends toward efficiency over time. The findings challenge those who advocate restructuring hospitals on the grounds of improving cost efficiency.

Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China.

PubMed

Xu, Xinglong; Zhou, Lulin; Antwi, Henry Asante; Chen, Xi

2018-02-20

While the demand for health services keep escalating at the grass roots or rural areas of China, a substantial portion of healthcare resources remain stagnant in the more developed cities and this has entrenched health inequity in many parts of China. At its conception, China's Deepen Medical Reform started in 2012 was intended to flush out possible disparities and promote a more equitable and efficient distribution of healthcare resources. Nearly half a decade of this reform, there are uncertainties as to whether the attainment of the objectives of the reform is in sight. Using a hybrid of panel data analysis and an augmented data envelopment analysis (DEA), we model human resources, material, finance to determine their technical and scale efficiency to comprehensively evaluate the transverse and longitudinal allocation efficiency of community health resources in Jiangsu Province. We observed that the Deepen Medical Reform in China has led to an increase concern to ensure efficient allocation of community health resources by health policy makers in the province. This has led to greater efficiency in health resource allocation in Jiangsu in general but serious regional or municipal disparities still exist. Using the DEA model, we note that the output from the Community Health Centers does not commensurate with the substantial resources (human resources, materials, and financial) invested in them. We further observe that the case is worst in less-developed Northern parts of Jiangsu Province. The government of Jiangsu Province could improve the efficiency of health resource allocation by improving the community health service system, rationalizing the allocation of health personnel, optimizing the allocation of material resources, and enhancing the level of health of financial resource allocation.

How Can Health System Efficiency Be Improved in Canada?

PubMed Central

Allin, Sara; Veillard, Jeremy; Wang, Li; Grignon, Michel

2015-01-01

Improving value for money in the health system is an often-stated policy goal. This study is the first to systematically measure the efficiency of health regions in Canada in producing health gains with their available resources, and to identify the factors that are associated with increased efficiency. Based on the objective elicited from decision-makers that the health system should ensure access to care for Canadians when they need it, we measured the efficiency with which regions reduce causes of death that are amenable to healthcare interventions using a linear programming approach (data envelopment analysis). Variations in efficiency were explained in part by public health factors, such as the prevalence of obesity and smoking in the population; in part by characteristics of the population, such as their average income; and in part by managerial factors, such as hospital readmissions. PMID:26571467

Geometric identification and damage detection of structural elements by terrestrial laser scanner

NASA Astrophysics Data System (ADS)

Hou, Tsung-Chin; Liu, Yu-Wei; Su, Yu-Min

2016-04-01

In recent years, three-dimensional (3D) terrestrial laser scanning technologies with higher precision and higher capability are developing rapidly. The growing maturity of laser scanning has gradually approached the required precision as those have been provided by traditional structural monitoring technologies. Together with widely available fast computation for massive point cloud data processing, 3D laser scanning can serve as an efficient structural monitoring alternative for civil engineering communities. Currently most research efforts have focused on integrating/calculating the measured multi-station point cloud data, as well as modeling/establishing the 3D meshes of the scanned objects. Very little attention has been spent on extracting the information related to health conditions and mechanical states of structures. In this study, an automated numerical approach that integrates various existing algorithms for geometric identification and damage detection of structural elements were established. Specifically, adaptive meshes were employed for classifying the point cloud data of the structural elements, and detecting the associated damages from the calculated eigenvalues in each area of the structural element. Furthermore, kd-tree was used to enhance the searching efficiency of plane fitting which were later used for identifying the boundaries of structural elements. The results of geometric identification were compared with M3C2 algorithm provided by CloudCompare, as well as validated by LVDT measurements of full-scale reinforced concrete beams tested in laboratory. It shows that 3D laser scanning, through the established processing approaches of the point cloud data, can offer a rapid, nondestructive, remote, and accurate solution for geometric identification and damage detection of structural elements.

System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals: A Descriptive Study.

PubMed

Underwood, Carlisa M; Hayne, Arlene N

The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems. Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations. Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment. Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance. Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.

The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases.

PubMed

Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Blanca-Tamayo, Milagrosa; Velasco-Velasco, Soledad; Escribano-Herranz, Esperanza; Llopart-López, Josep Ramon; Violan-Fors, Concepción; Vilaseca-Llobet, Josep Maria; Sánchez-Fontcuberta, Encarna; Benavent-Areu, Jaume; Flor-Serra, Ferran; Aguado-Jodar, Alba; Rodríguez-López, Daniel; Prados-Torres, Alejandra; Estelrich-Bennasar, Jose

2009-06-25

The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness.The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization.The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50).The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions. multiple regression analysis (procedure: enter), ANCOVA (method: Bonferroni's adjustment) and multilevel analysis will be carried out to correct models. The level of statistical significance will be p < 0.05.

[The new strategy of the British health system: reflections on the changes in British health care system in the light of the WHO report on the financing of health systems worldwide].

PubMed

Vaccari, Vittorio; Passerino, Costantino; Giagnorio, Maria Laura

2011-01-01

The search for a strategy that can optimise resources far the financing of health systems is currently the subject of numerous worldwide experiments. This interest stems from the fact that in most countries, although having each one different specific characteristics, governments try to improve the efficiency and equity of health care. This worle analyses how innovative financing options at national level can be combined with decision-making processes typical of quality management to devise strategies far funding health services that are oriented towards their continuous improvement. The paper discusses, in particular, the strategy adopted in England, where the new law Equity and Excellence, liberating the NHS radically changes the management of the NHS, giving patients the choice of using different types of structures and therefore the possibility to find the most convenient combination in order to obtain the required service.

Achieving Mental Health Care Parity Might Require Changes In Payments And Competition

PubMed Central

McGuire, Thomas G.

2016-01-01

One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. “Better enforcement” of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured. PMID:27269019

Structure, bioactivity, and synthesis of methylated flavonoids.

PubMed

Wen, Lingrong; Jiang, Yueming; Yang, Jiali; Zhao, Yupeng; Tian, Miaomiao; Yang, Bao

2017-06-01

Methylated flavonoids are an important type of natural flavonoid derivative with potentially multiple health benefits; among other things, they have improved bioavailability compared with flavonoid precursors. Flavonoids have been documented to have broad bioactivities, such as anticancer, immunomodulation, and antioxidant activities, that can be elevated, to a certain extent, by methylation. Understanding the structure, bioactivity, and bioavailability of methylated flavonoids, therefore, is an interesting topic with broad potential applications. Though methylated flavonoids are widely present in plants, their levels are usually low. Because developing efficient techniques to produce these chemicals would likely be beneficial, we provide an overview of their chemical and biological synthesis. © 2017 New York Academy of Sciences.

Home health nursing care services in Greece during an economic crisis.

PubMed

Adamakidou, T; Kalokerinou-Anagnostopoulou, A

2017-03-01

The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

PubMed

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Operational efficiency and sustainability of vector control of malaria and dengue: descriptive case studies from the Philippines

PubMed Central

2012-01-01

Background Analysis is lacking on the management of vector control systems in disease-endemic countries with respect to the efficiency and sustainability of operations. Methods Three locations were selected, at the scale of province, municipality and barangay (i.e. village). Data on disease incidence, programme activities, and programme management were collected on-site through meetings and focus group discussions. Results Adaptation of disease control strategies to the epidemiological situation per barangay, through micro-stratification, brings gains in efficiency, but should be accompanied by further capacity building on local situational analysis for better selection and targeting of vector control interventions within the barangay. An integrated approach to vector control, aiming to improve the rational use of resources, was evident with a multi-disease strategy for detection and response, and by the use of combinations of vector control methods. Collaboration within the health sector was apparent from the involvement of barangay health workers, re-orientation of job descriptions and the creation of a disease surveillance unit. The engagement of barangay leaders and use of existing community structures helped mobilize local resources and voluntary services for vector control. In one location, local authorities and the community were involved in the planning, implementation and evaluation of malaria control, which triggered local programme ownership. Conclusions Strategies that contributed to an improved efficiency and sustainability of vector control operations were: micro-stratification, integration of vector control within the health sector, a multi-disease approach, involvement of local authorities, and empowerment of communities. Capacity building on situational analysis and vector surveillance should be addressed through national policy and guidelines. PMID:22873707

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

PubMed

King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for health care, rather than specifics for the delivery of health care. 4 With the U.S. expenditures on health care producing inferior results, experts see consolidation and alternatives to fee-for-service as fundamental to reducing costs. 5 Integrating care coordination and delivery and increasing scale to drive efficiencies allows organizations to benefit from shared savings and relationships with payors and vendors. 6 Deloitte forecasts that, by 2024, the current health system landscape-which includes roughly 80 national health systems, 275 regional systems, 130 academic medical centers, and 1,300 small community systems-will morph into just over 900 multi-hospital systems. 7 Even though health care market and payment reforms encourage organizations to consolidate and integrate, innovators must proceed with extreme caution. Health care organizations attempting to drive efficiencies and bring down costs through mergers may run afoul of numerous federal and state laws and regulations. 8 Calls for updates or leniency in these laws are growing, including the possible recognition of an "Obamacare defense" to antitrust restrictions 9 and speculation that laws restricting physicians from having financial relationships will be repealed, ostensibly to allow sharing of the rewards reaped from coordinated care. 10 In the meantime, however, absent specific waivers or exemptions, all the usual rules and regulations apply, including antitrust constraints, 11 physician self-referral 12 and anti-kickback laws and regulations, 13 state fraud and abuse restrictions, 14 and more. In short, a maelstrom of conflicting political prescriptions, health care regulations, and antitrust restrictions undermine the ability of innovators to achieve efficiencies through joint ventures, transactions, innovative models, and other structures. This article first considers the conflicting positions taken by the United States government with respect to achieving efficiencies in health care under the ACA and alternative delivery models, on the one hand, and health care regulatory enforcement and antitrust enforcement, on the other. At almost a fifth of the U.S. economy, 15 health care arguably has grown ungovernable, exceeding the ability of any one law or branch of government to create or implement coherent reform. Indeed, the article posits that although the ACA reformed and expanded access to health care, it failed to transform the way health care is delivered beyond limited "demonstration projects", leaving fee-for-service intact. Nonetheless, even with limited rather than revolutionary goals, the ACA still lacks sufficient authority across disparate branches of government to achieve its stated goals. The article then examines the conflicting positions of the various United States regulatory schemes and enforcement agencies governing health care, and whether they can be reconciled with the stated goal of the government, often referred to as the "Triple Aim": 16 improving quality of care, improving population health, and lowering health care costs. It examines fundamental, systemic challenges to achieving the "Triple Aim": longstanding health care regulatory laws that impede adoption of innovative delivery systems beyond their current "demonstration project" status, and antitrust enforcement that promotes waste and duplication in densely populated areas, while preventing necessary consolidation to more efficiently reach rural areas. The article concludes with recommendations for promoting efficiency through modest reconciliation of the conflicting goals and regulations in health care.

Organizational climate, occupational stress, and employee mental health: mediating effects of organizational efficiency.

PubMed

Arnetz, Bengt B; Lucas, Todd; Arnetz, Judith E

2011-01-01

To determine whether the relationship between organizational climate and employee mental health is consistent (ie, invariant) or differs across four large hospitals, and whether organizational efficiency mediates this relationship. Participants (total N = 5316) completed validated measures of organizational climate variables (social climate, participatory management, goal clarity, and performance feedback), organizational efficiency, occupational stress, and mental health. Path analysis best supported a model in which organizational efficiency partially mediated relationships between organizational climate, occupational stress, and mental health. Focusing on improving both the psychosocial work environment and organizational efficiency might contribute to decreased employee stress, improved mental well-being, and organizational performance.

Using kaizen to improve employee well-being: Results from two organizational intervention studies.

PubMed

von Thiele Schwarz, Ulrica; Nielsen, Karina M; Stenfors-Hayes, Terese; Hasson, Henna

2017-08-01

Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions.

Using kaizen to improve employee well-being: Results from two organizational intervention studies

PubMed Central

von Thiele Schwarz, Ulrica; Nielsen, Karina M; Stenfors-Hayes, Terese; Hasson, Henna

2016-01-01

Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions. PMID:28736455

Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

PubMed Central

Magrath, Ian; Kingham, T. Peter; Elzawawy, Ahmed

2016-01-01

Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis. PMID:26578618

The Primary Mechanism of Cellular Internalization for a Short Cell- Penetrating Peptide as a Nano-Scale Delivery System.

PubMed

Liu, Betty R; Huang, Yue-Wern; Korivi, Mallikarjuna; Lo, Shih-Yen; Aronstam, Robert S; Lee, Han-Jung

2017-01-01

Development of effective drug delivery systems (DDS) is a critical issue in health care and medicine. Advances in molecular biology and nanotechnology have allowed the introduction of nanomaterial-based drug delivery systems. Cell-penetrating peptides (CPPs) can form the basis of drug delivery systems by virtue of their ability to support the transport of cargoes into the cell. Potential cargoes include proteins, DNA, RNA, liposomes, and nanomaterials. These cargoes generally retain their bioactivities upon entering cells. In the present study, the smallest, fully-active lactoferricin-derived CPP, L5a is used to demonstrate the primary contributor of cellular internalization. The secondary helical structure of L5a encompasses symmetrical positive charges around the periphery. The contributions of cell-specificity, peptide length, concentration, zeta potential, particle size, and spatial structure of the peptides were examined, but only zeta potential and spatial structure affected protein transduction efficiency. FITC-labeled L5a appeared to enter cells via direct membrane translocation insofar as endocytic modulators did not block FITC-L5a entry. This is the same mechanism of protein transduction active in Cy5 labeled DNA delivery mediated by FITC-L5a. A significant reduction of transduction efficiency was observed with structurally incomplete FITC-L5a formed by tryptic destruction, in which case the mechanism of internalization switched to a classical energydependent endocytosis pathway. These results support the continued development of the non-cytotoxic L5a as an efficient tool for drug delivery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Overcrowding and diversion in the emergency department: the health care safety net unravels.

PubMed

Velianoff, George D

2002-03-01

Emergency department overcrowding and diversion of patients are serious problems that are symptomatic of larger health care system issues. Downsizing, government regulations, managed care, increased numbers of uninsured, and reimbursement decreases are issues that have created the overcrowding and diversion issues. The Emergency Medical Treatment and Active Labor Act (EMTALA), poor operations and hospital processes, unavailable inpatient beds and closures, consolidations and workforce shortages are also contributors to the overcrowding and diversion issues. Options and solutions are proposed to alleviate the problem, however, greater collaboration, changed work environments, and reimbursement structures need to be developed and instituted. The safety net of the US health system is unraveling, and without intervention, the emergency department will not be able to provide services to the public at any level of quality and efficiency.

An empirical analysis of executive behaviour with hospital executive information systems in Taiwan.

PubMed

Huang, Wei-Min

2013-01-01

Existing health information systems largely only support the daily operations of a medical centre, and are unable to generate the information required by executives for decision-making. Building on past research concerning information retrieval behaviour and learning through mental models, this study examines the use of information systems by hospital executives in medical centres. It uses a structural equation model to help find ways hospital executives might use information systems more effectively. The results show that computer self-efficacy directly affects the maintenance of mental models, and that system characteristics directly impact learning styles and information retrieval behaviour. Other results include the significant impact of perceived environmental uncertainty on scan searches; information retrieval behaviour and focused searches on mental models and perceived efficiency; scan searches on mental model building; learning styles and model building on perceived efficiency; and finally the impact of mental model maintenance on perceived efficiency and effectiveness.

Rating health and stability of engineering structures via classification indexes of InSAR Persistent Scatterers

NASA Astrophysics Data System (ADS)

Pratesi, Fabio; Tapete, Deodato; Terenzi, Gloria; Del Ventisette, Chiara; Moretti, Sandro

2015-08-01

We propose a novel set of indexes to classify the information content of Persistent Scatterers (PS) and rate the health of engineering structures at urban to local scale. PS are automatically sampled and grouped via 'control areas' coinciding with the building and its surrounding environment. Density over the 'control areas' and velocity of PS are converted respectively into: Completeness of Information Index (Ici) that reflects the PS coverage grade; and Conservation Criticality Indexes (Icc) which rate the health condition of the monument separately for the object and surrounding control areas. The deformation pattern over the structure is classified as isolated (i) or diffused (d) based on the Velocity Distribution Index (Ivd). Both Ici and Icc are rated from A to E classes using a colour-coded system that intentionally emulates an energy-efficiency scale, to encourage the exploitation of PS by stakeholders and end-users in the practise of engineering surveying. Workability and reliability of the classification indexes are demonstrated over the urban heritage of Florence, Italy, using well established ERS-1/2 (1992-2000) descending, ENVISAT (2003-2010) ascending and descending PS datasets. The indexes are designed in perspective of handling outputs from InSAR processing of higher-resolution time series.

Habitats and Surface Construction Technology and Development Roadmap

NASA Technical Reports Server (NTRS)

Cohen, Marc; Kennedy, Kriss J.

1997-01-01

The vision of the technology and development teams at NASA Ames and Johnson Research Centers is to provide the capability for automated delivery and emplacement of habitats and surface facilities. The benefits of the program are as follows: Composites and Inflatables: 30-50% (goal) lighter than Al Hard Structures; Capability for Increased Habitable Volume, Launch Efficiency; Long Term Growth Potential; and Supports initiation of commercial and industrial expansion. Key Habitats and Surface Construction (H&SC) technology issues are: Habitat Shell Structural Materials; Seals and Mechanisms; Construction and Assembly: Automated Pro-Deploy Construction Systems; ISRU Soil/Construction Equipment: Lightweight and Lower Power Needs; Radiation Protection (Health and Human Performance Tech.); Life Support System (Regenerative Life Support System Tech.); Human Physiology of Long Duration Space Flight (Health and Human Performance Tech.); and Human Psychology of Long Duration Space Flight (Health and Human Performance Tech.) What is being done regarding these issues?: Use of composite materials for X-38 CRV, RLV, etc.; TransHAB inflatable habitat design/development; Japanese corporations working on ISRU-derived construction processes. What needs to be done for the 2004 Go Decision?: Characterize Mars Environmental Conditions: Civil Engineering, Material Durability, etc.; Determine Credibility of Inflatable Structures for Human Habitation; and Determine Seal Technology for Mechanisms and Hatches, Life Cycle, and Durability. An overview encompassing all of the issues above is presented.

Technical efficiency of women's health prevention programs in Bucaramanga, Colombia: a four-stage analysis.

PubMed

Ruiz-Rodriguez, Myriam; Rodriguez-Villamizar, Laura A; Heredia-Pi, Ileana

2016-10-13

Primary Health Care (PHC) is an efficient strategy to improve health outcomes in populations. Nevertheless, studies of technical efficiency in health care have focused on hospitals, with very little on primary health care centers. The objective of the present study was to use the Data Envelopment Analysis to estimate the technical efficiency of three women's health promotion and disease prevention programs offered by primary care centers in Bucaramanga, Colombia. Efficiency was measured using a four-stage data envelopment analysis with a series of Tobit regressions to account for the effect of quality outcomes and context variables. Input/output information was collected from the institutions' records, chart reviews and personal interviews. Information about contextual variables was obtained from databases from the primary health program in the municipality. A jackknife analysis was used to assess the robustness of the results. The analysis was based on data from 21 public primary health care centers. The average efficiency scores, after adjusting for quality and context, were 92.4 %, 97.5 % and 86.2 % for the antenatal care (ANC), early detection of cervical cancer (EDCC) and family planning (FP) programs, respectively. On each program, 12 of the 21 (57.1 %) health centers were found to be technically efficient; having had the best-practice frontiers. Adjusting for context variables changed the scores and reference rankings of the three programs offered by the health centers. The performance of the women's health prevention programs offered by the centers was found to be heterogeneous. Adjusting for context and health care quality variables had a significant effect on the technical efficiency scores and ranking. The results can serve as a guide to strengthen management and organizational and planning processes related to local primary care services operating within a market-based model such as the one in Colombia.

How Can Health System Efficiency Be Improved in Canada?

PubMed

Allin, Sara; Veillard, Jeremy; Wang, Li; Grignon, Michel

2015-08-01

Improving value for money in the health system is an often-stated policy goal. This study is the first to systematically measure the efficiency of health regions in Canada in producing health gains with their available resources, and to identify the factors that are associated with increased efficiency. Based on the objective elicited from decision-makers that the health system should ensure access to care for Canadians when they need it, we measured the efficiency with which regions reduce causes of death that are amenable to healthcare interventions using a linear programming approach (data envelopment analysis). Variations in efficiency were explained in part by public health factors, such as the prevalence of obesity and smoking in the population; in part by characteristics of the population, such as their average income; and in part by managerial factors, such as hospital readmissions. Copyright © 2015 Longwoods Publishing.

42 CFR 440.370 - Economy and efficiency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Economy and efficiency. 440.370 Section 440.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Benchmark Benefit and Benchmark-Equivalent Coverage § 440.370 Economy and efficiency....

Gold and Silver Health Plans: Accommodating Demand Heterogeneity in Managed Competition

PubMed Central

Glazer, Jacob; McGuire, Thomas G.

2011-01-01

New regulation of health insurance markets creates multiple levels of health plans, with designations like “Gold” and “Silver”. The underlying rationale for the heavy-metal approach to insurance regulation is that heterogeneity in demand for health care is not only due to health status (sick demand more than the healthy) but also to other, “taste” related factors (rich demand more than the poor). This paper models managed competition with demand heterogeneity to consider plan payment and enrollee premium policies in relation to efficiency (net consumer benefit) and fairness (the European concept of “solidarity”). Specifically, this paper studies how to implement a “Silver” and “Gold” health plan efficiently and fairly in a managed competition context. We show that there are sharp tradeoffs between efficiency and fairness. When health plans cannot or may not (because of regulation) base premiums on any factors affecting demand, enrollees do not choose the efficient plan. When taste (e.g. income) can be used as a basis of payment, a simple tax can achieve both efficiency and fairness. When only health status (and not taste) can be used as a basis of payment, health status-based taxes and subsidies are required and efficiency can only be achieved with a modified version of fairness we refer to as “weak solidarity.” An overriding conclusion is that the regulation of premiums for both the basic and the higher level plans is necessary for efficiency. PMID:21767887

The German Energiewende-a matter for health?

PubMed

Sutcliffe, Robynne; Orban, Ester; McDonald, Kelsey; Moebus, Susanne

2016-08-01

Germany's enormous transformation away from nuclear energy and fossil fuels towards a renewable and energy efficient system-called the Energiewende-is playing an essential role in Germany's economy and policymaking. This article summarises the current knowledge on possible health impacts of the Energiewende and describes the need and opportunities to incorporate health into energy-related policy. A structural model helped to narrow down specific topics and to conceptualise links between the Energiewende, the environment and health. A comprehensive literature search was conducted within policy documents and scientific databases with English and German language selections. Of 7800 publications first identified only 46 explicitly related energy measures to health, of which 40 were grey literature. Notably, only 12% published by health authorities all others were issued by environmental, energy or consumer protection agencies, ministries or institutions. Our study shows that health impacts of the German Energiewende are rarely explicitly addressed. An integration of a health perspective into energy-related policy is needed including the involvement of public health authorities. A health impact assessment can be a suitable tool to support and evaluate Energiewende-related developments from a health perspective. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Using a Qualitative Vignette to Explore a Complex Public Health Issue.

PubMed

Jackson, Michaela; Harrison, Paul; Swinburn, Boyd; Lawrence, Mark

2015-10-01

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique. © The Author(s) 2015.

Health systems: changes in hospital efficiency and profitability.

PubMed

Büchner, Vera Antonia; Hinz, Vera; Schreyögg, Jonas

2016-06-01

This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.

The Impact of Education on Health Knowledge

ERIC Educational Resources Information Center

Altindag, Duha; Cannonier, Colin; Mocan, Naci

2011-01-01

The theory on the demand for health suggests that schooling causes health because schooling increases the efficiency of health production. Alternatively, the allocative efficiency hypothesis argues that schooling alters the input mix chosen to produce health. This suggests that the more educated have more knowledge about the health production…

Coordination as a best practice from the polio eradication initiative: Experiences from five member states in the African region of the World Health Organization.

PubMed

Okeibunor, Joseph; Nsubuga, Peter; Salla, Mbaye; Mihigo, Richard; Mkanda, Pascal

2016-10-10

As part of the efforts to eradicate polioviruses in the African Region, structures were put in place to ensure coordinated mobilization and deployment of resources within the framework of the global polio eradication initiative (PEI). The successes of these structures made them not only attractive to other public health interventions, but also caused them to be deployed to the response efforts of other diseases interventions, without any systematic documentation. This article documents the contributions of PEI coordination units to other public health interventions in the African Region of World Health Organization METHODS: We reviewed the contributions of PEI coordination units to other public health interventions in five countries in the African Region. The analysis identified significant involvement of PEI coordination structures in the implementation of routine immunization programs in all the countries analyzed. Similarly, maternal and child health programs were planned, implemented, monitored and evaluation the Inter-Agency Coordination Committees of the PEI programs in the different countries. The hubs system used in PEI in Chad facilitated the efficient coordination of resources for immunization and other public health interventions in Chad. Similarly, in the Democratic Republic of Congo PEI led coordination activities benefited other public health programs like disease control and the national nutrition program, the national malaria control program, and the tuberculosis control program. In Nigeria, the polio Expert Review Committee effectively deployed the Emergency Operation Center for the implementation of prioritized strategies and activities of the National Polio Eradication Emergency Plan, and it was utilized in the response to Ebola Virus Disease outbreak in the country. The PEI-led coordination systems are thus recognized as having made significant contribution to the coordination and delivery of other public health interventions in the African Region. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Frequency Response Function Based Damage Identification for Aerospace Structures

NASA Astrophysics Data System (ADS)

Oliver, Joseph Acton

Structural health monitoring technologies continue to be pursued for aerospace structures in the interests of increased safety and, when combined with health prognosis, efficiency in life-cycle management. The current dissertation develops and validates damage identification technology as a critical component for structural health monitoring of aerospace structures and, in particular, composite unmanned aerial vehicles. The primary innovation is a statistical least-squares damage identification algorithm based in concepts of parameter estimation and model update. The algorithm uses frequency response function based residual force vectors derived from distributed vibration measurements to update a structural finite element model through statistically weighted least-squares minimization producing location and quantification of the damage, estimation uncertainty, and an updated model. Advantages compared to other approaches include robust applicability to systems which are heavily damped, large, and noisy, with a relatively low number of distributed measurement points compared to the number of analytical degrees-of-freedom of an associated analytical structural model (e.g., modal finite element model). Motivation, research objectives, and a dissertation summary are discussed in Chapter 1 followed by a literature review in Chapter 2. Chapter 3 gives background theory and the damage identification algorithm derivation followed by a study of fundamental algorithm behavior on a two degree-of-freedom mass-spring system with generalized damping. Chapter 4 investigates the impact of noise then successfully proves the algorithm against competing methods using an analytical eight degree-of-freedom mass-spring system with non-proportional structural damping. Chapter 5 extends use of the algorithm to finite element models, including solutions for numerical issues, approaches for modeling damping approximately in reduced coordinates, and analytical validation using a composite sandwich plate model. Chapter 6 presents the final extension to experimental systems-including methods for initial baseline correlation and data reduction-and validates the algorithm on an experimental composite plate with impact damage. The final chapter deviates from development and validation of the primary algorithm to discuss development of an experimental scaled-wing test bed as part of a collaborative effort for developing structural health monitoring and prognosis technology. The dissertation concludes with an overview of technical conclusions and recommendations for future work.

PPP insights in South Africa.

PubMed

du Toit, Japie

2003-01-01

After functioning for some time in an increasingly regulated and structured environment in dealing with the private sector in South Africa, it was important to Government, to carefully review the terminology used in this evolving playing field. As the definitions and mechanisms impacting on this form of interaction became clear, it was essential to find a broader definition to encompass all forms of commercial intervention between the two sectors. In preparation for the first South African National Health Summit during 2001, the term public private interaction became a general term used in this context. In the South African healthcare sectors this term is used specifically to indicate that all forms of interaction between the two sectors should be considered, rather than merely focussing on specific Public Private Partnerships (PPPs), that have a much more narrow definition. Recent health policy documents in South Africa all stress four key goals--equity, coherence, quality of care and efficiency--which provide a useful basis for decision-making about PPIs. The range of public-private interactions that may support or constrain the South African health system's development are set within the overall public/private mix of the country. In developing an equitable, efficient, coherent and high quality health system in South Africa, there is considerable potential for constructive engagement (collaboration and co-operation) between the public and the private health care sectors. Both sectors should embrace this opportunity and therefore it is useful to propose some basic guidelines for engagement based on the vision and goals of the national health system. In deciding whether or not to pursue any new PPI within the health sector, or in evaluating whether an existing PPI should continue or be revised, it is necessary to assess its merits in relation to the achievement of health system goals.

[Technical efficiency in primary care for patients with diabetes].

PubMed

Salinas-Martínez, Ana María; Amaya-Alemán, María Agustina; Arteaga-García, Julio César; Núñez-Rocha, Georgina Mayela; Garza-Elizondo, María Eugenia

2009-01-01

To quantify the technical efficiency of diabetes care in family practice settings, characterize the provision of services and health results, and recognize potential sources of variation. We used data envelopment analysis with inputs and outputs for diabetes care from 47 family units within a social security agency in Nuevo Leon. Tobit regression models were also used. Seven units were technically efficient in providing services and nine in achieving health goals. Only two achieved both outcomes. The metropolitan location and the total number of consultations favored efficiency in the provision of services regardless of patient attributes; and the age of the doctor, the efficiency of health results. Performance varied within and among family units; some were efficient at providing services while others at accomplishing health goals. Sources of variation also differed. It is necessary to include both outputs in the study of efficiency of diabetes care in family practice settings.

Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

PubMed

Kaplan, Avril D; Dominis, Sarah; Palen, John Gh; Quain, Estelle E

2013-02-15

Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance. The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers. The breadth of challenges facing the health workforce requires strengthening health governance as well as human resource systems in order to effect change in the health system. Further research into the effectiveness of specific interventions that enhance the link between the health workforce and governance are warranted to determine approaches to strengthening the health system.

Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

PubMed Central

2013-01-01

Background Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. Methods This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance. Results/discussion The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers. Conclusions The breadth of challenges facing the health workforce requires strengthening health governance as well as human resource systems in order to effect change in the health system. Further research into the effectiveness of specific interventions that enhance the link between the health workforce and governance are warranted to determine approaches to strengthening the health system. PMID:23414237

Analyzing whether countries are equally efficient at improving longevity for men and women.

PubMed

Barthold, Douglas; Nandi, Arijit; Mendoza Rodríguez, José M; Heymann, Jody

2014-11-01

We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems.

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis.

PubMed

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-05

Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. The study focused on all 72 health districts of Zambia. We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Barriers and facilitators to health care coordination in two integrated health care organizations in Catalonia (Spain)].

PubMed

Vargas Lorenzo, Ingrid; Vázquez Navarrete, M Luisa

2007-01-01

To analyze 2 integrated delivery systems (IDS) in Catalonia and identify areas for future development to improve their effectiveness. An exploratory, descriptive, qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews. A criterion sample of cases and, for each case, of documents and informants was selected. Study cases consisted of the Consorci Sanitari del Maresme (CSdM) and the Consorci Sanitari de Terrassa/Fundació Hospital Sant Llàtzer (FHSLL). A total of 127 documents were analyzed and 29 informants were interviewed: IDS managers (n = 10), technical staff (n = 5), operational unit managers (n = 5) and health professionals (n = 9). Content analysis was conducted, with mixed generation of categories and segmentation by cases and subjects. CSdM and CSdT/FHSLL are health care organizations with backward vertical integration, total services production, and real (CSdM) and virtual (CSdT/FHSLL) ownership. Funds are allocated by care level. The governing body is centralized in CSdM and decentralized in CSdT/FHSLL. In both organizations, the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units. Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization. Both IDS present facilitators and barriers to health care coordination. To improve coordination, changes in external elements (payment mechanism) and in internal elements (governing body role, organizational structure and coordination mechanisms) are required.

Health Literacy in Orthopaedic Trauma Patients.

PubMed

Cosic, Filip; Kimmel, Lara; Edwards, Elton

2017-03-01

This study aimed to determine the level of health literacy in a postoperative orthopaedic trauma population and to evaluate the efficacy of a simple predischarge discussion strategy, targeted at improving health literacy. A pre-post intervention study was conducted from April 2014 to January 2015. Academic Level 1 trauma center. One hundred ninety consecutive orthopaedic trauma patients with operatively managed lower limb fractures were recruited. All eligible participants agreed to participate. The first ninety-nine patients received usual care (UC). The following 91 patients received a structured predischarge discussion, including x-rays, written and verbal information, from the orthopaedic staff (DG). Patients were then randomized into health literacy evaluation before first outpatient review or after first outpatient review. The primary outcome measure was a questionnaire determining health literacy. Ninety-six (97%) of the UC patients and 87 (96%) of the discussion patients (DG) completed the interview. UC preoutpatient (n = 46) demonstrated a mean score of 4.67 of a maximum 8. UC postoutpatient (n = 50) demonstrated a mean score of 5.42. DG preoutpatient (n = 47) demonstrated a mean score of 6.70. DG postoutpatient (n = 40) demonstrated a mean score of 7.08. Australian orthopaedic trauma patients demonstrate poor health literacy, with this not showing improvement after their first outpatient follow-up visit. The use of a time efficient, structured predischarge discussion improved patient health literacy. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Building a diabetes screening population data repository using electronic medical records.

PubMed

Tuan, Wen-Jan; Sheehy, Ann M; Smith, Maureen A

2011-05-01

There has been a rapid advancement of information technology in the area of clinical and population health data management since 2000. However, with the fast growth of electronic medical records (EMRs) and the increasing complexity of information systems, it has become challenging for researchers to effectively access, locate, extract, and analyze information critical to their research. This article introduces an outpatient encounter data framework designed to construct an EMR-based population data repository for diabetes screening research. The outpatient encounter data framework is developed on a hybrid data structure of entity-attribute-value models, dimensional models, and relational models. This design preserves a small number of subject-specific tables essential to key clinical constructs in the data repository. It enables atomic information to be maintained in a transparent and meaningful way to researchers and health care practitioners who need to access data and still achieve the same performance level as conventional data warehouse models. A six-layer information processing strategy is developed to extract and transform EMRs to the research data repository. The data structure also complies with both Health Insurance Portability and Accountability Act regulations and the institutional review board's requirements. Although developed for diabetes screening research, the design of the outpatient encounter data framework is suitable for other types of health service research. It may also provide organizations a tool to improve health care quality and efficiency, consistent with the "meaningful use" objectives of the Health Information Technology for Economic and Clinical Health Act. © 2011 Diabetes Technology Society.

Commentary: Sense and sensibility: the role of specialists in health care reform.

PubMed

Schwann, Nanette M; Nester, Brian A; McLoughlin, Thomas M

2012-03-01

How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.

Structural and kinetic analysis of the unnatural fusion protein 4-coumaroyl-CoA ligase::stilbene synthase

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Yechun; Yi, Hankuil; Wang, Melissa

2012-10-24

To increase the biochemical efficiency of biosynthetic systems, metabolic engineers have explored different approaches for organizing enzymes, including the generation of unnatural fusion proteins. Previous work aimed at improving the biosynthesis of resveratrol, a stilbene associated a range of health-promoting activities, in yeast used an unnatural engineered fusion protein of Arabidopsis thaliana (thale cress) 4-coumaroyl-CoA ligase (At4CL1) and Vitis vinifera (grape) stilbene synthase (VvSTS) to increase resveratrol levels 15-fold relative to yeast expressing the individual enzymes. Here we present the crystallographic and biochemical analysis of the 4CL::STS fusion protein. Determination of the X-ray crystal structure of 4CL::STS provides the firstmore » molecular view of an artificial didomain adenylation/ketosynthase fusion protein. Comparison of the steady-state kinetic properties of At4CL1, VvSTS, and 4CL::STS demonstrates that the fusion protein improves catalytic efficiency of either reaction less than 3-fold. Structural and kinetic analysis suggests that colocalization of the two enzyme active sites within 70 {angstrom} of each other provides the basis for enhanced in vivo synthesis of resveratrol.« less

Efficiency of Health Care Production in Low-Resource Settings: A Monte-Carlo Simulation to Compare the Performance of Data Envelopment Analysis, Stochastic Distance Functions, and an Ensemble Model

PubMed Central

Giorgio, Laura Di; Flaxman, Abraham D.; Moses, Mark W.; Fullman, Nancy; Hanlon, Michael; Conner, Ruben O.; Wollum, Alexandra; Murray, Christopher J. L.

2016-01-01

Low-resource countries can greatly benefit from even small increases in efficiency of health service provision, supporting a strong case to measure and pursue efficiency improvement in low- and middle-income countries (LMICs). However, the knowledge base concerning efficiency measurement remains scarce for these contexts. This study shows that current estimation approaches may not be well suited to measure technical efficiency in LMICs and offers an alternative approach for efficiency measurement in these settings. We developed a simulation environment which reproduces the characteristics of health service production in LMICs, and evaluated the performance of Data Envelopment Analysis (DEA) and Stochastic Distance Function (SDF) for assessing efficiency. We found that an ensemble approach (ENS) combining efficiency estimates from a restricted version of DEA (rDEA) and restricted SDF (rSDF) is the preferable method across a range of scenarios. This is the first study to analyze efficiency measurement in a simulation setting for LMICs. Our findings aim to heighten the validity and reliability of efficiency analyses in LMICs, and thus inform policy dialogues about improving the efficiency of health service production in these settings. PMID:26812685

Energy-efficient digital and wireless IC design for wireless smart sensing

NASA Astrophysics Data System (ADS)

Zhou, Jun; Huang, Xiongchuan; Wang, Chao; Tae-Hyoung Kim, Tony; Lian, Yong

2017-10-01

Wireless smart sensing is now widely used in various applications such as health monitoring and structural monitoring. In conventional wireless sensor nodes, significant power is consumed in wirelessly transmitting the raw data. Smart sensing adds local intelligence to the sensor node and reduces the amount of wireless data transmission via on-node digital signal processing. While the total power consumption is reduced compared to conventional wireless sensing, the power consumption of the digital processing becomes as dominant as wireless data transmission. This paper reviews the state-of-the-art energy-efficient digital and wireless IC design techniques for reducing the power consumption of the wireless smart sensor node to prolong battery life and enable self-powered applications.

Analysis of changes in cancer health care system in Poland since the socio-economic transformation in 1989

PubMed

Dudek-Godeau, Dorota; Kieszkowska-Grudny, Anna; Kwiatkowska, Katarzyna; Bogusz, Joanna; Wysocki, Mirosław J; Bielska-Lasota, Magdalena

The transformation period in Poland is associated with a set of factors seen as ‘socio-economic stress’, which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90’s. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project. Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989. This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations. The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the ’Quick Oncological Therapy’ together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN. (1) ‘Socio-economic’ stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.

Marginal Structural Models with Counterfactual Effect Modifiers.

PubMed

Zheng, Wenjing; Luo, Zhehui; van der Laan, Mark J

2018-06-08

In health and social sciences, research questions often involve systematic assessment of the modification of treatment causal effect by patient characteristics. In longitudinal settings, time-varying or post-intervention effect modifiers are also of interest. In this work, we investigate the robust and efficient estimation of the Counterfactual-History-Adjusted Marginal Structural Model (van der Laan MJ, Petersen M. Statistical learning of origin-specific statically optimal individualized treatment rules. Int J Biostat. 2007;3), which models the conditional intervention-specific mean outcome given a counterfactual modifier history in an ideal experiment. We establish the semiparametric efficiency theory for these models, and present a substitution-based, semiparametric efficient and doubly robust estimator using the targeted maximum likelihood estimation methodology (TMLE, e.g. van der Laan MJ, Rubin DB. Targeted maximum likelihood learning. Int J Biostat. 2006;2, van der Laan MJ, Rose S. Targeted learning: causal inference for observational and experimental data, 1st ed. Springer Series in Statistics. Springer, 2011). To facilitate implementation in applications where the effect modifier is high dimensional, our third contribution is a projected influence function (and the corresponding projected TMLE estimator), which retains most of the robustness of its efficient peer and can be easily implemented in applications where the use of the efficient influence function becomes taxing. We compare the projected TMLE estimator with an Inverse Probability of Treatment Weighted estimator (e.g. Robins JM. Marginal structural models. In: Proceedings of the American Statistical Association. Section on Bayesian Statistical Science, 1-10. 1997a, Hernan MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. 2000;11:561-570), and a non-targeted G-computation estimator (Robins JM. A new approach to causal inference in mortality studies with sustained exposure periods - application to control of the healthy worker survivor effect. Math Modell. 1986;7:1393-1512.). The comparative performance of these estimators is assessed in a simulation study. The use of the projected TMLE estimator is illustrated in a secondary data analysis for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial where effect modifiers are subject to missing at random.

The Impact of Education on Health Knowledge. NBER Working Paper No. 16422

ERIC Educational Resources Information Center

Altindag, Duha Tore; Cannonier, Colin; Mocan, Naci H.

2010-01-01

The theory on the demand for health suggests that schooling causes health because schooling increases the efficiency of health production. Alternatively, the allocative efficiency hypothesis argues that schooling alters the input mix chosen to produce health. This suggests that the more educated have more knowledge about the health production…

Network influences on dissemination of evidence-based guidelines in state tobacco control programs.

PubMed

Luke, Douglas A; Wald, Lana M; Carothers, Bobbi J; Bach, Laura E; Harris, Jenine K

2013-10-01

Little is known regarding the social network relationships that influence dissemination of evidence-based public health practices and policies. In public health, it is critical that evidence-based guidelines, such as the Centers for Disease Control and Prevention's Best Practices for Comprehensive Tobacco Control Programs, are effectively and efficiently disseminated to intended stakeholders. To determine the organizational and network predictors of dissemination among state tobacco control programs, interviews with members of tobacco control networks across eight states were conducted between August 2009 and September 2010. Measures included partner attributes (e.g., agency type) and relationships among network members (frequency of contact, extent of collaboration, and dissemination of Best Practices). Exponential random graph modeling was used to examine attribute and structural predictors of collaboration and dissemination among partners in each network. Although density and centralization of dissemination ties varied across states, network analyses revealed a consistent prediction pattern across all eight states. State tobacco control dissemination networks were less dense but more centralized compared with organizational contact and collaboration networks. Tobacco control partners in each state were more likely to disseminate the Best Practices guidelines if they also had existing contact and collaboration relationships with one another. Evidence-based guidelines in public health need to be efficiently and broadly disseminated if we hope to translate science into practice. This study suggests that funders, advocacy groups, and public health agencies can take advantage of existing public health organizational relationships to support the communication and dissemination of evidence-based practices and policies.

The Chronic Care Model as vehicle for the development of disease management in Europe

PubMed Central

Spreeuwenberg, Cor

2008-01-01

The Chronic Care Model (Wagner, WHO) aims to improve the functioning and clinical situation of chronic patients by focussing on the patient, the practice team and the conditions that determine the functioning of the team. The patient is the most important actor who must be stimulated proactively by a competent, integrated practice team. Six interdependent conditional components are essential: health care organisation, delivery system design, community resources and policies, self-management support systems, decision support and clinical information systems. While the Chronic Care Model focuses on quality and effectiveness of care, disease management programmes underline more the efficiency of care. These programmes apply industrial management principles in health care. Information about process, structure and outcome is gathered and used systematically and human and material sources are used efficiently. There is evidence that the approaches of the Chronic Care Model and disease management can be integrated. Both approaches underline the need of information and focus on the patient as the main actor to improve and that a balance can be found between effectiveness and efficiency. Ideas will be given how the Chronic Care Model can be used as a framework for the development of a European way of disease management for people with a chronic condition.

Dynamic Creation of Social Networks for Syndromic Surveillance Using Information Fusion

NASA Astrophysics Data System (ADS)

Holsopple, Jared; Yang, Shanchieh; Sudit, Moises; Stotz, Adam

To enhance the effectiveness of health care, many medical institutions have started transitioning to electronic health and medical records and sharing these records between institutions. The large amount of complex and diverse data makes it difficult to identify and track relationships and trends, such as disease outbreaks, from the data points. INFERD: Information Fusion Engine for Real-Time Decision-Making is an information fusion tool that dynamically correlates and tracks event progressions. This paper presents a methodology that utilizes the efficient and flexible structure of INFERD to create social networks representing progressions of disease outbreaks. Individual symptoms are treated as features allowing multiple hypothesis being tracked and analyzed for effective and comprehensive syndromic surveillance.

Experimental Investigations on Effect of Damage on Vibration Characteristics of a Reinforced Concrete Beam

NASA Astrophysics Data System (ADS)

Srinivas, V.; Jeyasehar, C. Antony; Ramanjaneyulu, K.; Sasmal, Saptarshi

2012-02-01

Need for developing efficient non-destructive damage assessment procedures for civil engineering structures is growing rapidly towards structural health assessment and management of existing structures. Damage assessment of structures by monitoring changes in the dynamic properties or response of the structure has received considerable attention in recent years. In the present study, damage assessment studies have been carried out on a reinforced concrete beam by evaluating the changes in vibration characteristics with the changes in damage levels. Structural damage is introduced by static load applied through a hydraulic jack. After each stage of damage, vibration testing is performed and system parameters were evaluated from the measured acceleration and displacement responses. Reduction in fundamental frequencies in first three modes is observed for different levels of damage. It is found that a consistent decrease in fundamental frequency with increase in damage magnitude is noted. The beam is numerically simulated and found that the vibration characteristics obtained from the measured data are in close agreement with the numerical data.

A Bayesian Approach for Evaluation of Determinants of Health System Efficiency Using Stochastic Frontier Analysis and Beta Regression.

PubMed

Şenel, Talat; Cengiz, Mehmet Ali

2016-01-01

In today's world, Public expenditures on health are one of the most important issues for governments. These increased expenditures are putting pressure on public budgets. Therefore, health policy makers have focused on the performance of their health systems and many countries have introduced reforms to improve the performance of their health systems. This study investigates the most important determinants of healthcare efficiency for OECD countries using second stage approach for Bayesian Stochastic Frontier Analysis (BSFA). There are two steps in this study. First we measure 29 OECD countries' healthcare efficiency by BSFA using the data from the OECD Health Database. At second stage, we expose the multiple relationships between the healthcare efficiency and characteristics of healthcare systems across OECD countries using Bayesian beta regression.

Achieving Mental Health Care Parity Might Require Changes In Payments And Competition.

PubMed

McGuire, Thomas G

2016-06-01

One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. "Better enforcement" of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured. Project HOPE—The People-to-People Health Foundation, Inc.

Product policy - the main component of the marketing mix in the Romanian health services.

PubMed

Coculescu, B I; Purcarea, V L; Coculescu, E C

2016-01-01

The objectives of the reforms in the EU healthcare systems are based on the implementation of the marketing concept in the health systems, which are, among other things: • efficient management of the financial resources and control costs of the rendered health services; • increased satisfaction of the clients of health care services; • broad accessibility to health services; • effective implementation of modern technologies; • rational stimulation of medical services consumption; • achievement of a fair and neutral competition between the public/ private providers and health insurance companies; • introduction of performance criteria in order to increase the incomes of the medical staff and hierarchy in hospitals; • implementation of modern management methods in health services management; • decentralization of the public healthcare system. Product policy in the medical system of healthcare - the most important component of the marketing mix - is the attitude that addresses a medical organization to the volume, structure, and diversity of services subject to their own activities in relation to the requirements of the services market and the competitive actions of other medical institutions.

Product policy - the main component of the marketing mix in the Romanian health services

PubMed Central

Coculescu, BI; Purcarea, VL; Coculescu, EC

2016-01-01

The objectives of the reforms in the EU healthcare systems are based on the implementation of the marketing concept in the health systems, which are, among other things: • efficient management of the financial resources and control costs of the rendered health services; • increased satisfaction of the clients of health care services; • broad accessibility to health services; • effective implementation of modern technologies; • rational stimulation of medical services consumption; • achievement of a fair and neutral competition between the public/ private providers and health insurance companies; • introduction of performance criteria in order to increase the incomes of the medical staff and hierarchy in hospitals; • implementation of modern management methods in health services management; • decentralization of the public healthcare system. Product policy in the medical system of healthcare - the most important component of the marketing mix - is the attitude that addresses a medical organization to the volume, structure, and diversity of services subject to their own activities in relation to the requirements of the services market and the competitive actions of other medical institutions. PMID:27974913

The production and use of evidence in health care service innovation: a qualitative study.

PubMed

Vasileiou, Konstantina; Barnett, Julie; Young, Terry

2013-03-01

The focus of this article is on a range of concepts of evidence employed by health care innovators in pursuing service innovations and in demonstrating their success. In-depth, semi-structured interviews were conducted with 18 key informants in the United Kingdom who had won Health Service Journal awards for successfully implementing 15 service innovations. Four concepts of evidence were identified: (a) evidence of effectiveness-both direct and indirect, (b) evidence of efficiency, (c) evidence of innovation acceptance, and (d) evidence of relevance. The results suggest that the innovators articulated evidential concepts from the main approaches prevailing in the British National Health Service, namely clinical trials and improvement cycles. Most aspired to "better" evidence than they were able to obtain, while the approach to evidence gathering was very pragmatic and was more aligned with the improvement-cycle framework. Developing supporting mechanisms for assisting innovation evaluation is an important challenge if service innovation is to be routinely attempted and achieved in health care.

Benefit design innovations: implications for consumer-directed health care.

PubMed

Tu, Ha T; Ginsburg, Paul B

2007-02-01

Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rapidly rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a new study by the Center for Studying Health System Change (HSC). Innovative benefit designs include incentives to encourage healthy behaviors; incentives that vary by service type, patient condition or enrollee income; and incentives to use efficient providers. But most applications of these innovative designs are not widespread, suggesting that any significant cost impact is many years off. Moreover, regulations governing high-deductible, consumer-directed health plans eligible for health savings accounts (HSAs) preclude some promising benefit design innovations and dilute the incentives in others. A movement away from a one-size-fits-all HSA benefit structure toward a more flexible design might broaden the appeal of HSA plans and enable them to incorporate features that promote cost-effective care.

How Connecticut health directors deal with public health budget cuts at the local level.

PubMed

Prust, Margaret L; Clark, Kathleen; Davis, Brigette; Pallas, Sarah W; Kertanis, Jennifer; O'Keefe, Elaine; Araas, Michael; Iyer, Neel S; Dandorf, Stewart; Platis, Stephanie; Humphries, Debbie

2015-04-01

We investigated the perspectives of local health jurisdiction (LHJ) directors on coping mechanisms used to respond to budget reductions and constraints on their decision-making. We conducted in-depth interviews with 17 LHJ directors. Interviews were audio recorded, transcribed, and analyzed using the constant comparative method. LHJ directors use a range of coping mechanisms, including identifying alternative revenue sources, adjusting services, amending staffing arrangements, appealing to local political leaders, and forming strategic partnerships. LHJs also face constraints on their decision-making because of state and local statutory requirements, political priorities, pressures from other LHJs, and LHJ structure. LHJs respond creatively to budget cuts to maintain important public health services. Some LHJ adjustments to administrative resources may obscure the long-term costs of public health budget cuts in such areas as staff morale and turnover. Not all coping strategies are available to each LHJ because of the contextual constraints of its locality, pointing to important policy questions on identifying optimum jurisdiction size and improving efficiency.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

PubMed Central

Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity. PMID:28058199

A multiscale model of placental oxygen exchange: The effect of villous tree structure on exchange efficiency.

PubMed

Lin, Mabelle; Mauroy, Benjamin; James, Joanna L; Tawhai, Merryn H; Clark, Alys R

2016-11-07

The placenta is critical to fetal health during pregnancy as it supplies oxygen and nutrients to maintain life. It has a complex structure, and alterations to this structure across spatial scales are associated with several pregnancy complications, including intrauterine growth restriction (IUGR). The relationship between placental structure and its efficiency as an oxygen exchanger is not well understood in normal or pathological pregnancies. Here we present a computational framework that predicts oxygen transport in the placenta which accounts for blood and oxygen transport in the space around a placental functional unit (the villous tree). The model includes the well-defined branching structure of the largest villous tree branches, as well as a smoothed representation of the small terminal villi that comprise the placenta's gas exchange interfaces. The model demonstrates that oxygen exchange is sensitive to villous tree geometry, including the villous branch length and volume, which are seen to change in IUGR. This is because, to be an efficient exchanger, the architecture of the villous tree must provide a balance between maximising the surface area available for exchange, and the opposing condition of allowing sufficient maternal blood flow to penetrate into the space surrounding the tree. The model also predicts an optimum oxygen exchange when the branch angle is 24 °, as villous branches and TBs are spread out sufficiently to channel maternal blood flow deep into the placental tissue for oxygen exchange without being shunted directly into the DVs. Without concurrent change in the branch length and angles, the model predicts that the number of branching generations has a small influence on oxygen exchange. The modelling framework is presented in 2D for simplicity but is extendible to 3D or to incorporate the high-resolution imaging data that is currently evolving to better quantify placental structure. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Political Economy of Health Co-Benefits: Embedding Health in the Climate Change Agenda.

PubMed

Workman, Annabelle; Blashki, Grant; Bowen, Kathryn J; Karoly, David J; Wiseman, John

2018-04-04

A complex, whole-of-economy issue such as climate change demands an interdisciplinary, multi-sectoral response. However, evidence suggests that human health has remained elusive in its influence on the development of ambitious climate change mitigation policies for many national governments, despite a recognition that the combustion of fossil fuels results in pervasive short- and long-term health consequences. We use insights from literature on the political economy of health and climate change, the science–policy interface and power in policy-making, to identify additional barriers to the meaningful incorporation of health co-benefits into climate change mitigation policy development. Specifically, we identify four key interrelated areas where barriers may exist in relation to health co-benefits: discourse, efficiency, vested interests and structural challenges. With these insights in mind, we argue that the current politico-economic paradigm in which climate change is situated and the processes used to develop climate change mitigation policies do not adequately support accounting for health co-benefits. We present approaches for enhancing the role of health co-benefits in the development of climate change mitigation policies to ensure that health is embedded in the broader climate change agenda.

The Political Economy of Health Co-Benefits: Embedding Health in the Climate Change Agenda

PubMed Central

Workman, Annabelle; Blashki, Grant; Bowen, Kathryn J.; Karoly, David J.; Wiseman, John

2018-01-01

A complex, whole-of-economy issue such as climate change demands an interdisciplinary, multi-sectoral response. However, evidence suggests that human health has remained elusive in its influence on the development of ambitious climate change mitigation policies for many national governments, despite a recognition that the combustion of fossil fuels results in pervasive short- and long-term health consequences. We use insights from literature on the political economy of health and climate change, the science–policy interface and power in policy-making, to identify additional barriers to the meaningful incorporation of health co-benefits into climate change mitigation policy development. Specifically, we identify four key interrelated areas where barriers may exist in relation to health co-benefits: discourse, efficiency, vested interests and structural challenges. With these insights in mind, we argue that the current politico-economic paradigm in which climate change is situated and the processes used to develop climate change mitigation policies do not adequately support accounting for health co-benefits. We present approaches for enhancing the role of health co-benefits in the development of climate change mitigation policies to ensure that health is embedded in the broader climate change agenda. PMID:29617317

Data driven innovations in structural health monitoring

NASA Astrophysics Data System (ADS)

Rosales, M. J.; Liyanapathirana, R.

2017-05-01

At present, substantial investments are being allocated to civil infrastructures also considered as valuable assets at a national or global scale. Structural Health Monitoring (SHM) is an indispensable tool required to ensure the performance and safety of these structures based on measured response parameters. The research to date on damage assessment has tended to focus on the utilization of wireless sensor networks (WSN) as it proves to be the best alternative over the traditional visual inspections and tethered or wired counterparts. Over the last decade, the structural health and behaviour of innumerable infrastructure has been measured and evaluated owing to several successful ventures of implementing these sensor networks. Various monitoring systems have the capability to rapidly transmit, measure, and store large capacities of data. The amount of data collected from these networks have eventually been unmanageable which paved the way to other relevant issues such as data quality, relevance, re-use, and decision support. There is an increasing need to integrate new technologies in order to automate the evaluation processes as well as to enhance the objectivity of data assessment routines. This paper aims to identify feasible methodologies towards the application of time-series analysis techniques to judiciously exploit the vast amount of readily available as well as the upcoming data resources. It continues the momentum of a greater effort to collect and archive SHM approaches that will serve as data-driven innovations for the assessment of damage through efficient algorithms and data analytics.

Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

PubMed Central

Varga, Leah M.; Surratt, Hilary L.

2014-01-01

Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

Development of a Health Information Technology Acceptance Model Using Consumers’ Health Behavior Intention

PubMed Central

2012-01-01

Background For effective health promotion using health information technology (HIT), it is mandatory that health consumers have the behavioral intention to measure, store, and manage their own health data. Understanding health consumers’ intention and behavior is needed to develop and implement effective and efficient strategies. Objective To develop and verify the extended Technology Acceptance Model (TAM) in health care by describing health consumers’ behavioral intention of using HIT. Methods This study used a cross-sectional descriptive correlational design. We extended TAM by adding more antecedents and mediating variables to enhance the model’s explanatory power and to make it more applicable to health consumers’ behavioral intention. Additional antecedents and mediating variables were added to the hypothetical model, based on their theoretical relevance, from the Health Belief Model and theory of planned behavior, along with the TAM. We undertook structural equation analysis to examine the specific nature of the relationship involved in understanding consumers’ use of HIT. Study participants were 728 members recruited from three Internet health portals in Korea. Data were collected by a Web-based survey using a structured self-administered questionnaire. Results The overall fitness indices for the model developed in this study indicated an acceptable fit of the model. All path coefficients were statistically significant. This study showed that perceived threat, perceived usefulness, and perceived ease of use significantly affected health consumers’ attitude and behavioral intention. Health consumers’ health status, health belief and concerns, subjective norm, HIT characteristics, and HIT self-efficacy had a strong indirect impact on attitude and behavioral intention through the mediators of perceived threat, perceived usefulness, and perceived ease of use. Conclusions An extended TAM in the HIT arena was found to be valid to describe health consumers’ behavioral intention. We categorized the concepts in the extended TAM into 3 domains: health zone, information zone, and technology zone. PMID:23026508

Development of a health information technology acceptance model using consumers' health behavior intention.

PubMed

Kim, Jeongeun; Park, Hyeoun-Ae

2012-10-01

For effective health promotion using health information technology (HIT), it is mandatory that health consumers have the behavioral intention to measure, store, and manage their own health data. Understanding health consumers' intention and behavior is needed to develop and implement effective and efficient strategies. To develop and verify the extended Technology Acceptance Model (TAM) in health care by describing health consumers' behavioral intention of using HIT. This study used a cross-sectional descriptive correlational design. We extended TAM by adding more antecedents and mediating variables to enhance the model's explanatory power and to make it more applicable to health consumers' behavioral intention. Additional antecedents and mediating variables were added to the hypothetical model, based on their theoretical relevance, from the Health Belief Model and theory of planned behavior, along with the TAM. We undertook structural equation analysis to examine the specific nature of the relationship involved in understanding consumers' use of HIT. Study participants were 728 members recruited from three Internet health portals in Korea. Data were collected by a Web-based survey using a structured self-administered questionnaire. The overall fitness indices for the model developed in this study indicated an acceptable fit of the model. All path coefficients were statistically significant. This study showed that perceived threat, perceived usefulness, and perceived ease of use significantly affected health consumers' attitude and behavioral intention. Health consumers' health status, health belief and concerns, subjective norm, HIT characteristics, and HIT self-efficacy had a strong indirect impact on attitude and behavioral intention through the mediators of perceived threat, perceived usefulness, and perceived ease of use. An extended TAM in the HIT arena was found to be valid to describe health consumers' behavioral intention. We categorized the concepts in the extended TAM into 3 domains: health zone, information zone, and technology zone.

Effective L/D: A Theoretical Approach to the Measurement of Aero-Structural Efficiency in Aircraft Design

NASA Technical Reports Server (NTRS)

Guynn, Mark D.

2015-01-01

There are many trade-offs in aircraft design that ultimately impact the overall performance and characteristics of the final design. One well recognized and well understood trade-off is that of wing weight and aerodynamic efficiency. Higher aerodynamic efficiency can be obtained by increasing wing span, usually at the expense of higher wing weight. The proper balance of these two competing factors depends on the objectives of the design. For example, aerodynamic efficiency is preeminent for sailplanes and long slender wings result. Although the wing weight-drag trade is universally recognized, aerodynamic efficiency and structural efficiency are not usually considered in combination. This paper discusses the concept of "aero-structural efficiency," which combines weight and drag characteristics. A metric to quantify aero-structural efficiency, termed effective L/D, is then derived and tested with various scenarios. Effective L/D is found to be a practical and robust means to simultaneously characterize aerodynamic and structural efficiency in the context of aircraft design. The primary value of the effective L/D metric is as a means to better communicate the combined system level impacts of drag and structural weight.

Optimized guide RNA structure for genome editing via Cas9

PubMed Central

Xu, Jianyong; Lian, Wei; Jia, Yuning; Li, Lingyun; Huang, Zhong

2017-01-01

The genome editing tool Cas9-gRNA (guide RNA) has been successfully applied in different cell types and organisms with high efficiency. However, more efforts need to be made to enhance both efficiency and specificity. In the current study, we optimized the guide RNA structure of Streptococcus pyogenes CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)/Cas (CRISPR-associated) system to improve its genome editing efficiency. Comparing with the original functional structure of guide RNA, which is composed of crRNA and tracrRNA, the widely used chimeric gRNA has shorter crRNA and tracrRNA sequence. The deleted RNA sequence could form extra loop structure, which might enhance the stability of the guide RNA structure and subsequently the genome editing efficiency. Thus the genome editing efficiency of different forms of guide RNA was tested. And we found that the chimeric structure of gRNA with original full length of crRNA and tracrRNA showed higher genome editing efficiency than the conventional chimeric structure or other types of gRNA we tested. Therefore our data here uncovered the new type of gRNA structure with higher genome editing efficiency. PMID:29212218

The impact of a prospective survey-based workplace intervention program on employee health, biologic stress markers, and organizational productivity.

PubMed

Anderzén, Ingrid; Arnetz, Bengt B

2005-07-01

To study whether knowledge about psychosocial work indicators and a structured method to implement changes based on such knowledge comprise an effective management tool for enhancing organizational as well as employee health and well-being. White- collar employees representing 22 different work units were assessed before and after a 1-year intervention program. Subjective ratings on health and work environment, biologic markers, absenteeism, and productivity were measured. Significant improvements in performance feedback, participatory management, employeeship, skills development, efficiency, leadership, employee well-being, and work-related exhaustion were identified. The restorative hormone testosterone increased during the intervention and changes correlated with increased overall organizational well-being. Absenteeism decreased and productivity improved. Fact-based psychosocial workplace interventions are suggested to be an important process for enhancing employee well-being as well as organizational performance.

[Barriers for introducing a health technology assessment organization to inform health care decision-making in the Spanish National Health System].

PubMed

Artells, Juan José; Peiró, Salvador; Meneu, Ricard

2014-01-01

To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.

Analyzing Whether Countries Are Equally Efficient at Improving Longevity for Men and Women

PubMed Central

Nandi, Arijit; Mendoza Rodríguez, José M.; Heymann, Jody

2014-01-01

Objectives. We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. Methods. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Results. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. Conclusions. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems. PMID:24328639

Health resources management and physician control in a San Francisco, California, hospital.

PubMed Central

Rosenstein, A. H.; Stier, M. M.

1991-01-01

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education. Images PMID:2006564

Influences on influenza transmission within terminal based on hierarchical structure of personal contact network.

PubMed

Shao, Quan; Jia, Meng

2015-03-18

Since the outbreak of pandemics, influenza has caused extensive attention in the field of public health. It is actually hard to distinguish what is the most effective method to control the influenza transmission within airport terminal. The purpose of this study was to quantitatively evaluate the influences of passenger source, immunity difference and social relation structure on the influenza transmission in terminal. A method combining hierarchical structure of personal contact network with agent-based SEIR model was proposed to analyze the characteristics of influenza diffusion within terminal. Based on the spatial distance between individuals, the hierarchical structure of personal contact network was defined to construct a complex relationship of passengers in the real world. Moreover, the agent-based SEIR model was improved by considering the individual level of influenza spread characteristics. To evaluate the method, this process was fused in simulation based on the constructed personal contact network. In the terminal we investigated, personal contact network was defined by following four layers: social relation structure, procedure partition, procedure area, and the whole terminal. With the growing of layer, the degree distribution curves move right. The value of degree distribution p(k) reached a peak at a specific value, and then back down. Besides, with the increase of layer α, the clustering coefficients presented a tendency to exponential decay. Based on the influenza transmission experiments, the main infected areas were concluded when considering different factors. Moreover, partition of passenger sources was found to impact a lot in departure, while social relation structure imposed a great influence in arrival. Besides, immunity difference exerted no obvious effect on the spread of influenza in the transmission process both in departure and arrival. The proposed method is efficient to reproduce the evolution process of influenza transmission, and exhibits various roles of each factor in different processes, also better reflects the effect of passenger topological character on influenza spread. It contributes to proposing effective influenza measures by airport relevant department and improving the efficiency and ability of epidemic prevention on the public health.

Health systems organization for emergency care.

PubMed

Pedroto, Isabel; Amaro, Pedro; Romãozinho, José Manuel

2013-10-01

The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consolidation of medical groups into physician practice management organizations.

PubMed

Robinson, J C

1998-01-14

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

Emerging organizational structures in the ambulance industry in the United States.

PubMed

Narad, R A

2000-01-01

This analysis seeks to identify emerging forms of organizations in emergency medical services (EMS) in the United States, to provide examples of them, to relate them to changes in healthcare generally, and to apply a classification scheme. Public policy issues related to these new forms of organizations and lessons from other areas of the healthcare system are identified. Recent changes in the healthcare system in the United States have been marked by modifications in the structure of organizations that provide and pay for health services. New forms of organizations and alliances among existing organizations have emerged in an effort to improve the efficiency of the services provided and to improve organizations' market positions. Reflecting increased competition within EMS and the demands of the changing health-care delivery system, several types of organizations have begun to emerge in EMS that resemble those occurring in health care generally. These include forms of horizontal integration, such as consolidated ambulance services and various models of ambulance service networks; and forms of vertical integration, such as demand management programs and public-private joint ventures. The ultimate end might be complete integration with a carve-out of all non-scheduled care. Although changes in EMS organizations result largely from marketplace decisions by sellers and purchasers, this does not mean that there is no public policy role. While new organizational forms may increase the ambulance industry's efficiency, public policy makers must be concerned about quality and access as well. Some policy responses will promote marketplace changes, others will accept them generally, but will seek to correct problems, and a third group will attempt to restrain the market.

Does Price Transparency Improve Market Efficiency? Implications of Empirical Evidence in Other Markets for the Health Sector

DTIC Science & Technology

2007-07-24

for many high-volume stocks of CRS-3 1 William H. Christie and Paul H. Schultz, “Did NASDAQ Market Makers Implicitly Collude?,” Journal of Economic...abandoned, and spreads for several major stocks fell by about half.1 Some other examples of transparency in financial markets suggested transparency lowered...losses. CRS-34 67 For a more detailed description of the structure of modern financial markets, see Hans R. Stoll, “Electronic Trading in Stock

Assessment of screening practices for gestational hyperglycaemia in public health facilities: a descriptive study in bangalore, India.

PubMed

Babu, Giridhara R; Tejaswi, B; Kalavathi, M; Vatsala, G M; Murthy, G V S; Kinra, Sanjay; Neelon, Sara E Benjamin

2015-02-20

Screening and timely treatment of gestational hyperglycaemia (GH) is proved to be beneficial and improves maternal and foetal health outcomes. To understand screening practices, we explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women. We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used. We reported that gestational diabetes mellitus (GDM) screening was done in nearly all the health centres (96%). However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92%) of the doctors had poor knowledge (68%) about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time. Our study established that screening for GH is done in most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them. Significance for public healthRising burden of hyperglycaemia in pregnancy is a cause for concern and is associated with short and long term deleterious consequences for mother and offspring. Hence, there is an urgent need to explore the screening practices for gestational hyperglycaemia (GH). The current study considers patient and doctors' perspectives regarding GH screening. The results from our study indicate several issues during screening of gestational hyperglycaemia in public health facilities in Bangalore, India. These included low awareness levels among doctors, lack of standard operating procedures and lack of adequate care and attention provided to pregnant women. Re-orientation trainings of the doctors within public health facilities can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning and preparation of the patient prior to the tests can help ensure successful completion of the tests. The findings of the study are comparable with the practices of public health hospitals in India.

A performance assessment method for hospitals: the case of municipal hospitals in Angola.

PubMed

Kirigia, Joses M; Emrouznejad, Ali; Cassoma, Basilio; Asbu, Eyob Zere; Barry, Saidou

2008-12-01

Over 60% of the recurrent budget of the Ministry of Health (MoH) in Angola is spent on the operations of the fixed health care facilities (health centres plus hospitals). However, to date, no study has been attempted to investigate how efficiently those resources are used to produce health services. Therefore the objectives of this study were to assess the technical efficiency of public municipal hospitals in Angola; assess changes in productivity over time with a view to analyzing changes in efficiency and technology; and demonstrate how the results can be used in the pursuit of the public health objective of promoting efficiency in the use of health resources. The analysis was based on a 3-year panel data from all the 28 public municipal hospitals in Angola Data Envelopment Analysis (DEA), a non-parametric linear programming approach, was employed to assess the technical and scale efficiency and productivity change over time using Malmquist index. The results show that on average, productivity of municipal hospitals in Angola increased by 4.5% over the period 2000-2002; that growth was due to improvements in efficiency rather than innovation.

Trade in health services.

PubMed Central

Chanda, Rupa

2002-01-01

In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services. PMID:11953795

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China

PubMed Central

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

Background This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. Methods We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. Results The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the “best practice frontier”. The other 8 (25.8%) provinces were technically inefficient. Conclusions Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces. PMID:26679187

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China.

PubMed

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8%) provinces were technically inefficient. Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.

Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

PubMed

Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

2016-01-01

Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

[Implementation of modern operating room management -- experiences made at an university hospital].

PubMed

Hensel, M; Wauer, H; Bloch, A; Volk, T; Kox, W J; Spies, C

2005-07-01

Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. Therefore, the operating room statute of the Charité university hospital useful for other hospitals to develop an own concept is presented. In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.

A Study on the Secure User Profiling Structure and Procedure for Home Healthcare Systems.

PubMed

Ko, Hoon; Song, MoonBae

2016-01-01

Despite of various benefits such as a convenience and efficiency, home healthcare systems have some inherent security risks that may cause a serious leak on personal health information. This work presents a Secure User Profiling Structure which has the patient information including their health information. A patient and a hospital keep it at that same time, they share the updated data. While they share the data and communicate, the data can be leaked. To solve the security problems, a secure communication channel with a hash function and an One-Time Password between a client and a hospital should be established and to generate an input value to an OTP, it uses a dual hash-function. This work presents a dual hash function-based approach to generate the One-Time Password ensuring a secure communication channel with the secured key. In result, attackers are unable to decrypt the leaked information because of the secured key; in addition, the proposed method outperforms the existing methods in terms of computation cost.

An empirical investigation of the efficiency effects of integrated care models in Switzerland

PubMed Central

Reich, Oliver; Rapold, Roland; Flatscher-Thöni, Magdalena

2012-01-01

Introduction This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006–2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5%, respectively, of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy-makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care. PMID:22371691

Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition.

PubMed

Busse, Reinhard; Blümel, Miriam; Knieps, Franz; Bärnighausen, Till

2017-08-26

Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years. A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in turn led to the right for insured individuals to freely choose their health-care providers. In 1993, the freedom to choose one's sickness fund was formally introduced, and reforms that encourage competition and a strengthened market orientation have gradually gained importance in the past 25 years; these reforms were designed and implemented to protect the principles of solidarity and self-governance. In 2004, self-governance was strengthened through the establishment of the Federal Joint Committee, a major payer-provider structure given the task of defining uniform rules for access to and distribution of health care, benefits coverage, coordination of care across sectors, quality, and efficiency. Under the oversight of the Federal Joint Committee, payer and provider associations have ensured good access to high-quality health care without substantial shortages or waiting times. Self-governance has, however, led to an oversupply of pharmaceutical products, an excess in the number of inpatient cases and hospital stays, and problems with delivering continuity of care across sectoral boundaries. The German health insurance system is not as cost-effective as in some of Germany's neighbouring countries, which, given present expenditure levels, indicates a need to improve efficiency and value for patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lowering the barriers to consumer-directed health care: responding to concerns.

PubMed

Baicker, Katherine; Dow, William H; Wolfson, Jonathan

2007-01-01

Consumer-directed health care is a potentially promising tool for moving toward more efficient use of health care resources. Tax policy has long been biased against health plans with significant patient cost sharing. Tax advantages created by health savings accounts (HSAs) began to change that, and proposed tax reforms could go even further. We assess various critiques of these plans, focusing on why they benefit not just the healthy and wealthy. Lower costs and more efficient health spending would help all patients and reduce uninsurance. Potential negative distributional effects are important but can be remedied more efficiently without distorting insurance design.

Is the calorie concept a real solution to the obesity epidemic?

PubMed Central

Camacho, Salvador; Ruppel, Andreas

2017-01-01

ABSTRACT Background: The obesity epidemic has been growing steadily across the whole world, and so far not a single country has been able to reverse it. The cause of obesity is stated by the World Health Organization as an energy imbalance between calories consumed and calories expended. However, growing evidence suggests that the calorie imbalance concept may not be sufficient to manage and reverse the obesity epidemic. Objective: To discuss the use of the calorie imbalance concept and its elements as a tool for weight management as well as its possible negative consequences and implications for public health, with the aim to point toward the need of an updated concept for causes of obesity. This update should guide public health interventions more efficiently to limit obesity by preventing weight gain or promoting weight loss. Methods: This is a literature reviews based on a semi-structured approach to determine the material to be examined. Results: After revisiting general facts about fat generation and accumulation, we propose an updated concept for the causes of obesity including diet composition and hormonal regulation of fat metabolism. Conclusions: We discuss how this updated concept could benefit the overall efficiency of strategies against obesity, and hypothesize how potential resistance to adopting this new view could be lowered. PMID:28485680

User Perspectives of Characteristics of Improved Cookstoves from a Field Evaluation in Western Kenya

PubMed Central

Loo, Jennifer D.; Hyseni, Lirije; Ouda, Rosebel; Koske, Selline; Nyagol, Ronald; Sadumah, Ibrahim; Bashin, Michelle; Sage, Mike; Bruce, Nigel; Pilishvili, Tamara; Stanistreet, Debbi

2016-01-01

Over half of the world’s population uses biomass fuels; these households cook on open fires indoors, increasing their risk of adverse health effects due to household air pollution (HAP) from biomass combustion. This study evaluated six improved cookstoves (ICS) for effectiveness and acceptability in a rural community in Western Kenya. This paper describes women’s views on each ICS compared to the traditional three-stone fire. Views on stove characteristics, fuel consumption, health effects and acceptability were assessed through structured interviews and focus group discussions. Data were coded and analyzed using a thematic approach. In total, 262 interviews and 11 focus groups were conducted from 43 women. Overall, women preferred the ICS over the traditional three-stone fire for various reasons including ease of use, efficiency, fuel efficiency and perceived reduction in smoke and improved health. However, there were clear preferences for specific ICS with almost half of women preferring a Philips stove. Despite acceptance and use of ICS, women used multiple stoves to meet their daily needs. Qualitative studies are essential to field evaluations to provide insight into user perspectives and acceptability of ICS and to inform research and development of technologies that are both effective in reducing HAP and practical in use. PMID:26828505

Block-suffix shifting: fast, simultaneous medical concept set identification in large medical record corpora.

PubMed

Liu, Ying; Lita, Lucian Vlad; Niculescu, Radu Stefan; Mitra, Prasenjit; Giles, C Lee

2008-11-06

Owing to new advances in computer hardware, large text databases have become more prevalent than ever.Automatically mining information from these databases proves to be a challenge due to slow pattern/string matching techniques. In this paper we present a new, fast multi-string pattern matching method based on the well known Aho-Chorasick algorithm. Advantages of our algorithm include:the ability to exploit the natural structure of text, the ability to perform significant character shifting, avoiding backtracking jumps that are not useful, efficiency in terms of matching time and avoiding the typical "sub-string" false positive errors.Our algorithm is applicable to many fields with free text, such as the health care domain and the scientific document field. In this paper, we apply the BSS algorithm to health care data and mine hundreds of thousands of medical concepts from a large Electronic Medical Record (EMR) corpora simultaneously and efficiently. Experimental results show the superiority of our algorithm when compared with the top of the line multi-string matching algorithms.

Microsimulation Modeling for Health Decision Sciences Using R: A Tutorial.

PubMed

Krijkamp, Eline M; Alarid-Escudero, Fernando; Enns, Eva A; Jalal, Hawre J; Hunink, M G Myriam; Pechlivanoglou, Petros

2018-04-01

Microsimulation models are becoming increasingly common in the field of decision modeling for health. Because microsimulation models are computationally more demanding than traditional Markov cohort models, the use of computer programming languages in their development has become more common. R is a programming language that has gained recognition within the field of decision modeling. It has the capacity to perform microsimulation models more efficiently than software commonly used for decision modeling, incorporate statistical analyses within decision models, and produce more transparent models and reproducible results. However, no clear guidance for the implementation of microsimulation models in R exists. In this tutorial, we provide a step-by-step guide to build microsimulation models in R and illustrate the use of this guide on a simple, but transferable, hypothetical decision problem. We guide the reader through the necessary steps and provide generic R code that is flexible and can be adapted for other models. We also show how this code can be extended to address more complex model structures and provide an efficient microsimulation approach that relies on vectorization solutions.

U.S. Department of Energy, Office of Legacy Management Program Update, April-June 2009

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2009-04-01

Welcome to the April-June 2009 issue of the U.S. Department of Energy (DOE) Office of Legacy Management (LM) Program Update. This publication is designed to provide a status of activities within LM. The Legacy Management goals are: (1) Protect human health and the environment through effective and efficient long-term surveillance and maintenance - This goal highlights DOE's responsibility to ensure long-term protection of people, the environment, and the integrity of engineered remedies and monitoring systems. (2) Preserve, protect, and make accessible legacy records and information - This goal recognizes LM's commitment to successfully manage records, information, and archives of legacymore » sites under its authority. (3) Support an effective and efficient work force structured to accomplish Departmental missions and assure continuity of contractor worker pension and medical benefits - This goal recognizes DOE's commitment to its contracted work force and the consistent management of pension and health benefits. As sites continue to close, DOE faces the challenges of managing pension plan and health benefits liability. (4) Manage legacy land and assets, emphasizing protective real and personal property reuse and disposition - This goal recognizes a DOE need for local collaborative management of legacy assets, including coordinating land use planning, personal property disposition to community reuse organizations, and protecting heritage resources (natural, cultural, and historical). (5) Improve program effectiveness through sound management - This goal recognizes that LM's goals cannot be attained efficiently unless the federal and contractor work force is motivated to meet requirements and work toward continuous performance improvement.« less

Nanoscale control of energy and matter in plasma-surface interactions: towards energy-efficient nanotech

NASA Astrophysics Data System (ADS)

Ostrikov, Kostya

2010-11-01

This presentation focuses on the plasma issues related to the solution of the grand challenge of directing energy and matter at nanoscales. This ability is critical for the renewable energy and energy-efficient technologies for sustainable future development. It will be discussed how to use environmentally and human health benign non-equilibrium plasma-solid systems and control the elementary processes of plasma-surface interactions to direct the fluxes of energy and matter at multiple temporal and spatial scales. In turn, this makes it possible to achieve the deterministic synthesis of self- organised arrays of metastable nanostructures in the size range beyond the reach of the present-day nanofabrication. Such structures have tantalising prospects to enhance performance of nanomaterials in virtually any area of human activity yet remain almost inaccessible because the Nature's energy minimisation rules allow only a small number of stable equilibrium states. By using precisely controlled and kinetically fast nanoscale transfer of energy and matter under non-equilibrium conditions and harnessing numerous plasma- specific controls of species creation, delivery to the surface, nucleation and large-scale self-organisation of nuclei and nanostructures, the arrays of metastable nanostructures can be created, arranged, stabilised, and further processed to meet the specific requirements of the envisaged applications. These approaches will eventually lead to faster, unprecedentedly- clean, human-health-friendly, and energy-efficient nanoscale synthesis and processing technologies for the next-generation renewable energy and light sources, biomedical devices, information and communication systems, as well as advanced functional materials for applications ranging from basic food, water, health and clean environment needs to national security and space missions.

Distributed adaptive diagnosis of sensor faults using structural response data

NASA Astrophysics Data System (ADS)

Dragos, Kosmas; Smarsly, Kay

2016-10-01

The reliability and consistency of wireless structural health monitoring (SHM) systems can be compromised by sensor faults, leading to miscalibrations, corrupted data, or even data loss. Several research approaches towards fault diagnosis, referred to as ‘analytical redundancy’, have been proposed that analyze the correlations between different sensor outputs. In wireless SHM, most analytical redundancy approaches require centralized data storage on a server for data analysis, while other approaches exploit the on-board computing capabilities of wireless sensor nodes, analyzing the raw sensor data directly on board. However, using raw sensor data poses an operational constraint due to the limited power resources of wireless sensor nodes. In this paper, a new distributed autonomous approach towards sensor fault diagnosis based on processed structural response data is presented. The inherent correlations among Fourier amplitudes of acceleration response data, at peaks corresponding to the eigenfrequencies of the structure, are used for diagnosis of abnormal sensor outputs at a given structural condition. Representing an entirely data-driven analytical redundancy approach that does not require any a priori knowledge of the monitored structure or of the SHM system, artificial neural networks (ANN) are embedded into the sensor nodes enabling cooperative fault diagnosis in a fully decentralized manner. The distributed analytical redundancy approach is implemented into a wireless SHM system and validated in laboratory experiments, demonstrating the ability of wireless sensor nodes to self-diagnose sensor faults accurately and efficiently with minimal data traffic. Besides enabling distributed autonomous fault diagnosis, the embedded ANNs are able to adapt to the actual condition of the structure, thus ensuring accurate and efficient fault diagnosis even in case of structural changes.

Efficient reanalysis of structures by a direct modification method. [local stiffness modifications of large structures

NASA Technical Reports Server (NTRS)

Raibstein, A. I.; Kalev, I.; Pipano, A.

1976-01-01

A procedure for the local stiffness modifications of large structures is described. It enables structural modifications without an a priori definition of the changes in the original structure and without loss of efficiency due to multiple loading conditions. The solution procedure, implemented in NASTRAN, involved the decomposed stiffness matrix and the displacement vectors of the original structure. It solves the modified structure exactly, irrespective of the magnitude of the stiffness changes. In order to investigate the efficiency of the present procedure and to test its applicability within a design environment, several real and large structures were solved. The results of the efficiency studies indicate that the break-even point of the procedure varies between 8% and 60% stiffness modifications, depending upon the structure's characteristics and the options employed.

The impact of healthcare reform on the efficiency of public county hospitals in China.

PubMed

Jiang, Shuai; Min, Rui; Fang, Peng-Qian

2017-12-20

The new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The purpose of this study is to evaluate county hospitals efficiency before and after the healthcare reform, and further assess the reform effectiveness through the comparative analysis of the efficiency. Data envelopment analysis (DEA) was employed to calculate the efficiency of 1105 sample hospitals which were selected from 31 provinces of China, also, Tobit regression was used to regress against those main external environmental factors. Our results show that the scales and amounts of service of hospitals had increased sharply, however, the efficiency was relatively low and decreased slightly from 2008 to 2012. Thirteen (1.18%) in 2008 and six (0.54%) hospitals in 2012 were defined as technically efficient, and the average scores were 0.2916 and 0.2503. The technical efficiency average score of the post-reform was significantly less than that of the pre-reform (p < 0.001), and the score of eastern region was highest and the western was lowest among three regions of China. It suggests the reform had not well improved county hospital efficiency although hospitals have reached a fair developing scale, and the corresponding policies and measures should be put into effect for improving efficiency, especially in the level and structure of health investment, operation and supervision mechanism of county hospitals.

An optimal baseline selection methodology for data-driven damage detection and temperature compensation in acousto-ultrasonics

NASA Astrophysics Data System (ADS)

Torres-Arredondo, M.-A.; Sierra-Pérez, Julián; Cabanes, Guénaël

2016-05-01

The process of measuring and analysing the data from a distributed sensor network all over a structural system in order to quantify its condition is known as structural health monitoring (SHM). For the design of a trustworthy health monitoring system, a vast amount of information regarding the inherent physical characteristics of the sources and their propagation and interaction across the structure is crucial. Moreover, any SHM system which is expected to transition to field operation must take into account the influence of environmental and operational changes which cause modifications in the stiffness and damping of the structure and consequently modify its dynamic behaviour. On that account, special attention is paid in this paper to the development of an efficient SHM methodology where robust signal processing and pattern recognition techniques are integrated for the correct interpretation of complex ultrasonic waves within the context of damage detection and identification. The methodology is based on an acousto-ultrasonics technique where the discrete wavelet transform is evaluated for feature extraction and selection, linear principal component analysis for data-driven modelling and self-organising maps for a two-level clustering under the principle of local density. At the end, the methodology is experimentally demonstrated and results show that all the damages were detectable and identifiable.

A wireless laser displacement sensor node for structural health monitoring.

PubMed

Park, Hyo Seon; Kim, Jong Moon; Choi, Se Woon; Kim, Yousok

2013-09-30

This study describes a wireless laser displacement sensor node that measures displacement as a representative damage index for structural health monitoring (SHM). The proposed measurement system consists of a laser displacement sensor (LDS) and a customized wireless sensor node. Wireless communication is enabled by a sensor node that consists of a sensor module, a code division multiple access (CDMA) communication module, a processor, and a power module. An LDS with a long measurement distance is chosen to increase field applicability. For a wireless sensor node driven by a battery, we use a power control module with a low-power processor, which facilitates switching between the sleep and active modes, thus maximizing the power consumption efficiency during non-measurement and non-transfer periods. The CDMA mode is also used to overcome the limitation of communication distance, which is a challenge for wireless sensor networks and wireless communication. To evaluate the reliability and field applicability of the proposed wireless displacement measurement system, the system is tested onsite to obtain the required vertical displacement measurements during the construction of mega-trusses and an edge truss, which are the primary structural members in a large-scale irregular building currently under construction. The measurement values confirm the validity of the proposed wireless displacement measurement system and its potential for use in safety evaluations of structural elements.

Factors associated with preparedness of the US healthcare system to respond to a pediatric surge during an infectious disease pandemic: Is our nation prepared?

PubMed

Anthony, Christy; Thomas, Tito Joe; Berg, Bridget M; Burke, Rita V; Upperman, Jeffrey S

2017-01-01

Recent incidents have demonstrated that the US health system is unprepared for infectious pandemics resulting in a pediatric surge. Development of efficient plans and a structured and coordinated regional response to pediatric pandemic surge remains an opportunity. To address this gap, we conducted a literature review to assess current efforts, propose a response plan structure, and recommend policy actions. A literature review, utilizing MEDLINE and PubMed, through March 2017 identified articles regarding infectious disease pandemics affecting the US pediatric population. After review of current literature, a proposed response plan structure for a pediatric pandemic surge was designed. Inclusion and exclusion criteria reduced an initial screening of 1,787 articles to 162 articles. Articles ranged in their discussion of pediatric pandemic surge. Review of the articles led to the proposal of organizing the results according to 4 S's; (1) Structure, (2) Staff, (3) Stuff (Resources), and (4) Space. The review has supported the concern that the US health system is unprepared for a pediatric surge induced by infectious disease pandemics. Common themes suggest that response plans should reflect the 4Ss and national guidelines must be translated into regional response systems that account for local nuances.

Cost-effectiveness analysis and efficient use of the pharmaceutical budget: the key role of clinical pharmacologists

PubMed Central

Edlin, Richard; Round, Jeff; Hulme, Claire; McCabe, Christopher

2010-01-01

The purpose of this paper is to provide information about cost-effectiveness analysis and the roles of clinical pharmacologists generally in providing efficient health care. The paper highlights the potential consequences of ‘off-label prescribing’ and ‘indication creep’ behaviour given slower growth (or potential cuts) in the NHS budget. This paper highlights the key roles of clinical pharmacologists in delivering an efficient health care system when resources are allocated using cost-effectiveness analyses. It describes what cost-effectiveness analysis (CEA) is and how incremental cost-effectiveness ratios (ICERs) are used to identify efficient options. After outlining the theoretical framework within which using CEA can promote the efficient allocation of the health care budget, it considers the place of disinvestment within achieving efficient resource allocation. Clinical pharmacologists are argued to be critical to providing improved population health under CEA-based resource allocation processes because of their roles in implementation and disinvestment. Given that the challenges facing the United Kingdom National Health Service (NHS) are likely to increase, this paper sets out the stark choices facing clinical pharmacologists. PMID:20716234

Cost-effectiveness analysis and efficient use of the pharmaceutical budget: the key role of clinical pharmacologists.

PubMed

Edlin, Richard; Round, Jeff; Hulme, Claire; McCabe, Christopher

2010-09-01

The purpose of this paper is to provide information about cost-effectiveness analysis and the roles of clinical pharmacologists generally in providing efficient health care. The paper highlights the potential consequences of 'off-label prescribing' and 'indication creep' behaviour given slower growth (or potential cuts) in the NHS budget. This paper highlights the key roles of clinical pharmacologists in delivering an efficient health care system when resources are allocated using cost-effectiveness analyses. It describes what cost-effectiveness analysis (CEA) is and how incremental cost-effectiveness ratios (ICERs) are used to identify efficient options. After outlining the theoretical framework within which using CEA can promote the efficient allocation of the health care budget, it considers the place of disinvestment within achieving efficient resource allocation. Clinical pharmacologists are argued to be critical to providing improved population health under CEA-based resource allocation processes because of their roles in implementation and disinvestment. Given that the challenges facing the United Kingdom National Health Service (NHS) are likely to increase, this paper sets out the stark choices facing clinical pharmacologists.

Dysfunctional health service conflict: causes and accelerants.

PubMed

Nelson, H Wayne

2012-01-01

This article examines the causes and accelerants of dysfunctional health service conflict and how it emerges from the health system's core hierarchical structures, specialized roles, participant psychodynamics, culture, and values. This article sets out to answer whether health care conflict is more widespread and intense than in other settings and if it is, why? To this end, health care power, gender, and educational status gaps are examined with an eye to how they undermine open communication, teamwork, and collaborative forms of conflict and spark a range of dysfunctions, including a pervasive culture of fear; the deny-and-defend lawsuit response; widespread patterns of hierarchical, generational, and lateral bullying; overly avoidant conflict styles among non-elite groups; and a range of other behaviors that lead to numerous human resource problems, including burnout, higher staff turnover, increased errors, poor employee citizenship behavior, patient dissatisfaction, increased patient complaints, and lawsuits. Bad patient outcomes include decreased compliance and increased morbidity and mortality. Health care managers must understand the root causes of these problems to treat them at the source and implement solutions that avoid negative conflict spirals that undermine organizational morale and efficiency.

Impact of data governance on a nation's healthcare system building blocks.

PubMed

Hovenga, Evelyn J S

2013-01-01

This chapter gives an overview of a nation's healthcare system, particularly for those who are familiar with IT but not healthcare or for those working in one area of healthcare who may not be familiar with the system and data requirements across the care continuum. The structure of this chapter uses the World Health Organisation's (WHO) Health systems framework with a focus on the need for data and information governance to achieve a sustainable health system delivering improved health for all, responsively and equitably meeting genuine demands for health services, with social and financial risk protection and overall improved efficiency. It is argued that there is a need to gather the right data and to process these data in a manner that provides good information in order to more fully understand how the health system is working and where and when it isn't working well. This needs to be achieved in the most cost effective manner that doesn't detract from the allocation of resources to healthcare or the clinical workflow required to achieve quality healthcare.

Reflection a neglected art in health promotion.

PubMed

Fleming, Paul

2007-10-01

Evaluation and quality assurance have, over time, become the bedrock of health promotion practice in ensuring effectiveness and efficiency of programme planning and delivery. There has been less emphasis, however, on formal recognition of the contribution of the personal characteristics and perspectives of those who plan and deliver programmes and to the more subtle underlying effects of prevailing societal and professional norms. This paper seeks to highlight the neglect of formal reflection as a key professional skill in professional health promotion practice. It outlines key theories underpinning the development of the concepts of reflection and reflective practice. The role of reflection in critical health education as it contributes to critical consciousness raising is highlighted through its contribution to the empowerment of change agents in a societal change context. A conceptual typology of reflective practice is described which provides a flexible structure with which professionals can reflect on the role of self, the context and the process of health promotion programme planning. Its use is illustrated from the author's published work in health promotion which is related to prevention of workplace violence.

Application of GIS in public health in India: A literature-based review, analysis, and recommendations.

PubMed

Ruiz, Marilyn O'Hara; Sharma, Arun Kumar

2016-01-01

The implementation of geospatial technologies and methods for improving health has become widespread in many nations, but India's adoption of these approaches has been fairly slow. With a large population, ongoing public health challenges, and a growing economy with an emphasis on innovative technologies, the adoption of spatial approaches to disease surveillance, spatial epidemiology, and implementation of health policies in India has great potential for both success and efficacy. Through our evaluation of scientific papers selected through a structured key phrase review of the National Center for Biotechnology Information on the database PubMed, we found that current spatial approaches to health research in India are fairly descriptive in nature, but the use of more complex models and statistics is increasing. The institutional home of the authors is skewed regionally, with Delhi and South India more likely to show evidence of use. The need for scientists engaged in spatial health analysis to first digitize basic data, such as maps of road networks, hydrological features, and land use, is a strong impediment to efficiency, and their work would certainly advance more quickly without this requirement.

Composite isogrid structures for parabolic surfaces

NASA Technical Reports Server (NTRS)

Silverman, Edward M. (Inventor); Boyd, Jr., William E. (Inventor); Rhodes, Marvin D. (Inventor); Dyer, Jack E. (Inventor)

2000-01-01

The invention relates to high stiffness parabolic structures utilizing integral reinforced grids. The parabolic structures implement the use of isogrid structures which incorporate unique and efficient orthotropic patterns for efficient stiffness and structural stability.

A robust damage-detection technique with environmental variability combining time-series models with principal components

NASA Astrophysics Data System (ADS)

Lakshmi, K.; Rama Mohan Rao, A.

2014-10-01

In this paper, a novel output-only damage-detection technique based on time-series models for structural health monitoring in the presence of environmental variability and measurement noise is presented. The large amount of data obtained in the form of time-history response is transformed using principal component analysis, in order to reduce the data size and thereby improve the computational efficiency of the proposed algorithm. The time instant of damage is obtained by fitting the acceleration time-history data from the structure using autoregressive (AR) and AR with exogenous inputs time-series prediction models. The probability density functions (PDFs) of damage features obtained from the variances of prediction errors corresponding to references and healthy current data are found to be shifting from each other due to the presence of various uncertainties such as environmental variability and measurement noise. Control limits using novelty index are obtained using the distances of the peaks of the PDF curves in healthy condition and used later for determining the current condition of the structure. Numerical simulation studies have been carried out using a simply supported beam and also validated using an experimental benchmark data corresponding to a three-storey-framed bookshelf structure proposed by Los Alamos National Laboratory. Studies carried out in this paper clearly indicate the efficiency of the proposed algorithm for damage detection in the presence of measurement noise and environmental variability.

Identification of delaminations in composite: structural health monitoring software based on spectral estimation and hierarchical genetic algorithm

NASA Astrophysics Data System (ADS)

Nag, A.; Mahapatra, D. Roy; Gopalakrishnan, S.

2003-10-01

A hierarchical Genetic Algorithm (GA) is implemented in a high peformance spectral finite element software for identification of delaminations in laminated composite beams. In smart structural health monitoring, the number of delaminations (or any other modes of damage) as well as their locations and sizes are no way completely known. Only known are the healthy structural configuration (mass, stiffness and damping matrices updated from previous phases of monitoring), sensor measurements and some information about the load environment. To handle such enormous complexity, a hierarchical GA is used to represent heterogeneous population consisting of damaged structures with different number of delaminations and their evolution process to identify the correct damage configuration in the structures under monitoring. We consider this similarity with the evolution process in heterogeneous population of species in nature to develop an automated procedure to decide on what possible damaged configuration might have produced the deviation in the measured signals. Computational efficiency of the identification task is demonstrated by considering a single delamination. The behavior of fitness function in GA, which is an important factor for fast convergence, is studied for single and multiple delaminations. Several advantages of the approach in terms of computational cost is discussed. Beside tackling different other types of damage configurations, further scope of research for development of hybrid soft-computing modules are highlighted.

An Inverse Interpolation Method Utilizing In-Flight Strain Measurements for Determining Loads and Structural Response of Aerospace Vehicles

NASA Technical Reports Server (NTRS)

Shkarayev, S.; Krashantisa, R.; Tessler, A.

2004-01-01

An important and challenging technology aimed at the next generation of aerospace vehicles is that of structural health monitoring. The key problem is to determine accurately, reliably, and in real time the applied loads, stresses, and displacements experienced in flight, with such data establishing an information database for structural health monitoring. The present effort is aimed at developing a finite element-based methodology involving an inverse formulation that employs measured surface strains to recover the applied loads, stresses, and displacements in an aerospace vehicle in real time. The computational procedure uses a standard finite element model (i.e., "direct analysis") of a given airframe, with the subsequent application of the inverse interpolation approach. The inverse interpolation formulation is based on a parametric approximation of the loading and is further constructed through a least-squares minimization of calculated and measured strains. This procedure results in the governing system of linear algebraic equations, providing the unknown coefficients that accurately define the load approximation. Numerical simulations are carried out for problems involving various levels of structural approximation. These include plate-loading examples and an aircraft wing box. Accuracy and computational efficiency of the proposed method are discussed in detail. The experimental validation of the methodology by way of structural testing of an aircraft wing is also discussed.

New public management in Iran's health complex: a management framework for primary health care system.

PubMed

Tabrizi, Jafar Sadegh; HaghGoshayie, Elaheh; Doshmangir, Leila; Yousefi, Mahmood

2018-05-01

New public management (NPM) was developed as a management reform to improve the efficiency and effectiveness in public organizations, especially in health sector. Using the features of private sector management, the managers of health organizations may try to implement the elements of NPM with the hope to improve the performance of their systems.AimsOur aim in the present study was to identify the elements and infrastructures suitable for implementing NPM in the Iranian health complex. In this qualitative study with conventional content analysis approach, we tried to explore the NPM elements and infrastructures in Iranian public health sector. A series of semi-structured interviews (n=48) were conducted in 2016 with a managers in public and private health complex. Three focus group discussions with nine faculty members were also conducted. A data collection form was used to collect the demographic characteristics and perspectives of the participants.FindingsFrom the perspective of managers, managerialism, decentralization, using market mechanism, performance management, customer orientation and performance budgeting were the main elements of NPM in the Iranian context. The most important infrastructures for implementing this reform were as follows: education and training, information technology, the proper use of human resources, decision support systems, top management commitment, organizational culture, flexibility of rules, rehabilitating of the aging infrastructures, and expanding the coverage of services. The NPM was generally identified to be an effective replacement for the traditional administration method. These reforms may be helpful in strengthening the public health complex and the management capacity, as well. NPM also seems to be useful in interacting the public health sector with the private sector in terms of personnel and resources, performance, reward structure, and methods of doing business.

Development of a Cloud Computing-Based Pier Type Port Structure Stability Evaluation Platform Using Fiber Bragg Grating Sensors.

PubMed

Jo, Byung Wan; Jo, Jun Ho; Khan, Rana Muhammad Asad; Kim, Jung Hoon; Lee, Yun Sung

2018-05-23

Structure Health Monitoring is a topic of great interest in port structures due to the ageing of structures and the limitations of evaluating structures. This paper presents a cloud computing-based stability evaluation platform for a pier type port structure using Fiber Bragg Grating (FBG) sensors in a system consisting of a FBG strain sensor, FBG displacement gauge, FBG angle meter, gateway, and cloud computing-based web server. The sensors were installed on core components of the structure and measurements were taken to evaluate the structures. The measurement values were transmitted to the web server via the gateway to analyze and visualize them. All data were analyzed and visualized in the web server to evaluate the structure based on the safety evaluation index (SEI). The stability evaluation platform for pier type port structures involves the efficient monitoring of the structures which can be carried out easily anytime and anywhere by converging new technologies such as cloud computing and FBG sensors. In addition, the platform has been successfully implemented at “Maryang Harbor” situated in Maryang-Meyon of Korea to test its durability.

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.

Applying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System.

PubMed

Librero, Julián; Ibañez, Berta; Martínez-Lizaga, Natalia; Peiró, Salvador; Bernal-Delgado, Enrique

2017-01-01

To illustrate the ability of hierarchical Bayesian spatio-temporal models in capturing different geo-temporal structures in order to explain hospital risk variations using three different conditions: Percutaneous Coronary Intervention (PCI), Colectomy in Colorectal Cancer (CCC) and Chronic Obstructive Pulmonary Disease (COPD). This is an observational population-based spatio-temporal study, from 2002 to 2013, with a two-level geographical structure, Autonomous Communities (AC) and Health Care Areas (HA). The Spanish National Health System, a quasi-federal structure with 17 regional governments (AC) with full responsibility in planning and financing, and 203 HA providing hospital and primary care to a defined population. A poisson-log normal mixed model in the Bayesian framework was fitted using the INLA efficient estimation procedure. The spatio-temporal hospitalization relative risks, the evolution of their variation, and the relative contribution (fraction of variation) of each of the model components (AC, HA, year and interaction AC-year). Following PCI-CCC-CODP order, the three conditions show differences in the initial hospitalization rates (from 4 to 21 per 10,000 person-years) and in their trends (upward, inverted V shape, downward). Most of the risk variation is captured by phenomena occurring at the HA level (fraction variance: 51.6, 54.7 and 56.9%). At AC level, the risk of PCI hospitalization follow a heterogeneous ascending dynamic (interaction AC-year: 17.7%), whereas in COPD the AC role is more homogenous and important (37%). In a system where the decisions loci are differentiated, the spatio-temporal modeling allows to assess the dynamic relative role of different levels of decision and their influence on health outcomes.

From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.

PubMed

Austin, J Matthew; Demski, Renee; Callender, Tiffany; Lee, K H Ken; Hoffman, Ann; Allen, Lisa; Radke, Deborah A; Kim, Yungjin; Werthman, Ronald J; Peterson, Ronald R; Pronovost, Peter J

2017-04-01

As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

[Rethinking the place of primary healthcare in France--role of general practice].

PubMed

Gay, B

2013-06-01

Primary healthcare is poorly structured in France while it is well defined at the international level: it is the point of first medical contact of the population with the healthcare system. General practice is the clinical specialty oriented to primary healthcare. Data in the scientific literature highlight the need of refocusing the health system on primary care known to improve both morbi-mortality and care efficiency. In France, health authorities acknowledge general practitioners as playing a key role in the health care system: its time to move from intention to action. Structural changes are needed to achieve this reinforcement of primary healthcare: to re-orientate medical studies towards primary care; to develop research in primary care; to promote cooperation between care providers; to ease the daily workload of practitioners; to diversify methods of payment; to propose a guide for patient's use of primary care. The transformation of the healthcare system in France requires a real strategy of primary healthcare implementation. Regardless of financial constraints, it is possible to redistribute the resources towards ambulatory care. Strengthening the role of general practice and favoring its societal recognition will be the major stages of this change. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Application of the multi-scale finite element method to wave propagation problems in damaged structures

NASA Astrophysics Data System (ADS)

Casadei, F.; Ruzzene, M.

2011-04-01

This work illustrates the possibility to extend the field of application of the Multi-Scale Finite Element Method (MsFEM) to structural mechanics problems that involve localized geometrical discontinuities like cracks or notches. The main idea is to construct finite elements with an arbitrary number of edge nodes that describe the actual geometry of the damage with shape functions that are defined as local solutions of the differential operator of the specific problem according to the MsFEM approach. The small scale information are then brought to the large scale model through the coupling of the global system matrices that are assembled using classical finite element procedures. The efficiency of the method is demonstrated through selected numerical examples that constitute classical problems of great interest to the structural health monitoring community.

[Results of 2 years of activity].

PubMed

Panigazzi, M

2010-01-01

Work-related injuries and occupational diseases are a scourge of modern, western societies, which, although technologically advanced, have difficulty in preventing, treating and rehabilitating victims with speed and efficiency. The current hospital neuromotor rehabilitation centres, whether public or accredited private structures, have notable difficulty in meeting the demand, which despite annual fluctuations and variable needs, does not, overall, seem to be decreasing. We present the results of an organization model developed at the "Fondazione Maugeri" Scientific Institute (Pavia, Italy), the criteria used for the activity, the technological innovations employed to determine ability, and the prospects for further development. This model is effective from a health care-rehabilitative point of view, also in the light of the new legislative scenarios, and is sustainable from an economic points of view; overall it is, therefore, efficient.

The determinants of efficiency in the Canadian health care system.

PubMed

Allin, Sara; Grignon, Michel; Wang, Li

2016-01-01

In spite of the vast number of studies measuring economic efficiency in health care, there has been little take-up of this evidence by policy-makers to date. This study provides an illustration of how a system-level study drawing on best practice in empirical measurement of efficiency may be of practical use to health system decision makers and managers. We make use of the rich data available in Canada to undertake a robust two-stage data envelopment analysis to calculate efficiency at the regional (sub-provincial) level. Decisions about what the health system produces (the outcome to measure efficiency against) and what are the resources it has to produce that outcome were based on interviews and consultation with health system decision makers. Overall, we find large inefficiencies in the Canadian health care system, which could improve outcomes (here, measured as a reduction in treatable causes of death) by between 18 and 35% across our analyses. Also, we find that inefficiencies are the result of three main sets of factors that policy makers could pay attention to: management factors, such as hospital re-admissions; public health factors, such as obesity and smoking rates; and environmental factors such as the population's average income.

Perspectives: parity--prelude to a fifth cycle of reform.

PubMed

Goldman, Howard H

2002-09-01

Based on 2000 Carl Taube Lecture at the NIMH Mental Health Economics Meeting. This perspective article examines the relationship between a policy of parity in financing mental health services and the future of reform in service delivery. Applying theories of static and dynamic efficiency to an understanding of parity and the evolution of mental health services, drawing upon Burton Weisbrod s concept of the health care quadrilemma . Each of four cycles of reform in mental health services have contended with issues of static and dynamic efficiency. Each cycle was associated with static efficiency in the management and financing of services, and each was associated with a set of new treatment technologies intended to improve dynamic efficiency. Each reform proved ultimately unsuccessful primarily because of the failure of the treatment technologies to prevent future patient chronicity or to achieve sustained recovery. Recent advances in treatment technology and management of care can permit an unprecedented level of efficiency consistent with a policy of improved access to mainstream health and social welfare resources, including insurance coverage. This policy of so-called financing parity can improve current mental health service delivery, but it may also portend a future fifth cycle of reform. If new technologies continue to advance as full technologies - simple to deliver and producing true recovery - and mainstream resources are made available, then the specialty mental health services may contract dramatically in favor of effective care and treatment of mental illness in primary care and other mainstream settings. Predicting the future of health care is speculative, but it may be easier using the Weisbrod formulation to understand the process of mental health reform. Over-reliance on administrative techniques for building static efficiency and false optimism about dynamic efficiency from new technology have stymied previous reforms. All the same, a fifth cycle of reform could succeed, if the right conditions are met and mainstream resources are available.

Measuring Efficiency of Health Systems of the Middle East and North Africa (MENA) Region Using Stochastic Frontier Analysis.

PubMed

Hamidi, Samer; Akinci, Fevzi

2016-06-01

The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined. We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity. The average estimated technical inefficiency of health systems in the MENA region was 6.9 % with a range of 5.7-7.9 % across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models. Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.

[The role of the Federal Government in the prevention and control of infectious diseases. Organizational structures, responsibilities and duties--an overview].

PubMed

Hamouda, O

2005-09-01

Health policy is faced today with the challenge of keeping the health care system up to a high standard and affordable at the same time. A comprehensive health protection system that is efficient and readily accessible to all is required. Although it is to a great extent the responsibility of every citizen to promote and sustain their own health, it is the duty of the Federal Government to provide for risks that can emanate from pathogens, products or environmental factors. Protection against all known risks should be improved, new health threats have to be countered and new scientific findings must be considered. Prevention, health promotion and health protection are important key factors to improve health in the general population and to reduce health care costs. The prevention of and protection from infectious diseases are high priority tasks in the further development of an effective health care system in Germany. In order to accomplish these tasks in the control of infectious diseases close collaboration between a number of federal agencies and federal institutes under the responsibility of the Ministry of Health and Social Security as well as the Ministry of Consumer Protection, Food and Agriculture has to be ensured.

Laboratory and field performance of FOS sensors in static and dynamic strain monitoring in concrete bridge decks

NASA Astrophysics Data System (ADS)

Benmokrane, B.; Debaiky, A.; El-Ragaby, A.; Roy, R.; El-Gamal, S.; El-Salakawy, E.

2006-03-01

There is a growing need for designing and constructing innovative concrete bridges using FRP reinforcing bars as internal reinforcement to avoid the corrosion problems and high costs of maintenance and repair. For efficient use and to increase the lifetime of these bridges, it is important to develop efficient monitoring systems for such innovative structures. Fabry-Perot and Bragg fibre optic sensors (FOS) that can measure the strains and temperature are promising candidates for life-long health monitoring of these structures. This article reports laboratory and field performance of Fabry-Perot and Bragg FOS sensors as well as electrical strain gauges in static and dynamic strain monitoring in concrete bridge decks. The laboratory tests include tensile testing of glass FRP bars and testing of full-scale concrete bridge deck slabs reinforced with glass and carbon FRP bars under static and cyclic concentrated loads. The field tests include static and dynamic testing of two bridges reinforced with steel and glass FRP bars. The obtained strain results showed satisfactory agreement between the different gauges.

Rapid microwave-assisted synthesis of polydextrose and identification of structure and function.

PubMed

Wang, Haisong; Shi, Yonghui; Le, Guowei

2014-11-26

Microwave irradiation is a rapid and efficient method to synthesize oligomers and can be employed in polysaccharides production. As an artificial polysaccharide, polydextrose is known for its solid performance in food processing and its additional health benefits. This study was aimed at producing polydextrose by microwave irradiation using glucose and sorbitol as substrates; water and phosphoric acid as initiator and catalyst. The actual maximum yield was 99%. Synthetic polydextrose were purified by ethanol elution and Sepherdex G-25 column chromatography. Its purity was demonstrated by the high-performance gel-permeation chromatography as a single symmetrical sharp peak, additionally the average molecular weight was calculated to be 2.131 kDa. FT-IR spectra showed that the synthesized polydextrose has the structural feature similar to Polydextrose-Litesse(®). In vitro fermentation revealed that polydextrose possesses the biological function similar to Polydextrose-Litesse(®) in increasing the concentration of short chain fatty acid and decreasing pH. This research demonstrated the feasibility of a rapid and efficient microwave mediated method to synthesize polydextrose and potentially other value added carbohydrate polymers. Copyright © 2014 Elsevier Ltd. All rights reserved.

A new strategy toward Internet of Things: structural health monitoring using a combined fiber optic and acoustic emission wireless sensor platform

NASA Astrophysics Data System (ADS)

Nguyen, A. D.; Page, C.; Wilson, C. L.

2016-04-01

This paper investigates a new low-power structural health monitoring (SHM) strategy where fiber Bragg grating (FBG) rosettes can be used to continuously monitor for changes in a host structure's principal strain direction, suggesting damage and thus enabling the immediate triggering of a higher power acoustic emissions (AE) sensor to provide for better characterization of the damage. Unlike traditional "always on" AE platforms, this strategy has the potential for low power, while the wireless communication between different sensor types supports the Internet of Things (IoT) approach. A combination of fiber-optic sensor rosettes for strain monitoring and a fiber-optic sensor for acoustic emissions monitoring was attached to a sample and used to monitor crack initiation. The results suggest that passive principal strain direction monitoring could be used as a damage initiation trigger for other active sensing elements such as acoustic emissions. In future work, additional AE sensors can be added to provide for damage location; and a strategy where these sensors can be powered on periodically to further establish reliability while preserving an energy efficient scheme can be incorporated.

Implementation of a novel efficient low cost method in structural health monitoring

NASA Astrophysics Data System (ADS)

Asadi, S.; Sepehry, N.; Shamshirsaz, M.; Vaghasloo, Y. A.

2017-05-01

In active structural health monitoring (SHM) methods, it is necessary to excite the structure with a preselected signal. More studies in the field of active SHM are focused on applying SHM on higher frequency ranges since it is possible to detect smaller damages, using higher excitation frequency. Also, to increase spatial domain of measurements and enhance signal to noise ratio (SNR), the amplitude of excitation signal is usually amplified. These issues become substantial where piezoelectric transducers with relatively high capacitance are used and consequently, need to utilize high power amplifiers becomes predominant. In this paper, a novel method named Step Excitation Method (SEM) is proposed and implemented for Lamb wave and transfer impedance-based SHM for damage detection in structures. Three different types of structure are studied: beam, plate and pipe. The related hardware is designed and fabricated which eliminates high power analog amplifiers and decreases complexity of driver significantly. Spectral Finite Element Method (SFEM) is applied to examine performance of proposed SEM. In proposed method, by determination of impulse response of the system, any input could be applied to the system by both finite element simulations and experiments without need for multiple measurements. The experimental results using SEM are compared with those obtained by conventional direct excitation method for healthy and damaged structures. The results show an improvement of amplitude resolution in damage detection comparing to conventional method which is due to achieving an SNR improvement up to 50%.

The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study.

PubMed

Grey, Charlotte N B; Jiang, Shiyu; Nascimento, Christina; Rodgers, Sarah E; Johnson, Rhodri; Lyons, Ronan A; Poortinga, Wouter

2017-01-31

Research suggests that living in fuel poverty and cold homes contributes to poor physical and mental health, and that interventions targeted at those living in poor quality housing may lead to health improvements. However, little is known about the socio-economic intermediaries and processes that contribute to better health. This study examined the relationship between energy efficiency investments to homes in low-income areas and mental and physical health of residents, as well as a number of psychosocial outcomes likely to be part of the complex relationship between energy efficiency measures and health outcomes. A quasi-experimental field study with a controlled pretest-posttest design was conducted (intervention n = 364; control n = 418) to investigate the short-term health and psychosocial impacts of a domestic energy efficiency programme that took place across Wales between 2013 and 2015. Survey data were collected in the winters before and after installation of energy efficiency measures, including external wall insulation. The study used a multilevel modelling repeated measures approach to analyse the data. The energy efficiency programme was not associated with improvements in physical and mental health (using the SF-12v2 physical and mental health composite scales) or reductions in self-reported respiratory and asthma symptoms. However, the programme was associated with improved subjective wellbeing (B = 0.38, 95% CI 0.12 to 0.65), as well as improvements in a number of psychosocial outcomes, including increased thermal satisfaction (OR = 3.83, 95% CI 2.40 to 5.90), reduced reports of putting up with feeling cold to save heating costs (OR = 0.49, CI = 0.25 to 0.94), fewer financial difficulties (B = -0.15, 95% CI -0.25 to -0.05), and reduced social isolation (OR = 0.32, 95% CI 0.13 to 0.77). The study showed that investing in energy efficiency in low-income communities does not lead to self-reported health improvements in the short term. However, investments increased subjective wellbeing and were linked to a number of psychosocial intermediaries that are conducive to better health. It is likely that better living conditions contribute to improvements in health outcomes in the longer term. Better understanding of the impacts on recipients of energy efficiency schemes, could improve targeting of future fuel poverty policies.

Strategic contracting practices to improve procurement of health commodities

PubMed Central

Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor

2014-01-01

ABSTRACT Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result. PMID:25276589

Strategic contracting practices to improve procurement of health commodities.

PubMed

Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor

2014-08-01

Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result.

Predicting health care utilization in marginalized populations: Black, female, street-based sex workers.

PubMed

Varga, Leah M; Surratt, Hilary L

2014-01-01

Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Site Suitability Analysis for Beekeeping via Analythical Hyrearchy Process, Konya Example

NASA Astrophysics Data System (ADS)

Sarı, F.; Ceylan, D. A.

2017-11-01

Over the past decade, the importance of the beekeeping activities has been emphasized in the field of biodiversity, ecosystems, agriculture and human health. Thus, efficient management and deciding correct beekeeping activities seems essential to maintain and improve productivity and efficiency. Due to this importance, considering the economic contributions to the rural area, the need for suitability analysis concept has been revealed. At this point, Multi Criteria Decision Analysis (MCDA) and Geographical Information Systems (GIS) integration provides efficient solutions to the complex structure of decision- making process for beekeeping activities. In this study, site suitability analysis via Analytical Hierarchy Process (AHP) was carried out for Konya city in Turkey. Slope, elevation, aspect, distance to water resources, roads and settlements, precipitation and flora criteria are included to determine suitability. The requirements, expectations and limitations of beekeeping activities are specified with the participation of experts and stakeholders. The final suitability map were validated with existing 117 beekeeping locations and Turkish Statistical Institute 2016 beekeeping statistics for Konya province.

Developing a one-stop tinnitus service: outcomes of a joined up management strategy: a retrospective observational cohort study.

PubMed

Farr, Matthew R B; Moraleda Deleito, Javier; Xu, Yanmin; Ray, Jaydip

2016-02-01

The pressure to deliver quality care with finite resources means that dealing with single-symptom conditions like tinnitus in an efficient and individualized manner has never been more important. Both primary and secondary care practitioners have an obligation to explore efficient delivery of simple management pathways. Commissioners of health care are in a unique position to affect evidence-based strategic change in the management of uncomplicated tinnitus. This study is an attempt to explore one such option. We present the outcomes of a tinnitus patient pathway designed for one-stop management, thereby minimizing unnecessary additional appointments. A retrospective observational cohort study of 452 patients referred to a NHS one-stop tinnitus clinic from 2008 to 2012. Clinical care guided was through the use of a structured approach to history taking, neurotological examination and management. 294 out of 452 (65%) of patients referred had unilateral tinnitus. The most common associated complaints were hearing loss (387/452, 86%) and hyperacusis (329/452, 73%). 210 (46%) of patients had their presenting complaint dealt with in a single clinic visit. A structured system for referral and management of tinnitus within the health system ensures patients have timely access to evidence-based investigation and treatment. A consistent approach to imaging aimed at identifying retrocochlear pathology can benefit patients through early diagnosis of central pathology and the reassurance provided by a negative scan. © 2015 John Wiley & Sons, Ltd.

Barriers to sustainable tuberculosis control in the Russian Federation health system.

PubMed Central

Atun, R. A.; Samyshkin, Y. A.; Drobniewski, F.; Skuratova, N. M.; Gusarova, G.; Kuznetsov, S. I.; Fedorin, I. M.; Coker, R. J.

2005-01-01

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. PMID:15798846

The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons.

PubMed

Varabyova, Yauheniya; Müller, Julia-Maria

2016-03-01

There has been an ongoing interest in the analysis and comparison of the efficiency of health care systems using nonparametric and parametric applications. The objective of this study was to review the current state of the literature and to synthesize the findings on health system efficiency in OECD countries. We systematically searched five electronic databases through August 2014 and identified 22 studies that analyzed the efficiency of health care production at the country level. We summarized these studies with view on their sample, methods, and utilized variables. We developed and applied a checklist of 14 items to assess the quality of the reviewed studies along four dimensions: reporting, external validity, bias, and power. Moreover, to examine the internal validity of findings we meta-analyzed the efficiency estimates reported in 35 models from ten studies. The qualitative synthesis of the literature indicated large differences in study designs and methods. The meta-analysis revealed low correlations between country rankings suggesting a lack of internal validity of the efficiency estimates. In conclusion, methodological problems of existing cross-country comparisons of the efficiency of health care systems draw into question the ability of these comparisons to provide meaningful guidance to policy-makers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Reducing readmissions to detoxification: an interorganizational network perspective.

PubMed

Spear, Suzanne E

2014-04-01

The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients' odds of readmission to detox within 1 year. Administrative data from 32 counties in California in 2008-2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N=18,278). After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission. The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Reducing Readmissions to Detoxification: An Interorganizational Network Perspective

PubMed Central

Spear, Suzanne E.

2014-01-01

Background The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients’ odds of readmission to detox within 1 year. Methods Administrative data from 32 counties in California in 2008–2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N =18,278). Results After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission. Conclusion The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed. PMID:24529966

Evaluating the Impact of Hospital Efficiency on Wellness in the Military Health System.

PubMed

Bastian, Nathaniel D; Kang, Hyojung; Swenson, Eric R; Fulton, Lawrence V; Griffin, Paul M

2016-08-01

Like all health care delivery systems, the U.S. Department of Defense Military Health System (MHS) strives to achieve top preventative care and population health outcomes for its members while operating at an efficient level and containing costs. The objective of this study is to understand the overall efficiency performance of military hospitals and investigate the relationship between efficiency and wellness. This study uses data envelopment analysis and stochastic frontier analysis to compare the efficiency of 128 military treatment facilities from the Army, Navy, and Air Force during the period of 2011 to 2013. Fixed effects panel regression is used to determine the association between the hospital efficiency and wellness scores. The results indicate that data envelopment analysis and stochastic frontier analysis efficiency scores are congruent in direction. Both results indicate that the majority of the MHS hospitals and clinics can potentially improve their productive efficiency by managing their input resources better. When comparing the performance of the three military branches of service, Army hospitals as a group outperformed their Navy and Air Force counterparts; thus, best practices from the Army should be shared across service components. The findings also suggest no statistically significant, positive association between efficiency and wellness over time in the MHS. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Occupant comfort and health in green and conventional university buildings.

PubMed

Hedge, A; Miller, L; Dorsey, J A

2014-01-01

Green building standards are significantly impacting modern construction practices. The resulting structures are more energy efficient, but their impact on occupant health has not been widely studied. To investigate a range of indoor environment and ergonomic issues in green buildings. Retrospective post-occupancy evaluation survey of 319 occupants in two Leadership in Energy and Environmental Design (LEED) certified buildings and one conventional building on a Canadian University campus. Results show that working in the LEED buildings was a generally positive experience for their health, performance, and satisfaction. However, the LEED buildings did not always receive the highest ratings for environmental conditions or for health and productivity. Respondents indicated a range of concerns with thermal conditions, office lighting, noise and their overall workstation designs and these were not always better in the green buildings. These results highlight the need for better integration of ergonomic design into green buildings and into the LEED rating system, and these implications are discussed.

Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation.

PubMed

Ozkaynak, Mustafa; Johnson, Sharon; Shimada, Stephanie; Petrakis, Beth Ann; Tulu, Bengisu; Archambeault, Cliona; Fix, Gemmae; Schwartz, Erin; Woods, Susan

2014-01-01

Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direct users of the system. This study explores SM implementation at two Veterans Health Administration facilities. We interviewed twenty-nine members of eight primary care teams using semi-structured interviews. Questions addressed staff opinions about the integration of SM with daily practice, and team members' attitudes and experiences with SM. We describe the clinical workflow for SM, examining complexity and variability. We identified eight workflow issues directly related to efficiency and patient satisfaction, based on an exploration of the technology fit with multilevel factors. These findings inform organizational interventions that will accommodate SM implementation and lead to more patient-centered care.

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China.

PubMed

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution.

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

PubMed Central

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

Background While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. Methods To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. Discussion This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. Conclusion The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution. PMID:26034466

Towards universal health coverage in India: a historical examination of the genesis of Rashtriya Swasthya Bima Yojana - The health insurance scheme for low-income groups.

PubMed

Virk, A K; Atun, R

2015-06-01

Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publicly-funded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Qualitative case study of the RSBY in Delhi. This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Technical efficiency in the use of health care resources: a comparison of OECD countries.

PubMed

Retzlaff-Roberts, Donna; Chang, Cyril F; Rubin, Rose M

2004-07-01

Our paper analyzes technical efficiency in the production of aggregate health outcomes of reduced infant mortality and increased life expectancy, using Organization for Economic Cooperation and Development (OECD) health data. Application of data envelopment analysis (DEA) reveals that some countries achieve relative efficiency advantages, including those with good health outcomes (Japan, Sweden, Norway, and Canada) and those with modest health outcomes (Mexico and Turkey). We conclude the USA may learn from countries more economical in their allocation of healthcare resources that more is not necessarily better. Specifically, we find that the USA can substantially reduce inputs while maintaining the current level of life expectancy.

Health care and ICT, partnership is a must.

PubMed

Bakker, Albert R

2002-11-20

This article comments on the article 'Health Care in the Information Society; A Prognosis for the Year 2013' by Reinhold Haux et al. It is emphasised that besides the driving forces as identified in that article, the changes in the composition of the population will lead to a structural shortage of health professionals. So, despite the willingness of both individual patients and the society as a whole to pay more for health care no significant change will occur in the percentage of the gross domestic product spent on health care. By consequence we can not meet the challenges health care is facing by 'more of the same'. New forms of health care delivery have to be invented and implemented that lead to higher efficiency. The question is discussed whether health care is lagging behind other sectors of society in the application of ICT, the answer to that question is negative. It is explained why the percentage of the budget spent on ICT is no valuable yardstick. Comments are made to the quantitative expectations of Haux et al. Finally it is recommended that IMIA takes the initiative to organise in co-operation with international associations of health professionals a multidisciplinary working conference on the future role of ICT in health care.

[The German Statutory Accident Insurance: A successful example of a value-based healthcare structure].

PubMed

Wich, Michael; Auhuber, Thomas; Scholtysik, Dirk; Ekkernkamp, Axel

2018-02-01

In the mid-1920s Porter and others developed a reform approach for existing health care systems, aiming at a patient-focused, value-based orientation. Improving patient outcomes by attaining, preserving and restoring good health is inherently less costly than dealing with poor health. The authors of the present article will outline that the German statutory accident insurance system, which was already introduced in1884 and is of an evolving nature, reflects key elements of Porter's efficient value-based health care system. The German accident insurance system with its statutory mandate limited to the prevention and rehabilitation of work-related damage to one's health can also serve as a model for other larger health care insurance systems. Prevention and rehabilitation is pursued using all appropriate means to achieve the set goals of protecting and restoring individual health. In line with these objectives, the statutory health insurance controls the process in terms of the required care quality. The components of a complex health care system, usually managed by a variety of different institutions, are consolidated. Thus it can be ensured that in both prevention and rehabilitation all services that are necessary to keep focussing the value "individual health" rather than indemnities are applied. Copyright © 2018. Published by Elsevier GmbH.

[National health research systems in Latin America: a 14-country review].

PubMed

Alger, Jackeline; Becerra-Posada, Francisco; Kennedy, Andrew; Martinelli, Elena; Cuervo, Luis Gabriel

2009-11-01

This article discusses the main features of the national health research systems (NHRS) of Argentina, Bolivia, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Honduras, Panama, Paraguay, Peru, Uruguay, and Venezuela, based on documents prepared by their country experts who participated in the First Latin American Conference on Research and Innovation for Health held in April 2008, in Rio de Janeiro, Brazil. The review also includes sources cited in the reports, published scientific papers, and expert opinion, as well as regional secondary sources. Six countries reported having formal entities for health research governance and management: Brazil and Costa Rica's entities are led by their ministries of health; while Argentina, Cuba, Ecuador, and Venezuela have entities shared by their ministries of health and ministries of science and technology. Brazil and Ecuador each reported having a comprehensive national policy devoted specifically to health science, technology, and innovation. Argentina, Brazil, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru, and Venezuela reported having established health research priorities. In conclusion, encouraging progress has been made, despite the structural and functional heterogeneity of the study countries' NHRS and their disparate levels of development. Instituting good NHRS governance/management is of utmost importance to how efficiently ministries of health, other government players, and society-at-large can tackle health research.

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost.

PubMed

Humphries, Debbie L; Hyde, Justeen; Hahn, Ethan; Atherly, Adam; O'Keefe, Elaine; Wilkinson, Geoffrey; Eckhouse, Seth; Huleatt, Steve; Wong, Samuel; Kertanis, Jennifer

2018-01-01

Forty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use. To characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA). We interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews. The findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models - independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population. There are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

Modelling and Decision Support of Clinical Pathways

NASA Astrophysics Data System (ADS)

Gabriel, Roland; Lux, Thomas

The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems.

Factors affecting the technical efficiency of health systems: A case study of Economic Cooperation Organization (ECO) countries (2004-10).

PubMed

Ravangard, Ramin; Hatam, Nahid; Teimourizad, Abedin; Jafari, Abdosaleh

2014-07-01

Improving efficiency of health sector is of particular importance in all countries. To reach this end, it is paramount to measure the efficiency. On the other hand, there are many factors that affect the efficiency of health systems. This study aimed to measure the Technical Efficiency (TE) of health systems in Economic Cooperation Organization (ECO) countries during 2004-10 and to determine the factors affecting their TE. This was a descriptive-analytical and panel study. The required data were gathered using library and field studies, available statistics and international websites through completing data collection forms. In this study, the TE of health systems in 10 ECO countries was measured using their available data and Data Envelopment Analysis (DEA) through two approaches. The first approach used GDP per capita, education and smoking as its inputs and life expectancy and infant mortality rates as the outputs. The second approach, also, used the health expenditures per capita, the number of physicians per thousand people, and the number of hospital beds per thousand people as its inputs and life expectancy and under-5 mortality rates as the outputs. Then, the factors affecting the TE of health systems were determined using the panel data logit model. Excel 2010, Win4Deap 1.1.2 and Stata 11.0 were used to analyze the collected data. According to the first approach, the mean TE of health systems was 0.497 and based on the second one it was 0.563. Turkey and Turkmenistan had, respectively, the highest and lowest mean of efficiency. Also, the results of panel data logit model showed that only GDP per capita and health expenditures per capita had significant relationships with the TE of health systems. In order to maximize the TE of health systems, health policy-makers should pay special attention to the proper use of healthcare resources according to the people's needs, the appropriate management of the health system resources, allocating adequate budgets to the health sector, establishing an appropriate referral system to provide better public access to health services according to their income and needs, among many others.

[Alcohol consumption in adolescents (12 to 17 years): the point of view of health professionals].

PubMed

March Cerdá, Joan Carles; Prieto Rodríguez, María Ángeles; Danet, Alina; Suess, Amets; Ruiz Román, Paloma; García Toyos, Noelia

2012-09-01

To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. Qualitative and exploratory study, based on semi-structured interviews. Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentiones samples. A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0. Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. Specific professional training is required in order to guarantee the coordination between the health and education systems and the family. Copyright © 2008 Elsevier España, S.L. All rights reserved.

Using innovative instructional technology to meet training needs in public health: a design process.

PubMed

Millery, Mari; Hall, Michelle; Eisman, Joanna; Murrman, Marita

2014-03-01

Technology and distance learning can potentially enhance the efficient and effective delivery of continuing education to the public health workforce. Public Health Training Centers collaborate with instructional technology designers to develop innovative, competency-based online learning experiences that meet pressing training needs and promote best practices. We describe one Public Health Training Center's online learning module design process, which consists of five steps: (1) identify training needs and priority competencies; (2) define learning objectives and identify educational challenges; (3) pose hypotheses and explore innovative, technology-based solutions; (4) develop and deploy the educational experience; and (5) evaluate feedback and outcomes to inform continued cycles of revision and improvement. Examples illustrate the model's application. These steps are discussed within the context of design practices in the fields of education, engineering, and public health. They incorporate key strategies from across these fields, including principles of programmatic design familiar to public health professionals, such as backward design. The instructional technology design process we describe provides a structure for the creativity, collaboration, and systematic strategies needed to develop online learning products that address critical training needs for the public health workforce.

[Local public health networks. Apropos of an experience].

PubMed

Guix, Joan; Bocio, Ana; Ferràs, Joaquim; Margalef, Jordi; Osanz, Anna C; Serrano, Mónica; Sentenà, Anna

2013-01-01

Public health action on a territory is complex and requires the involvement of multiple actors, who do not always act coordinately. Networks of organizations structures including the whole of the local actors facilitate the generation of synergies and enable greater effectiveness and efficiency of the joint action from the different actors on a same landscape. We present 3 years experience of four Public Health Committees in a region of Catalonia (Spain), composed by the main actors in public health planning. Each of the committees is organized on a plenary and working groups on issues arising from the regional health diagnosis, and coincident with the Health Plan of the Region. Coordination in no case implies the loss or dilution of the firm of the actor generator of intervention initiative in public health, but their empowerment and collaboration by the other actors. In conclusion welcomes the creation of a culture of collaboration and synergies between the different organizations concerned. Lack of specificity is observed in establishing operational objectives, and the need for greater coordination and involvement of the components of the various working groups. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

The French Health Care System; What can We Learn?

PubMed

El Taguri, A; Nasef, A

2008-12-01

All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific) objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services. The French Health Care System (FHCS) ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

Working towards a national health information system in Australia.

PubMed

Bomba, B; Cooper, J; Miller, M

1995-01-01

One of the major administrative dilemmas facing the Australian national health care system is the need to reform practices associated with massive data-information overload. The current system is burdened with paper-based administrative forms, patient record files, referral notes and other manual methods of data organisation. An integrated computer-based information system may be perceived as an attractive solution to such burdens. However, computerisation must not be seen as a panacea with the possibility of exacerbating information overload and accentuating privacy concerns. Recent surveys in Australia [1] and the US [2] indicate a perceived causal link between computers and privacy invasion. Any moves toward a national health information system must counter this perception through macro-level education schemes of affected parties and micro-level mechanisms such as the establishment of hospital privacy officers. Such concerns may be viewed as a subset of the wider privacy debate, and information policy development should address such considerations to develop policies to prevent unauthorized access to personal information and to avoid the extraction and sale of sensitive health data. Conservative in nature and slow to change the health care sector may be forced to adopt more efficient work practices through the increasing proliferation of information technology (IT) in health care delivery and an escalating emphasis upon accountability and efficiency of the public health care dollar. The economic rationalist stance taken by governments in Australia and other nations generally will also force health care workers to adopt and develop more efficient information management practices, health indicators and best practice care methods than presently employed by this sector The benefits of a national health information system are far reaching, particularly in developing a more effective health care system through better identifying and understanding community health care trends and in applying IT to the efficient collection of data for the development of more appropriate performance measures and statistical indicators. A coherent and integrated approach is called for in the design of a national health information system which incorporates the necessary and requisite security features to meet privacy concerns. Protecting information privacy poses complex political, economic, technological, legal and social problems for systems developers and health care providers alike [2]. According to Brannigan [3] there are three components involved in the formulation and implementation of privacy: public policy (What level of privacy does society want?); legal structure (Does the law adequately provide for society's privacy requirements?); and technical (how much privacy can technical tools provide, at what cost, and with what effects on the system?). Examining technical tools alone, it is apparent that the necessary technologies are available in Australia to provide the security of medical records required by public policy. Such tools may include encryption, user and data authentication methods, authorisation schemes and mechanisms for the prevention of data inference. While none of these available measures are infallible, it is suitable for most applications where the encryption mechanism can provide protection for a given length of time. Australia needs to develop a coherent national health information infrastructure policy to ultimately avoid fragmented, duplicated and incompatible systems that rely on different standards and protocols. Such a policy will only work by addressing the key issue of patient privacy within a technological framework. The application of IT to health care systems is a sensitive social experiment affecting many professions including general practitioners, medical administrators, politicians, lawyers, computer specialists, privacy advocates and patients whose records will ultimately reside in the system. (abstract trun

Analysis of damaging process and crack propagation

NASA Astrophysics Data System (ADS)

Semenski, D.; Wolf, H.; Božić, Ž.

2010-06-01

Supervising and health monitoring of structures can assess the actual state of existing structures after initial loading or in the state of operation. Structural life management requires the integration of design and analysis, materials behavior and structural testing, as given for several examples. Procedure of survey of structural elements and criteria for their selection must be strongly defined as it is for the offshore gas platforms. Numerical analysis of dynamic loading is shown for the Aeolian vibrations of overhead transmission line conductors. Since the damper’s efficiency strongly depends on its position, the procedure of determining the optimum position of the damper is described. The optical method of caustics is established in isotropic materials for determination of the stress intensity factors (SIFs) of the cracks in deformed structures and is advantageously improved for the application to fiberreinforced composites. A procedure for simulation of crack propagation for multiple cracks was introduced and SIFs have been calculated by using finite element method. Crack growth of a single crack or a periodical array of cracks initiated at the stiffeners in a stiffened panel has been investigated.

Mental health and sleep of older wife caregivers for spouses with Alzheimer's disease and related disorders.

PubMed

Willette-Murphy, Karen; Todero, Catherine; Yeaworth, Rosalee

2006-10-01

This descriptive study examined sleep and mental health variables in 37 older wife caregivers for spouses with dementia compared to 37 age-matched controls. The relationships among selected caregiving variables (behavioral problems, caregiving hours, and years of caregiving), appraisal of burden, self-reported sleep efficiency for the past week, and mental health outcomes were examined. Lazarus and Folkman's stress and coping framework guided the study. Mental health and sleep were poorer for caregivers. Caregiving and appraisal of burden variables showed direct and indirect effects on mental health. However, caregiving and appraisal of burden variables were not significant for predicting sleep efficiency. Sleep efficiency was a good predictor of mental health in this sample of wife caregivers.

Implementing a new governance model.

PubMed

Stanley-Clarke, Nicky; Sanders, Jackie; Munford, Robyn

2016-05-16

Purpose - The purpose of this paper is to discuss the lessons learnt from the process of implementing a new model of governance within Living Well, a New Zealand statutory mental health agency. Design/methodology/approach - It presents the findings from an organisational case study that involved qualitative interviews, meeting observations and document analysis. Archetype theory provided the analytical framework for the research enabling an analysis of both the formal structures and informal value systems that influenced the implementation of the governance model. Findings - The research found that the move to a new governance model did not proceed as planned. It highlighted the importance of staff commitment, the complexity of adopting a new philosophical approach and the undue influence of key personalities as key determining factors in the implementation process. The findings suggest that planners and managers within statutory mental health agencies need to consider the implications of any proposed governance change on existing roles and relationships, thinking strategically about how to secure professional commitment to change. Practical implications - There are ongoing pressures within statutory mental health agencies to improve the efficiency and effectiveness of organisational structures and systems. This paper has implications for how planners and managers think about the process of implementing new governance models within the statutory mental health environment in order to increase the likelihood of sustaining and embedding new approaches to service delivery. Originality/value - The paper presents insights into the process of implementing new governance models within a statutory mental health agency in New Zealand that has relevance for other jurisdictions.

Utilization and Monetization of Healthcare Data in Developing Countries.

PubMed

Bram, Joshua T; Warwick-Clark, Boyd; Obeysekare, Eric; Mehta, Khanjan

2015-06-01

In developing countries with fledgling healthcare systems, the efficient deployment of scarce resources is paramount. Comprehensive community health data and machine learning techniques can optimize the allocation of resources to areas, epidemics, or populations most in need of medical aid or services. However, reliable data collection in low-resource settings is challenging due to a wide range of contextual, business-related, communication, and technological factors. Community health workers (CHWs) are trusted community members who deliver basic health education and services to their friends and neighbors. While an increasing number of programs leverage CHWs for last mile data collection, a fundamental challenge to such programs is the lack of tangible incentives for the CHWs. This article describes potential applications of health data in developing countries and reviews the challenges to reliable data collection. Four practical CHW-centric business models that provide incentive and accountability structures to facilitate data collection are presented. Creating and strengthening the data collection infrastructure is a prerequisite for big data scientists, machine learning experts, and public health administrators to ultimately elevate and transform healthcare systems in resource-poor settings.

Utilization and Monetization of Healthcare Data in Developing Countries

PubMed Central

Bram, Joshua T.; Warwick-Clark, Boyd; Obeysekare, Eric; Mehta, Khanjan

2015-01-01

Abstract In developing countries with fledgling healthcare systems, the efficient deployment of scarce resources is paramount. Comprehensive community health data and machine learning techniques can optimize the allocation of resources to areas, epidemics, or populations most in need of medical aid or services. However, reliable data collection in low-resource settings is challenging due to a wide range of contextual, business-related, communication, and technological factors. Community health workers (CHWs) are trusted community members who deliver basic health education and services to their friends and neighbors. While an increasing number of programs leverage CHWs for last mile data collection, a fundamental challenge to such programs is the lack of tangible incentives for the CHWs. This article describes potential applications of health data in developing countries and reviews the challenges to reliable data collection. Four practical CHW-centric business models that provide incentive and accountability structures to facilitate data collection are presented. Creating and strengthening the data collection infrastructure is a prerequisite for big data scientists, machine learning experts, and public health administrators to ultimately elevate and transform healthcare systems in resource-poor settings. PMID:26487984

Healthcare and development: a dialog with the thinking of Celso Furtado.

PubMed

Costa, Laís Silveira; Bahia, Ligia; Braga, Patrícia Seixas da Costa

2017-07-01

Understanding that conditions of health are dependent on more general nationwide factors relating to the level of development means admitting that 'sectorization' of health service is something that tends to limit the formation of knowledge. It also points to the importance of investigating the relationship between health and development, including issues about the processes that feed the persistence of the polarization between modernization and exclusion which has been a history of Brazil's contemporary development. This paper, based on a review of the literature, aims to look more deeply at the structural conditioning factors of the relationship between health and development, and their reproduction in the formation of contemporary knowledge, based on a dialog with the ideas of Celso Furtado. It concludes that a 'virtuous' articulation between health and development calls for policies that are able to reconcile the antagonistic factors represented by the interests of capitalism, and the interests of social wellbeing, in a harmonious co-existence. In Furtado's conception, this would be possible, if the process of social homogenization is correlated with an efficient production system that has a degree of technological autonomy.

Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners.

PubMed

Dufour, Sinéad Patricia; Brown, Judith; Deborah Lucy, S

2014-09-01

The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

How Connecticut Health Directors Deal With Public Health Budget Cuts at the Local Level

PubMed Central

Prust, Margaret L.; Clark, Kathleen; Davis, Brigette; Pallas, Sarah W.; Kertanis, Jennifer; O’Keefe, Elaine; Araas, Michael; Iyer, Neel S.; Dandorf, Stewart; Platis, Stephanie

2015-01-01

Objectives. We investigated the perspectives of local health jurisdiction (LHJ) directors on coping mechanisms used to respond to budget reductions and constraints on their decision-making. Methods. We conducted in-depth interviews with 17 LHJ directors. Interviews were audio recorded, transcribed, and analyzed using the constant comparative method. Results. LHJ directors use a range of coping mechanisms, including identifying alternative revenue sources, adjusting services, amending staffing arrangements, appealing to local political leaders, and forming strategic partnerships. LHJs also face constraints on their decision-making because of state and local statutory requirements, political priorities, pressures from other LHJs, and LHJ structure. Conclusions. LHJs respond creatively to budget cuts to maintain important public health services. Some LHJ adjustments to administrative resources may obscure the long-term costs of public health budget cuts in such areas as staff morale and turnover. Not all coping strategies are available to each LHJ because of the contextual constraints of its locality, pointing to important policy questions on identifying optimum jurisdiction size and improving efficiency. PMID:25689206

Does fiscal discipline towards subnational governments affect citizens' well-being? Evidence on health.

PubMed

Piacenza, Massimiliano; Turati, Gilberto

2014-02-01

This paper aims to assess the impact on citizens' well-being of fiscal discipline imposed by the central government on subnational governments. Because healthcare policies involve strategic interactions between different layers of governments in many different countries, we focus on a particular dimension of well-being, namely citizens' health. We model fiscal discipline by considering government expectations of future deficit bailouts from the central government. We then study how these bailout expectations affect the expenditure for healthcare policies carried out by decentralized governments. To investigate this issue, we separate efficient health spending from inefficiencies by estimating an input requirement frontier. This allows us to assess the effects of bailout expectations on both the structural component of health expenditure and its deviations from the 'best practice'. The evidence from the 15 Italian ordinary statute regions (observed from 1993 to 2006) points out that bailout expectations do not significantly influence the position of the frontier, thus not affecting citizens' health. However, they do appear to exert a remarkable impact on excess spending. Copyright © 2013 John Wiley & Sons, Ltd.

European network for health technology assessment, EUnetHTA: planning, development, and implementation of a sustainable European network for health technology assessment.

PubMed

Kristensen, Finn Børlum; Mäkelä, Marjukka; Neikter, Susanna Allgurin; Rehnqvist, Nina; Håheim, Lise Lund; Mørland, Berit; Milne, Ruairidh; Nielsen, Camilla Palmhøj; Busse, Reinhard; Lee-Robin, Sun Hae; Wild, Claudia; Espallargues, Mireia; Chamova, Julia

2009-12-01

The European network on Health Technology Assessment (EUnetHTA) aimed to produce tangible and practical results to be used in the various phases of health technology assessment and to establish a framework and processes to support this. This article presents the background, objectives, and organization of EUnetHTA, which involved a total of sixty-four partner organizations. Establishing an effective and sustainable structure for a transnational network involved many managerial, policy, and methodological tools, according to the objective of each task or Work Package. Transparency in organization, financial transactions, and decision making was a key principle in the management of the Project as was the commitment to appropriately involve stakeholders. EUnetHTA activities resulted in a clear management and governance structure, efficient partnership, and transnational cooperation. The Project developed a model for sustainable continuation of the EUnetHTA Collaboration. The EUnetHTA Project achieved its goals by producing a suite of practical tools, a strong network, and plans for continuing the work in a sustainable EUnetHTA Collaboration that facilitates and promotes the use of HTA at national and regional levels. Responsiveness to political developments in Europe should be balanced with maintaining a high level of ambition to promote independent, evidence-based information and well-tested tools for best practice based on a strong network of HTA institutions.

Divergence of compost extract and bio-organic manure effects on lucerne plant and soil

PubMed Central

Hu, Jian; Hu, Yifei; Yang, Gaowen; Zhang, Yingjun

2017-01-01

Aim Application of organic materials into agricultural systems enhances plant growth and yields, and improves soil fertility and structure. This study aimed to examine the effects of “compost extract (CE)”, a soil conditioner, and bio-organic manure (BOM) on the growth of lucerne (Medicago sativa), and compare the efficiency between BOM (including numbers of microorganisms) and CE (including no added microorganisms). Method A greenhouse experiment was conducted with four soil amendment treatments (control, BOM, CE and CEBOM), and was arranged in a completely randomized design with 10 replicates for each treatment. Plant biomass, nutritive value and rhizobia efficacy as well as soil characteristics were monitored. Result CE rather than BOM application showed a positive effect on plant growth and soil properties when compared with the control. Lucerne nodulation responded equally to CE addition and rhizobium inoculation. CE alone and in combination with BOM significantly increased plant growth and soil microbial activities and improved soil structure. The synergistic effects of CE and BOM indicate that applying CE and BOM together could increase their efficiency, leading to higher economic returns and improved soil health. However, CE alone is more effective for legume growth since nodulation was suppressed by nitrogen input from BOM. CE had a higher efficiency than BOM for enriching soil indigenous microorganisms instead of adding microorganisms and favouring plant nodulation. PMID:28894647

Factors affecting utilization of university health services in a tertiary institution in South-West Nigeria.

PubMed

Obiechina, G O; Ekenedo, G O

2013-01-01

Most university health services have extensive health infrastructures, for the provision of effective and efficient health services to the students. In this study, we have tried to determine student's perception of factors affecting their utilization. To determine students' perception of health care services provided in a tertiary institution and assess students' attitude towards utilization. Simple random sampling technique was used to select 540 respondents, comprising of 390 males and 150 females. A structured and self-administered questionnaire was the instrument used to collect data for the study, while data collected was analyzed using descriptive statistics of frequency count and percentage. High cost of drugs (72.0%), non availability of essential drugs (54.8%), time spent waiting for treatment (67.2%), inadequate referral services (81.7%), and satisfaction with services (60.6%) were considered by the respondents as factors affecting the utilization of university health services. Students-medical staff relationship and accessibility to health facility (77.6% and 74.3% respectively) were, however, not considered as factors that affect utilization of university health services. It is recommended that to improve utilization and cost of care, government should make necessary efforts to incorporate tertiary institution into National Health Insurance scheme so that students above the age of 18 years can benefit from free treatment.

Managing bundled payments.

PubMed

Draper, Andrew

2011-04-01

Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

CMOS-compatible plenoptic detector for LED lighting applications.

PubMed

Neumann, Alexander; Ghasemi, Javad; Nezhadbadeh, Shima; Nie, Xiangyu; Zarkesh-Ha, Payman; Brueck, S R J

2015-09-07

LED lighting systems with large color gamuts, with multiple LEDs spanning the visible spectrum, offer the potential of increased lighting efficiency, improved human health and productivity, and visible light communications addressing the explosive growth in wireless communications. The control of this "smart lighting system" requires a silicon-integrated-circuit-compatible, visible, plenoptic (angle and wavelength) detector. A detector element, based on an offset-grating-coupled dielectric waveguide structure and a silicon photodetector, is demonstrated with an angular resolution of less than 1° and a wavelength resolution of less than 5 nm.

[Advances in the study of anti-MRSA natural products].

PubMed

Song, Hao; Qin, Yong

2016-05-01

Methicillin-resistant Staphylococcus aureus (MRSA) is a multi-drug resistant pathogenic bacteria, which has seriously threatened human health for a long time. Discovery of novel anti-MRSA lead compounds with high efficiency and low toxicity represents an important research focus in the realm of antibiotic studies. Owing to their structural diversity and complexity, natural products have exhibited unique advantages and great potential in the development of anti-MRSA new drugs.This review summarizes the studies of anti-MRSA natural products and their relevant medicinal chemistry reported since 2010.

Recent Advances in Marine Algae Polysaccharides: Isolation, Structure, and Activities.

PubMed

Xu, Shu-Ying; Huang, Xuesong; Cheong, Kit-Leong

2017-12-13

Marine algae have attracted a great deal of interest as excellent sources of nutrients. Polysaccharides are the main components in marine algae, hence a great deal of attention has been directed at isolation and characterization of marine algae polysaccharides because of their numerous health benefits. In this review, extraction and purification approaches and chemico-physical properties of marine algae polysaccharides (MAPs) are summarized. The biological activities, which include immunomodulatory, antitumor, antiviral, antioxidant, and hypolipidemic, are also discussed. Additionally, structure-function relationships are analyzed and summarized. MAPs' biological activities are closely correlated with their monosaccharide composition, molecular weights, linkage types, and chain conformation. In order to promote further exploitation and utilization of polysaccharides from marine algae for functional food and pharmaceutical areas, high efficiency, and low-cost polysaccharide extraction and purification methods, quality control, structure-function activity relationships, and specific mechanisms of MAPs activation need to be extensively investigated.

Static and Dynamic Behaviour Assessment of the Trajan Arch by Means of New Monitoring Technologies

NASA Astrophysics Data System (ADS)

Petti, L.; Barone, F.; Mammone, A.; Giordano, G.

2017-08-01

An effective assessment of the static and dynamic structural behavior of historical monuments requires the development and validation of suitable adaptive structural models using high-quality experimental data acquired with an effectively continuous and distributed monitoring. Furthermore, the adaptive strategy allows an efficient evaluation of the health status and of the evolution along the time of a historical monument, providing relevant information to plan appropriate actions for its long-term preservation. The Trajan Arch in Benevento chosen as a case of study to develop and apply this new adaptive strategy in cultural heritage conservation. The paper, after a description of the innovative monitoring system, based on state-of-the-art mechanical sensors, presents and discusses the results of two tests, comparing the measurements with the predictions of an adaptive structural FEM model developed for the dynamical simulation of the Trajan Arch.

Impact of IT on health care professionals: changes in work and the productivity paradox.

PubMed

Hebert, M A

1998-05-01

Health care organizations are under increasing pressure to become more efficient while at the same time maintaining or improving the quality of care. Information technology (IT), with its potential to increase efficiency, accuracy and accessibility of information, has been expected to play an important role in supporting these changes. We report the impact of patient care information systems on health care professionals in five community hospitals. The study framework incorporated both quality of care in Donabedian's elements of structure-process-outcome and Grusec's three levels of IT impact: direct substitution, proceduralization and new capabilities. The study results suggest that, for specific tasks, IT increased efficiency and productivity--a single employee was able to complete more tasks. However, this produced other consequences not predicted. Participants noted this change did not 'free up time' to spend with patients, but meant there were potentially more opportunities to provide services and more tasks to complete. Other effects included: reduced job satisfaction as more time was spent on the computer; less frequent interactions with patients and for shorter duration; and an increasingly 'visible' accountability as performance was easily monitored. There were also changes in roles and responsibilities as the computer enabled tasks to be carried out from a number of locations and by a variety of personnel. When innovations are introduced into organizations there are both expected and unexpected consequences. Increased awareness of the interactive relationship between computer users and the technology helps organizations better understand why results do, or do not, occur. One must look beyond just simply increasing productivity by replacing manual tasks with automated ones, to examining how the changes influence the nature of work and relationships within the organization.

Improving the Efficiency and Ease of Healthcare Analysis Through Use of Data Visualization Dashboards.

PubMed

Stadler, Jennifer G; Donlon, Kipp; Siewert, Jordan D; Franken, Tessa; Lewis, Nathaniel E

2016-06-01

The digitization of a patient's health record has profoundly impacted medicine and healthcare. The compilation and accessibility of medical history has provided clinicians an unprecedented, holistic account of a patient's conditions, procedures, medications, family history, and social situation. In addition to the bedside benefits, this level of information has opened the door for population-level monitoring and research, the results of which can be used to guide initiatives that are aimed at improving quality of care. Cerner Corporation partners with health systems to help guide population management and quality improvement projects. With such an enormous and diverse client base-varying in geography, size, organizational structure, and analytic needs-discerning meaning in the data and how they fit with that particular hospital's goals is a slow, difficult task that requires clinical, statistical, and technical literacy. This article describes the development of dashboards for efficient data visualization at the healthcare facility level. Focusing on two areas with broad clinical importance, sepsis patient outcomes and 30-day hospital readmissions, dashboards were developed with the goal of aggregating data and providing meaningful summary statistics, highlighting critical performance metrics, and providing easily digestible visuals that can be understood by a wide range of personnel with varying levels of skill and areas of expertise. These internal-use dashboards have allowed associates in multiple roles to perform a quick and thorough assessment on a hospital of interest by providing the data to answer necessary questions and to identify important trends or opportunities. This automation of a previously manual process has greatly increased efficiency, saving hours of work time per hospital analyzed. Additionally, the dashboards have standardized the analysis process, ensuring use of the same metrics and processes so that overall themes can be compared across hospitals and health systems.

Structural efficiency studies of corrugated compression panels with curved caps and beaded webs

NASA Technical Reports Server (NTRS)

Davis, R. C.; Mills, C. T.; Prabhakaran, R.; Jackson, L. R.

1984-01-01

Curved cross-sectional elements are employed in structural concepts for minimum-mass compression panels. Corrugated panel concepts with curved caps and beaded webs are optimized by using a nonlinear mathematical programming procedure and a rigorous buckling analysis. These panel geometries are shown to have superior structural efficiencies compared with known concepts published in the literature. Fabrication of these efficient corrugation concepts became possible by advances made in the art of superplastically forming of metals. Results of the mass optimization studies of the concepts are presented as structural efficiency charts for axial compression.

The NASA Aircraft Energy Efficiency program

NASA Technical Reports Server (NTRS)

Klineberg, J. M.

1979-01-01

A review is provided of the goals, objectives, and recent progress in each of six aircraft energy efficiency programs aimed at improved propulsive, aerodynamic and structural efficiency for future transport aircraft. Attention is given to engine component improvement, an energy efficient turbofan engine, advanced turboprops, revolutionary gains in aerodynamic efficiency for aircraft of the late 1990s, laminar flow control, and composite primary aircraft structures.

Nanodiamond-Based Composite Structures for Biomedical Imaging and Drug Delivery.

PubMed

Rosenholm, Jessica M; Vlasov, Igor I; Burikov, Sergey A; Dolenko, Tatiana A; Shenderova, Olga A

2015-02-01

Nanodiamond particles are widely recognized candidates for biomedical applications due to their excellent biocompatibility, bright photoluminescence based on color centers and outstanding photostability. Recently, more complex architectures with a nanodiamond core and an external shell or nanostructure which provides synergistic benefits have been developed, and their feasibility for biomedical applications has been demonstrated. This review is aimed at summarizing recent achievements in the fabrication and functional demonstrations of nanodiamond-based composite structures, along with critical considerations that should be taken into account in the design of such structures from a biomedical point of view. A particular focus of the review is core/shell structures of nanodiamond surrounded by porous silica shells, which demonstrate a remarkable increase in drug loading efficiency; as well as nanodiamonds decorated with carbon dots, which have excellent potential as bioimaging probes. Other combinations are also considered, relying on the discussed inherent properties of the inorganic materials being integrated in a way to advance inorganic nanomedicine in the quest for better health-related nanotechnology.

42 CFR 414.420 - Physician or treating practitioner authorization and consideration of clinical efficiency and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Physician or treating practitioner authorization and consideration of clinical efficiency and value of items. 414.420 Section 414.420 Public Health... practitioner authorization and consideration of clinical efficiency and value of items. (a) Prescription for a...

42 CFR 414.420 - Physician or treating practitioner authorization and consideration of clinical efficiency and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Physician or treating practitioner authorization and consideration of clinical efficiency and value of items. 414.420 Section 414.420 Public Health... practitioner authorization and consideration of clinical efficiency and value of items. (a) Prescription for a...

Technological innovation and its effect on public health in the United States

PubMed Central

Gill, Preetinder Singh

2013-01-01

Background Good public health ensures an efficient work force. Organizations can ensure a prominent position on the global stage by staying on the leading edge of technological development. Public health and technological innovation are vital elements of prosperous economies. It is important to understand how these elements affect each other. This research study explored and described the relationship between these two critical elements/constructs. Methods Indicators representing technological innovation and public health were identified. Indicator data from 2000 to 2009 were collected from various US federal government sources, for the four US Census regions. The four US Census regions were then compared in terms of these indicators. Canonical correlation equations were formulated to identify combinations of the indicators that are strongly related to each other. Additionally, the cause–effect relationship between public health and technological innovation was described using the structural equation modeling technique. Results The four US Census regions ranked differently in terms of both type of indicators in a statistically significant manner. The canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, with a magnitude > 0.65 at the 95% confidence interval, for all census regions. Structural equation modeling analysis provided β < −0.69 and Student’s t statistic > 12.98, for all census regions. The threshold Student’s t statistic was 1.98. Hence, it was found that the β values were significant at the 95% confidence interval, for all census regions. Discussion The results of the study showed that better technological innovation indicator scores were associated with better public health indicator scores. Furthermore, the study provided preliminary evidence that technological innovation shares causal relation with public health. PMID:23378771

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

PubMed Central

2012-01-01

Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

PubMed

Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

2012-06-22

In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

Interpersonal relationships and safety culture in Brazilian health care organisations.

PubMed

Migowski, Eliana R; Oliveira Júnior, Nery; Riegel, Fernando; Migowski, Sérgio A

2018-06-20

To examine the association between interpersonal relationships, nursing leadership and patient safety culture and the impact on the efficiency of hospitals. Hospitals are still affected by the increased complexity of the treatments offered and by the diverse knowledge of professionals involved, which has made this assistance model ineffective, expensive and unsustainable over time. A qualitative study of 32 professionals from three large hospitals in Southern Brazil was made. Semi-structured interviews, document analysis and analysis of electronic records were used. All the hospitals had infection rates and an average stay higher than their goal. Lack of interpersonal relationships and physicians failing to commit to organisational objectives were demonstrated. Nursing leadership styles are not definitive factors to improving patient safety and efficiency. The flaws in consolidating interpersonal relationships seem to be related to difficulties in consolidating patient safety culture, which prevented hospitals reaching their efficiency indicators. Professionals who work at the patients' bedside should be involved in the development of strategies, in order to commit them to the organisational objectives. The consolidation of interpersonal relationships of nursing professionals can lead to improvements with medical professionals, with positive impacts on patient safety and efficiency. © 2018 John Wiley & Sons Ltd.

Methodological approach to a multidimensional evaluation of food and nutrition policies.

PubMed

Santos, Leonor Maria Pacheco; dos Santos, Sandra Maria Chaves

2003-01-01

Recommendations arising from global conferences and summits, expressed the need to formulate and implement public policies to improve household food security. In the context of maximizing benefits given available resources, comprehensive evaluations of the nutrition policies and programs are needed. One obstacle to overcome was a clear definition of terminology; the words efficiency, effectiveness, efficacy and impact, widely used in the context of program evaluation, are sometimes interchanged and there is no consensus about their precise definition. Another approach to health evaluation is based in the paradigm structure-process-outcome. The level structure contemplated the installations, resources, instruments (physical and discursive), as well as the technical bureaucratic organizational structures. Process encompassed the whole set of intervention activities developed, whereas the dimension of outcome comprised the effects of interventions on the health and nutrition of beneficiaries. Each of the three dimensions constitutes a continuum in the evaluation procedure: the structure only fulfills its purposes if the processes are adequate and conversely, processes cannot alone supersede structural limitations. Moreover, all the three dimensions only reach their ultimate objectives through the completion of outcomes. The methodology proposed here has been tested in the case of Bahia, Northeast Brazil, and it was found to be adequate for this type of analysis. We hope this approach of a comprehensive multidimensional evaluation, constitutes an effective contribution for program planners and program managers, in particular with regard to the obstacles detected, some of which can surely be overcome.

Distributed Prognostics based on Structural Model Decomposition

NASA Technical Reports Server (NTRS)

Daigle, Matthew J.; Bregon, Anibal; Roychoudhury, I.

2014-01-01

Within systems health management, prognostics focuses on predicting the remaining useful life of a system. In the model-based prognostics paradigm, physics-based models are constructed that describe the operation of a system and how it fails. Such approaches consist of an estimation phase, in which the health state of the system is first identified, and a prediction phase, in which the health state is projected forward in time to determine the end of life. Centralized solutions to these problems are often computationally expensive, do not scale well as the size of the system grows, and introduce a single point of failure. In this paper, we propose a novel distributed model-based prognostics scheme that formally describes how to decompose both the estimation and prediction problems into independent local subproblems whose solutions may be easily composed into a global solution. The decomposition of the prognostics problem is achieved through structural decomposition of the underlying models. The decomposition algorithm creates from the global system model a set of local submodels suitable for prognostics. Independent local estimation and prediction problems are formed based on these local submodels, resulting in a scalable distributed prognostics approach that allows the local subproblems to be solved in parallel, thus offering increases in computational efficiency. Using a centrifugal pump as a case study, we perform a number of simulation-based experiments to demonstrate the distributed approach, compare the performance with a centralized approach, and establish its scalability. Index Terms-model-based prognostics, distributed prognostics, structural model decomposition ABBREVIATIONS

The next frontier: Bringing collaborative care to scale.

PubMed

Levkovich, Natalie

2015-12-01

In my position as CEO of the Health Federation of Philadelphia (HFP), I am acutely aware of the effort required to implement practice transformation, including fully integrated behavioral health (IBH) and primary care. We integrate knowledge of our marketplace, best practices from the field, and the wisdom of our providers to achieve our practice goals. We have found this to be a key to the success of our advocacy, efficient replication, and rapid regional spread of IBH. Even when payment models, the other driving barrier to IBH, catch up and reflect a better fit with the demands of efficiently integrated, whole-person, teambased care, the challenges resulting from lack of implementation support will still exist. That's where the Collaborative Family Healthcare Association (CFHA) comes in. CFHA can be that centralized and reliable structure to help guide the planning and application of the essential core elements of integrated care: aligned systems, metrics and operations; patient and family centered approaches; workforce competencies; and strategies for stakeholder engagement. In spite of its influence, integrity, and accomplishments, CFHA is still a "too-well-kept secret." By embracing a focused approach, strategic partnerships, clear communication of our unique strengths and capabilities, and the collective might that exists within our own CFHA family, CFHA can grow and thrive and continue to lead the field of collaborative family health care. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Optimisation of GaN LEDs and the reduction of efficiency droop using active machine learning

DOE PAGES

Rouet-Leduc, Bertrand; Barros, Kipton Marcos; Lookman, Turab; ...

2016-04-26

A fundamental challenge in the design of LEDs is to maximise electro-luminescence efficiency at high current densities. We simulate GaN-based LED structures that delay the onset of efficiency droop by spreading carrier concentrations evenly across the active region. Statistical analysis and machine learning effectively guide the selection of the next LED structure to be examined based upon its expected efficiency as well as model uncertainty. This active learning strategy rapidly constructs a model that predicts Poisson-Schrödinger simulations of devices, and that simultaneously produces structures with higher simulated efficiencies.

Optimal statistical damage detection and classification in an experimental wind turbine blade using minimum instrumentation

NASA Astrophysics Data System (ADS)

Hoell, Simon; Omenzetter, Piotr

2017-04-01

The increasing demand for carbon neutral energy in a challenging economic environment is a driving factor for erecting ever larger wind turbines in harsh environments using novel wind turbine blade (WTBs) designs characterized by high flexibilities and lower buckling capacities. To counteract resulting increasing of operation and maintenance costs, efficient structural health monitoring systems can be employed to prevent dramatic failures and to schedule maintenance actions according to the true structural state. This paper presents a novel methodology for classifying structural damages using vibrational responses from a single sensor. The method is based on statistical classification using Bayes' theorem and an advanced statistic, which allows controlling the performance by varying the number of samples which represent the current state. This is done for multivariate damage sensitive features defined as partial autocorrelation coefficients (PACCs) estimated from vibrational responses and principal component analysis scores from PACCs. Additionally, optimal DSFs are composed not only for damage classification but also for damage detection based on binary statistical hypothesis testing, where features selections are found with a fast forward procedure. The method is applied to laboratory experiments with a small scale WTB with wind-like excitation and non-destructive damage scenarios. The obtained results demonstrate the advantages of the proposed procedure and are promising for future applications of vibration-based structural health monitoring in WTBs.

Assessing the value of information for long-term structural health monitoring

NASA Astrophysics Data System (ADS)

Pozzi, Matteo; Der Kiureghian, Armen

2011-04-01

In the field of Structural Health Monitoring, tests and sensing systems are intended as tools providing diagnoses, which allow the operator of the facility to develop an efficient maintenance plan or to require extraordinary measures on a structure. The effectiveness of these systems depends directly on their capability to guide towards the most optimal decision for the prevailing circumstances, avoiding mistakes and wastes of resources. Though this is well known, most studies only address the accuracy of the information gained from sensors without discussing economic criteria. Other studies evaluate these criteria separately, with only marginal or heuristic connection with the outcomes of the monitoring system. The concept of "Value of Information" (VoI) provides a rational basis to rank measuring systems according to a utility-based metric, which fully includes the decision-making process affected by the monitoring campaign. This framework allows, for example, an explicit assessment of the economical justifiability of adopting a sensor depending on its precision. In this paper we outline the framework for assessing the VoI, as applicable to the ranking of competitive measuring systems. We present the basic concepts involved, highlight issues related to monitoring of civil structures, address the problem of non-linearity of the cost-to-utility mapping, and introduce an approximate Monte Carlo approach suitable for the implementation of time-consuming predictive models.

Healthy coral reefs may assure coastal protection in face of climate change related sea level rise

NASA Astrophysics Data System (ADS)

Harris, D. L.; Rovere, A.; Parravicini, V.; Casella, E.; Canavesio, R.; Collin, A.

2016-12-01

Coral reefs are diverse ecosystems that support millions of people worldwide providing crucial services, of which, coastal protection is one of the most relevant. The efficiency of coral reefs in protecting coastlines and dissipating waves is directly linked to the cover of living corals and three dimensional reef structural complexity. Climate change and human impacts are leading to severe global reductions in live coral cover, posing serious concerns regarding the capacity of degraded reef systems in protecting tropical coastal regions. Although it is known that the loss of structurally complex reefs may lead to greater erosion of coastlines, this process has rarely been quantified and it is still unknown whether the maintenance of healthy reefs through conservation will be enough to guarantee coastal protection during rising sea levels. We show that a significant loss of wave dissipation and a subsequent increase in back-reef wave height (up to 5 times present wave height) could occur even at present sea level if living corals are lost and reef structural complexity is reduced. Yet we also show that healthy reefs, measured by structural complexity and efficiency of vertical reef accretion, may maintain their present capacity of wave dissipation even under rising sea levels. Our results indicate that the health of coral reefs and not sea level rise will be the major determinant of the coastal protection services provided by coral reefs and calls for investments into coral reef conservation to ensure the future protection of tropical coastal communities.

Wireless Zigbee strain gage sensor system for structural health monitoring

NASA Astrophysics Data System (ADS)

Ide, Hiroshi; Abdi, Frank; Miraj, Rashid; Dang, Chau; Takahashi, Tatsuya; Sauer, Bruce

2009-05-01

A compact cell phone size radio frequency (ZigBee) wireless strain measurement sensor system to measure the structural strain deformation was developed. The developed system provides an accurate strain measurement data stream to the Internet for further Diagnostic and Prognostic (DPS) correlation. Existing methods of structural measurement by strain sensors (gauges) do not completely satisfy problems posed by continuous structural health monitoring. The need for efficient health monitoring methods with real-time requirements to bidirectional data flow from sensors and to a commanding device is becoming critical for keeping our daily life safety. The use of full-field strain measurement techniques could reduce costly experimental programs through better understanding of material behavior. Wireless sensor-network technology is a monitoring method that is estimated to grow rapidly providing potential for cost savings over traditional wired sensors. The many of currently available wireless monitoring methods have: the proactive and constant data rate character of the data streams rather than traditional reactive, event-driven data delivery; mostly static node placement on structures with limited number of nodes. Alpha STAR Electronics' wireless sensor network system, ASWN, addresses some of these deficiencies, making the system easier to operate. The ASWN strain measurement system utilizes off-the-shelf sensors, namely strain gauges, with an analog-to-digital converter/amplifier and ZigBee radio chips to keep cost lower. Strain data is captured by the sensor, converted to digital form and delivered to the ZigBee radio chip, which in turn broadcasts the information using wireless protocols to a Personal Data Assistant (PDA) or Laptop/Desktop computers. From here, data is forwarded to remote computers for higher-level analysis and feedback using traditional cellular and satellite communication or the Ethernet infrastructure. This system offers a compact size, lower cost, and temperature insensitivity for critical structural applications, which require immediate monitoring and feedback.

Does the use of structured reporting improve usability? A comparative evaluation of the usability of two approaches for findings reporting in a large-scale telecardiology context.

PubMed

Lacerda, Thaisa Cardoso; von Wangenheim, Christiane Gresse; von Wangenheim, Aldo; Giuliano, Isabela

2014-12-01

One of the main reasons that leads to a low adoption rate of telemedicine systems is poor usability. An aspect that influences usability during the reporting of findings is the input mode, e.g., if a free-text (FT) or a structured report (SR) interface is employed. The objective of our study is to compare the usability of FT and ST telemedicine systems, specifically in terms of user satisfaction, efficiency and general usability. We comparatively evaluate the usability of these two input modes in a telecardiology system for issuing electrocardiography reports in the context of a statewide telemedicine system in Brazil with more than 350.000 performed tele-electrocardiography examinations. We adopted a multiple method research strategy, applying three different kinds of usability evaluations: user satisfaction was evaluated through interviews with seven medical professionals using the System Usability Scale (SUS) questionnaire and specific questions related to adequacy and user experience. Efficiency was evaluated by estimating execution time using the Keystroke-Level Model (KLM). General usability was assessed based on the conformity of the systems to a set of e-health specific usability heuristics. The results of this comparison provide a first indication that a structured report (SR) input mode for such a system is more satisfactory and efficient with a larger conformity to usability heuristics than free-text (FT) input. User satisfaction using the SUS questionnaire has been scored in average with 58.8 and 77.5 points for the FT and SR system, respectively, which means that the SR system was rated 18.65 points higher than the FT system. In terms of efficiency, the completion of a findings report using the SR mode is estimated to take 8.5s, 3.74 times faster than using the FT system (31.8s). The SR system also demonstrated less violations to usability heuristics (8 points) in comparison to 14 points observed in the FT system. These results provide a first indication that the usage of structured reporting as an input mode in telecardiology systems may enhance usability. This also seems to confirm the advantages of the usage of structured reporting, as already described in the literature for other areas such as teleradiology. Copyright © 2014 Elsevier Inc. All rights reserved.

[Managing a health research institute: towards research excellence through continuous improvement].

PubMed

Olmedo, Carmen; Buño, Ismael; Plá, Rosa; Lomba, Irene; Bardinet, Thierry; Bañares, Rafael

2015-01-01

Health research institutes are a strategic commitment considered the ideal environment to develop excellence in translational research. Achieving quality research requires not only a powerful scientific and research structure but also the quality and integrity of management systems that support it. The essential instruments in our institution were solid strategic planning integrated into and consistent with the system of quality management, systematic evaluation through periodic indicators, measurement of key user satisfaction and internal audits, and implementation of an innovative information management tool. The implemented management tools have provided a strategic thrust to our institute while ensuring a level of quality and efficiency in the development and management of research that allows progress towards excellence in biomedical research. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Structuring a central business office to succeed in a managed care dominated environment.

PubMed

Lomicka, E W

2001-01-01

Integrated delivery systems have begun to consolidate the business office functions of their member facilities in response to a decline in managed care revenues and an increase in health care expenses. Many who have pursued this strategy have experienced cost reductions through staff restructuring, but have not experienced the revenue retention, cash acceleration, and other performance gains originally envisioned. This often occurs when the role of the central business office (CBO) has been limited to serving only the "back-office" functions of claims processing. In today's health care environment, the viability of a CBO depends on its responsiveness to the administrative complexities of managed care. Successful CBOs accommodate extensive cross-functional coordination, achieve operational efficiencies through the use of automation, and adopt best practices for implementing managed care contractual obligations.

Determinants of Self-Care in Diabetic Patients Based on Health Belief Model

PubMed Central

Dehghani-Tafti, Abbasali; Mahmoodabad, Seyed Saeed Mazloomy; Morowatisharifabad, Mohammad Ali; Ardakani, Mohammad Afkhami; Rezaeipandari, Hassan; Lotfi, Mohammad Hassan

2015-01-01

Introduction: The aim of this study was to determine self-care predictors in diabetic patients based on health belief model. Materials and Methods: The cross-sectional study was conducted on 110 diabetic patients referred to health service centers in Ardakan city, Yazd, Iran. The data was collected by a questionnaire including perceived benefits, barriers, severity, susceptibility, self-efficacy, social support, self-care behaviors and demographic variables. Results: Regularly medicine use (mean= 6.48 times per week) and shoes checking (mean= 1.17 times per week) were reported as the highest and the lowest self-care behaviors respectively. Health belief model constructs including perceived benefits, barriers, severity, susceptibility, self-efficacy and social support predicted 33.5% of the observed variance of self-care behaviors. Perceived susceptibility and self-efficacy had positive effect on self-care behavior; whereas perceived barrier’s has negative effect. Self-efficacy, perceived susceptibility and barriers were most powerful predictor respectively. Conclusion: The findings approved the efficiency of health belief model in prediction of self-care behaviors among diabetic patients. The findings realized the health belief model structure; therefore, it can be used as a framework for designing and implementing educational interventions in diabetes control plans. PMID:26156902

Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region

PubMed Central

Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.

2016-01-01

The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process. PMID:27034543

Health workers' perceptions of private-not-for-profit health facilities' organizational culture and its influence on retention in Uganda.

PubMed

Shumba, Constance Sibongile; Kielmann, Karina; Witter, Sophie

2017-12-06

An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs' working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention. Thirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi-structured topic guide. Interview transcripts were analysed using thematic content analysis. Interviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management. The findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.

Those conversion blues.

PubMed

Forgione, D A

1999-01-01

With the ever-increasing market penetration of capitated payment systems throughout health care markets, average payment rates for health services have dropped correspondingly. At the same time, the added competitive pressures from managed care organizations have served to increase the demand for new capital investment in information systems, lower cost facilities, and innovative modes for delivering all types of health care services. As a result, many nonprofit health care organizations have converted, or have attempted to convert, to for-profit status in an effort to gain access to the public equity capital markets. As hospitals, Blue Cross and Blue Shield organizations, and other nonprofit health care organizations across the U.S. seek to convert to for-profit status, they are finding the path is not easy. Access to capital, operating efficiencies, and the need to accelerate movement into new markets are offset by public benefit obligations, potential private inurement, and significant political cost issues. The bottom line is whether the conversion will be structured to both protect the public interest and allow the health care organization the flexibility and access to capital it needs in order to continue as a viable, competitive organization into the next millennium.

The impact of national policies on animal disease reporting within selected Pacific Island Countries and Territories (PICTs).

PubMed

Tukana, Andrew; Hedlefs, Robert; Gummow, Bruce

2018-04-20

A semi-systematic literature review of national policies was carried out in relation to surveillance and disease reporting in Pacific Island Countries and Territories (PICTs). It also analysed the animal disease reporting structures in Fiji, Papua New Guinea (PNG), Vanuatu and the Solomon Islands. The strengths, weaknesses, opportunities and threats (SWOT) of those reporting structures were examined in relation to how they impacted the detection and management of animal diseases in PICTs. Field missions collected information on animal disease reporting structures and these were discussed in detail with country officials and documented. The findings from the literature review indicated that there is very little policy to support work in surveillance and disease reporting within national government structures of the countries studied. This increases the potential for disease transmission and the introduction of exotic diseases as the efficiency of disease reporting is low. The findings from the SWOT analysis of the reporting structures indicated that there were commonalities across the countries studied, i.e. reporting structures were long with multiple legs that were not functioning properly and this was worsened when positions were vacant in the reporting structure. The hierarchical nature of the reporting structure also reduced reporting efficiency as reports took a longer time to reach decision makers at the top of the structure. High officer turnover and the shortage of veterinarians in the countries studied also affected the efficiency of disease reporting as most in-county officials were inexperienced and could not recognise disease signs and there were no veterinarians to supervise them. Existing reporting structures need to be reviewed to remove duplication and shorten the chain. However, this could override existing command structures and would need to be documented and awareness created with the officers involved. There also needs to be more collaboration with FAO, OIE, academic institutions and national governments to create an environment conducive for the development of policies that support work on surveillance to improve disease reporting in PICTs. The shortage of veterinarians could be addressed by influencing national governments to create better policies to retain veterinarians in the animal health services; this should be supported by creating reasonable work conditions and remuneration packages. This should also be supported with policies to send young graduates to study veterinary science overseas and have a career path for them when they return. Engagement of retired veterinarians from developed countries and re-evaluating the criteria for veterinarian registration could be short-term solutions to address the shortage of veterinarians in PICTs.

Understanding value in health data ecosystems: A review of current evidence and ways forward.

PubMed

Sonja, Marjanovic; Ioana, Ghiga; Miaoqing, Yang; Anna, Knack

2018-01-01

The potential of health data to improve the efficiency and effectiveness of health research and development, healthcare delivery, and health systems more widely is substantial. There are many initiatives across the EU that are experimenting with ways to capture value and address the nexus of technical, legal, ethics-related, governance and data protection-related, and cultural challenges to delivering potential benefits for society and the economy. The field of health data research and policy is highly dynamic and there is a need for further reflection, thematic learning and evaluation to better understand how to create and connect receptive places, to inform future interventions and to identify transferable lessons. Our research emphasises that realising the benefits of health data at scale will require: a simultaneous focus on the technological and structural conditions that are required; collaboration and coordination to transform working cultures and build health and care workforce and citizen capacity to engage with data; and efforts to ensure that policy, industry, and research communities respond to public concerns, needs, and expectations in a timely and sustained manner. The global community of individuals and organisations with a stake in health data will also need to consider how progress can benefit different populations across the world in an equitable manner.

Understanding value in health data ecosystems

PubMed Central

Sonja, Marjanovic; Ioana, Ghiga; Miaoqing, Yang; Anna, Knack

2018-01-01

Abstract The potential of health data to improve the efficiency and effectiveness of health research and development, healthcare delivery, and health systems more widely is substantial. There are many initiatives across the EU that are experimenting with ways to capture value and address the nexus of technical, legal, ethics-related, governance and data protection-related, and cultural challenges to delivering potential benefits for society and the economy. The field of health data research and policy is highly dynamic and there is a need for further reflection, thematic learning and evaluation to better understand how to create and connect receptive places, to inform future interventions and to identify transferable lessons. Our research emphasises that realising the benefits of health data at scale will require: a simultaneous focus on the technological and structural conditions that are required; collaboration and coordination to transform working cultures and build health and care workforce and citizen capacity to engage with data; and efforts to ensure that policy, industry, and research communities respond to public concerns, needs, and expectations in a timely and sustained manner. The global community of individuals and organisations with a stake in health data will also need to consider how progress can benefit different populations across the world in an equitable manner. PMID:29416943

Battling Malaria in Rural Zambia with Modern Technology: A Qualitative Study on the Value of Cell Phones, Geographical Information Systems, Asymptomatic Carriers and Rapid Diagnostic Tests to Identify, Treat and Control Malaria.

PubMed

Nygren, David; Isaksson, Arvid Lissel

2014-02-04

During the last decade much progress has been made in reducing malaria transmission in Macha, Southern Province, Zambia. Introduction of artemisinin combination therapies as well as mass screenings of asymptomatic carriers is believed to have contributed the most. When an endemic malaria situation is moving towards a non-endemic situation the resident population loses acquired immunity and therefore active case detection and efficient surveillance is crucial to prevent epidemic outbreaks. Our purpose was to evaluate the impact of cell phone surveillance and geographical information systems on malaria control in Macha. Furthermore, it evaluates what screening and treatment of asymptomatic carriers and implementation of rapid diagnostic tests in rural health care has led to. Ten in-depth semi-structured interviews, field observations and data collection were performed at the Macha Research Trust and at surrounding rural health centers. This qualitative method was inspired by rapid assessment procedure. The cell phone surveillance has been easily integrated in health care, and its integration with Geographical Information Systems has provided the ability to follow malaria transmission on a weekly basis. In addition, active case detection of asymptomatic carriers has been fruitful, which is reflected in it soon being applied nationwide. Furthermore, rapid diagnostic tests have provided rural health centers with reliable malaria diagnostics, thereby decreasing excessive malaria treatments and selection for drug resistance. This report reflects the importance of asymptomatic carriers in targeting malaria elimination, as well as development of effective surveillance systems when transmission decreases. Such an approach would be cost-efficient in the long run through positive effects in reduced child mortality and relief in health care.

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

PubMed Central

Alhuwail, Dari

2016-01-01

Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. PMID:27437035

Ensemble Modeling of the Likely Public Health Impact of a Pre-Erythrocytic Malaria Vaccine

PubMed Central

Smith, Thomas; Ross, Amanda; Maire, Nicolas; Chitnis, Nakul; Studer, Alain; Hardy, Diggory; Brooks, Alan; Penny, Melissa; Tanner, Marcel

2012-01-01

Background The RTS,S malaria vaccine may soon be licensed. Models of impact of such vaccines have mainly considered deployment via the World Health Organization's Expanded Programme on Immunization (EPI) in areas of stable endemic transmission of Plasmodium falciparum, and have been calibrated for such settings. Their applicability to low transmission settings is unclear. Evaluations of the efficiency of different deployment strategies in diverse settings should consider uncertainties in model structure. Methods and Findings An ensemble of 14 individual-based stochastic simulation models of P. falciparum dynamics, with differing assumptions about immune decay, transmission heterogeneity, and treatment access, was constructed. After fitting to an extensive library of field data, each model was used to predict the likely health benefits of RTS,S deployment, via EPI (with or without catch-up vaccinations), supplementary vaccination of school-age children, or mass vaccination every 5 y. Settings with seasonally varying transmission, with overall pre-intervention entomological inoculation rates (EIRs) of two, 11, and 20 infectious bites per person per annum, were considered. Predicted benefits of EPI vaccination programs over the simulated 14-y time horizon were dependent on duration of protection. Nevertheless, EPI strategies (with an initial catch-up phase) averted the most deaths per dose at the higher EIRs, although model uncertainty increased with EIR. At two infectious bites per person per annum, mass vaccination strategies substantially reduced transmission, leading to much greater health effects per dose, even at modest coverage. Conclusions In higher transmission settings, EPI strategies will be most efficient, but vaccination additional to the EPI in targeted low transmission settings, even at modest coverage, might be more efficient than national-level vaccination of infants. The feasibility and economics of mass vaccination, and the circumstances under which vaccination will avert epidemics, remain unclear. The approach of using an ensemble of models provides more secure conclusions than a single-model approach, and suggests greater confidence in predictions of health effects for lower transmission settings than for higher ones. Please see later in the article for the Editors' Summary PMID:22272189

Impact of PACS in hospital management

NASA Astrophysics Data System (ADS)

Hur, Gham; Cha, Soon-Joo; Kim, Yong H.; Hwang, Yoon J.; Kim, Soo Y.

2002-05-01

Since the low-cost, NT-based, full PACS was successfully implemented in a large-scale hospital at the end of 1999, many hospital administrators have rushed to purchase the system competitively. It is now a worldwide trend to implement the technology, but Korea has several unique environments for the fast spread of the full PACS. Since hospitals in Korea operate inpatient and outpatient clinics in the same building and use identical OCS, full integration of PACS with the OCS was relatively easy and highly efficient. The simple governing structures of the hospitals also made the decision-making process short and effective. In addition, the national health insurance reimbursement policy that started pay in the beginning of 2000 has also played a catalytic role for the swift propagation of PACS. The recent appearance of the affordable PACS gave hospital administrators the opportunity to learn and understand the role of digital imaging in the areas that are directly related to the efficiency and quality of medical services, as well as cost containment. Furthermore, PACS provided them with windows to the 'all-digital hospital,' which will lead them to realign policies in the management of the hospitals in order to compete successfully in the fast-changing world of health care.

Structural and functional correlates for language efficiency in auditory word processing.

PubMed

Jung, JeYoung; Kim, Sunmi; Cho, Hyesuk; Nam, Kichun

2017-01-01

This study aims to provide convergent understanding of the neural basis of auditory word processing efficiency using a multimodal imaging. We investigated the structural and functional correlates of word processing efficiency in healthy individuals. We acquired two structural imaging (T1-weighted imaging and diffusion tensor imaging) and functional magnetic resonance imaging (fMRI) during auditory word processing (phonological and semantic tasks). Our results showed that better phonological performance was predicted by the greater thalamus activity. In contrary, better semantic performance was associated with the less activation in the left posterior middle temporal gyrus (pMTG), supporting the neural efficiency hypothesis that better task performance requires less brain activation. Furthermore, our network analysis revealed the semantic network including the left anterior temporal lobe (ATL), dorsolateral prefrontal cortex (DLPFC) and pMTG was correlated with the semantic efficiency. Especially, this network acted as a neural efficient manner during auditory word processing. Structurally, DLPFC and cingulum contributed to the word processing efficiency. Also, the parietal cortex showed a significate association with the word processing efficiency. Our results demonstrated that two features of word processing efficiency, phonology and semantics, can be supported in different brain regions and, importantly, the way serving it in each region was different according to the feature of word processing. Our findings suggest that word processing efficiency can be achieved by in collaboration of multiple brain regions involved in language and general cognitive function structurally and functionally.

Structural and functional correlates for language efficiency in auditory word processing

PubMed Central

Kim, Sunmi; Cho, Hyesuk; Nam, Kichun

2017-01-01

This study aims to provide convergent understanding of the neural basis of auditory word processing efficiency using a multimodal imaging. We investigated the structural and functional correlates of word processing efficiency in healthy individuals. We acquired two structural imaging (T1-weighted imaging and diffusion tensor imaging) and functional magnetic resonance imaging (fMRI) during auditory word processing (phonological and semantic tasks). Our results showed that better phonological performance was predicted by the greater thalamus activity. In contrary, better semantic performance was associated with the less activation in the left posterior middle temporal gyrus (pMTG), supporting the neural efficiency hypothesis that better task performance requires less brain activation. Furthermore, our network analysis revealed the semantic network including the left anterior temporal lobe (ATL), dorsolateral prefrontal cortex (DLPFC) and pMTG was correlated with the semantic efficiency. Especially, this network acted as a neural efficient manner during auditory word processing. Structurally, DLPFC and cingulum contributed to the word processing efficiency. Also, the parietal cortex showed a significate association with the word processing efficiency. Our results demonstrated that two features of word processing efficiency, phonology and semantics, can be supported in different brain regions and, importantly, the way serving it in each region was different according to the feature of word processing. Our findings suggest that word processing efficiency can be achieved by in collaboration of multiple brain regions involved in language and general cognitive function structurally and functionally. PMID:28892503

Damage assessment of bridge infrastructure subjected to flood-related hazards

NASA Astrophysics Data System (ADS)

Michalis, Panagiotis; Cahill, Paul; Bekić, Damir; Kerin, Igor; Pakrashi, Vikram; Lapthorne, John; Morais, João Gonçalo Martins Paulo; McKeogh, Eamon

2017-04-01

Transportation assets represent a critical component of society's infrastructure systems. Flood-related hazards are considered one of the main climate change impacts on highway and railway infrastructure, threatening the security and functionality of transportation systems. Of such hazards, flood-induced scour is a primarily cause of bridge collapses worldwide and one of the most complex and challenging water flow and erosion phenomena, leading to structural instability and ultimately catastrophic failures. Evaluation of scour risk under severe flood events is a particularly challenging issue considering that depth of foundations is very difficult to evaluate in water environment. The continual inspection, assessment and maintenance of bridges and other hydraulic structures under extreme flood events requires a multidisciplinary approach, including knowledge and expertise of hydraulics, hydrology, structural engineering, geotechnics and infrastructure management. The large number of bridges under a single management unit also highlights the need for efficient management, information sharing and self-informing systems to provide reliable, cost-effective flood and scour risk management. The "Intelligent Bridge Assessment Maintenance and Management System" (BRIDGE SMS) is an EU/FP7 funded project which aims to couple state-of-the art scientific expertise in multidisciplinary engineering sectors with industrial knowledge in infrastructure management. This involves the application of integrated low-cost structural health monitoring systems to provide real-time information towards the development of an intelligent decision support tool and a web-based platform to assess and efficiently manage bridge assets. This study documents the technological experience and presents results obtained from the application of sensing systems focusing on the damage assessment of water-hazards at bridges over watercourses in Ireland. The applied instrumentation is interfaced with an open-source platform that can offer a more economical remote monitoring solution. The results presented in this investigation provide an important guide for a multidisciplinary approach to bridge monitoring and can be used as a benchmark for the field application of cost-effective and robust sensing methods. This will deliver key information regarding the impact of water-related hazards at bridge structures through an integrated structural health monitoring and management system. Acknowledgement: The authors wish to acknowledge the financial support of the European Commission, through the Marie Curie action Industry-Academia Partnership and Pathways Network BRIDGE SMS (Intelligent Bridge Assessment Maintenance and Management System) - FP7-People-2013-IAPP- 612517.

Fish intestinal microbiome: diversity and symbiosis unravelled by metagenomics.

PubMed

Tarnecki, A M; Burgos, F A; Ray, C L; Arias, C R

2017-02-07

The gut microbiome of vertebrates plays an integral role in host health by stimulating development of the immune system, aiding in nutrient acquisition and outcompeting opportunistic pathogens. Development of next-generation sequencing technologies allows researchers to survey complex communities of microorganisms within the microbiome at great depth with minimal costs, resulting in a surge of studies investigating bacterial diversity of fishes. Many of these studies have focused on the microbial structure of economically significant aquaculture species with the goal of manipulating the microbes to increase feed efficiency and decrease disease susceptibility. The unravelling of intricate host-microbe symbioses and identification of core microbiome functions is essential to our ability to use the benefits of a healthy microbiome to our advantage in fish culture, as well as gain deeper understanding of bacterial roles in vertebrate health. This review aims to summarize the available knowledge on fish gastrointestinal communities obtained from metagenomics, including biases from sample processing, factors influencing assemblage structure, intestinal microbiology of important aquaculture species and description of the teleostean core microbiome. Journal of Applied Microbiology © 2017 The Society for Applied Microbiology.

Research on Damage Identification of Bridge Based on Digital Image Measurement

NASA Astrophysics Data System (ADS)

Liang, Yingjing; Huan, Shi; Tao, Weijun

2017-12-01

In recent years, the number of the damage bridge due to excessive deformation gradually increased, which caused significant property damage and casualties. Hence health monitoring and the damage detection of the bridge structure based on the deflection measurement are particularly important. The current conventional deflection measurement methods, such as total station, connected pipe, GPS, etc., have many shortcomings as low efficiency, heavy workload, low degree of automation, operating frequency and working time constrained. GPS has a low accuracy in the vertical displacement measurement and cannot meet the dynamic measured requirements of the current bridge engineering. This paper presents a bridge health monitoring and damage detection technology based on digital image measurement method in which the measurement accuracy is sub-millimeter level and can achieve the 24-hour automatic non-destructive monitoring for the deflection. It can be concluded from this paper that it is feasible to use digital image measurement method for identification of the damage in the bridge structure, because it has been validated by the theoretical analysis, the laboratory model and the application of the real bridge.

Application of Multiplexed FBG and PZT Impedance Sensors for Health Monitoring of Rocks

PubMed Central

Yang, Yaowen; Annamdas, Venu Gopal Madhav; Wang, Chao; Zhou, Yingxin

2008-01-01

Reliable structural health monitoring (SHM) including nondestructive evaluation (NDE) is essential for safe operation of infrastructure systems. Effective monitoring of the rock components of civil infrastructures such as tunnels and caverns remains challenging. The feasibility of employing smart optical fibre sensor (OFS) and piezoelectric impedance sensor made up of lead zirconate titanate (PZT) for comprehensive health monitoring of rocks, covering load history monitoring/retrieval as well as damage assessment is presented in this paper. The rock specimens are subjected to cyclic loading and their conditions are continuously monitored using OFS and PZT sensors. OFS based multiplexed fibre Bragg grating (FBG) sensors are surface bonded on the rock specimens. Their strain sensing performance is compared with the conventional electric strain gauges (ESGs). In addition, PZT patches are also bonded on the specimens to study the damage pattern during different loading cycles. Unlike the FBGs or ESGs, PZT patches are used as bi-functional sensors and actuators, enabling them to be efficient detectors of incipient damages using the principle of electromechanical impedance. The experimental study demonstrated superior performance of these smart FBG and PZT impedance sensors. This work is expected to be useful for SHM based NDE application of rock structures such as caverns and tunnels. PMID:27879708

The effect of "countrywide services management law" on the work motivation of the employees of Iranian ministry of health.

PubMed

Shafeghat, Hossein; Jafari, Mehdi; Monavarian, Abbas; Shafayi, Maryam; Dehnavieh, Reza

2014-02-01

Labor laws and regulations have inevitable effects on employees' work motivation as well as the overall efficiency and productivity of the organization. This study was conducted to assess the effects of the "Countrywide Services Management Law" on the work motivation level of the employees of the Iranian Ministry of Health. This cross-sectional study was done in 2011 in the Iran's Ministry of Health. Data was collected by a 51-item Likert scale questionnaire, in five domains including: organizational structure, information technology, training patterns, salary and bonus system and re-engineering process. The reliability and validity of the questionnaire was evaluated (Cronbach's alpha= 0.96). Data analysis was conducted using descriptive and inferential statistics (t-test). Out of 192 samples examined, 55.2% of the respondents were female, 88 (45.8%) had BS degree and 116 (60.4%) had less than 10 years' experience. The mean scores in the domains of organizational structure, information technology, training patterns, salary and bonus system and re-engineering patterns were: 3.11, 3.51, 3.05, 3.21 and 3.14, respectively. Relationship between the items related to manpower in the "Countrywide Services Management Law", with employees' work motivation was significant (P < 0.0001). The training patterns did not show a significant relation (P < 0.26) with any of five domains. According to our results and the views of the employees of the Iranian Ministry of Health, "Countrywide Services Management Law" positively affected the personnel's work motivation regarding all the factors associated with motivation including: organizational structure, information technology, training patterns, salary and bonus system and re-engineering pattern. Finally, to enhance the workforce motivation and satisfaction level, application and implementation of the rules and regulations should be based on the organizational needs.

Structural Correlates for Lexical Efficiency and Number of Languages in Non-Native Speakers of English

ERIC Educational Resources Information Center

Grogan, A.; Parker Jones, O.; Ali, N.; Crinion, J.; Orabona, S.; Mechias, M. L.; Ramsden, S.; Green, D. W.; Price, C. J.

2012-01-01

We used structural magnetic resonance imaging (MRI) and voxel based morphometry (VBM) to investigate whether the efficiency of word processing in the non-native language (lexical efficiency) and the number of non-native languages spoken (2+ versus 1) were related to local differences in the brain structure of bilingual and multilingual speakers.…

[Efficiency of human resources for health: an approach to its analysis in Mexico].

PubMed

Nigenda, Gustavo; Alcalde-Rabanal, Jaqueline; González-Robledo, Luz María; Serván-Mori, Edson; García-Saiso, Sebastián; Lozano, Rafael

2016-01-01

To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.

A Look into Miners' Health in Prevailing Ambience of Underground Coal Mine Environment

NASA Astrophysics Data System (ADS)

Dey, N. C.; Pal, S.

2012-04-01

Environmental factors such as noise, vibration, illumination, humidity, temperature and air velocity, etc. do play a major role on the health, comfort and efficient performance of underground coal miners at work. Ergonomics can help to promote health, efficiency and well being of miners and to make best use of their capabilities within the ambit of underground coal mine environment. Adequate work stretch and work-rest scheduling have to be determined for every category of miners from work physiology point of view so as to keep better health of the miners in general and to have their maximum efficiency at work in particular.

Future Launch Vehicle Structures - Expendable and Reusable Elements

NASA Astrophysics Data System (ADS)

Obersteiner, M. H.; Borriello, G.

2002-01-01

Further evolution of existing expendable launch vehicles will be an obvious element influencing the future of space transportation. Besides this reusability might be the change with highest potential for essential improvement. The expected cost reduction and finally contributing to this, the improvement of reliability including safe mission abort capability are driving this idea. Although there are ideas of semi-reusable launch vehicles, typically two stages vehicles - reusable first stage or booster(s) and expendable second or upper stage - it should be kept in mind that the benefit of reusability will only overwhelm if there is a big enough share influencing the cost calculation. Today there is the understanding that additional technology preparation and verification will be necessary to master reusability and get enough benefits compared with existing launch vehicles. This understanding is based on several technology and system concepts preparation and verification programmes mainly done in the US but partially also in Europe and Japan. The major areas of necessary further activities are: - System concepts including business plan considerations - Sub-system or component technologies refinement - System design and operation know-how and capabilities - Verification and demonstration oriented towards future mission mastering: One of the most important aspects for the creation of those coming programmes and activities will be the iterative process of requirements definition derived from concepts analyses including economical considerations and the results achieved and verified within technology and verification programmes. It is the intention of this paper to provide major trends for those requirements focused on future launch vehicles structures. This will include the aspects of requirements only valid for reusable launch vehicles and those common for expendable, semi-reusable and reusable launch vehicles. Structures and materials is and will be one of the important technology areas to be improved. This includes: - Primary structures - Thermal protection systems (for high and low temperatures) - Hot structures (leading edges, engine cowling, ...) - Tanks (for various propellants and fluids, cryo, ...) Requirements to be considered are including materials properties and a variety of loads definition - static and dynamic. Based on existing knowledge and experience for expendable LV (Ariane, ...) and aircraft there is the need to established a combined understanding to provide the basis for an efficient RLV design. Health monitoring will support the cost efficient operation of future reusable structures, but will also need a sound understanding of loads and failure mechanisms as basis. Risk mitigation will ask for several steps of demonstration towards a cost efficient RLV (structures) operation. Typically this has or will start with basic technology, to be evolved to components demonstration (TPS, tanks, ...) and finally to result in the demonstration of the cost efficient reuse operation. This paper will also include a programmatic logic concerning future LV structures demonstration.

Betavoltaic Battery Conversion Efficiency Improvement Based on Interlayer Structures

NASA Astrophysics Data System (ADS)

Li, Da-Rang; Jiang, Lan; Yin, Jian-Hua; Tan, Yuan-Yuan; Lin, Nai

2012-07-01

Significant differences among the doping densities of PN junctions in semiconductors cause lattice mismatch and lattice defects that increase the recombination current of betavoltaic batteries. This extensively decreases the open circuit voltage and the short current, which results in low conversion efficiency. This study proposes P+PINN+-structure based betavoltaic batteries by adding an interlayer to typical PIN structures to improve conversion efficiency. Numerical simulations are conducted for the energy deposition of beta particles along the thickness direction in semiconductors. Based on this, 63Ni-radiation GaAs batteries with PIN and P+PINN+ structures are designed and fabricated to experimentally verify the proposed design. It turns out that the conversion efficiency of the betavoltaic battery with the proposed P+PINN+ structure is about 1.45 times higher than that with the traditional PIN structure.

Differentiating innovation priorities among stakeholder in hospital care.

PubMed

Lambooij, Mattijs S; Hummel, Marjan J

2013-08-16

Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovations.

Differentiating innovation priorities among stakeholder in hospital care

PubMed Central

2013-01-01

Background Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. Methods The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. Results The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. Conclusions The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovations. PMID:23947398

Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia.

PubMed

Villamil, María Del Pilar; Barrera, David; Velasco, Nubia; Bernal, Oscar; Fajardo, Esteban; Urango, Carlos; Buitrago, Sebastian

2017-09-15

While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable insight into the inner workings of the Colombian Health System, especially in terms of the treatment process performed by health care providers in critical illnesses such as cancer. However, no sufficiently compelling results were found to establish the contribution of such a combination to evaluate the quality in the delivery of health services.

Agile, a guiding principle for health care improvement?

PubMed

Tolf, Sara; Nyström, Monica E; Tishelman, Carol; Brommels, Mats; Hansson, Johan

2015-01-01

The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

Patients’ mobility as an indicator for (in)efficiency:a panel data analysis on Italian health care authorities

PubMed Central

2013-01-01

Abstract This paper investigates the influence of internal managerial patterns of heath care authorities on the decision of patients to migrate towards different health care organizations to avail treatments. The efficiency and productivity issues are analyzed, considering the (passive) migration as a proxy for the (in)efficient service availed. We follow the “vote by feet” theorization by Tiebout , assuming that citizens can choose to avail a health treatment in a public service provider different from their resident one. The choice for a center that is far from home implies a negative judgment to the alternative health care supplier that is closer to the patient. Testing Fixed Effects Panel Model on a sample of Italian health care authorities, a strong correlation is found among variables in our model and some relevant dependence is tested between patients’ mobility behavior and their resident authorities’ efficiency in allocating resources on the proper operating cost. Spending in the proper way on health care could bring about an enhancement of performances. Instead, wasting resources is immediately perceived by the patient, who consequently seems to move to a different health care authority. JEL code M48 PMID:23422329

Food-grade microemulsions based on nonionic emulsifiers: media to enhance lycopene solubilization.

PubMed

Spernath, Aviram; Yaghmur, Anan; Aserin, Abraham; Hoffman, Roy E; Garti, Nissim

2002-11-06

Water-dilutable food-grade microemulsions consisting of ethoxylated sorbitan esters, and in some cases blended with other emulsifiers, water, (R)-(+)-limonene, ethanol, and propylene glycol, have been prepared. These microemulsions are of growing interest to the food industry as vehicles for delivering and enhancing solubilization of natural food supplements with nutritional and health benefits. Lycopene, an active natural lipophilic antioxidant from tomato, has solubilized in water-in-oil, bicontinuous, and oil-in-water types of microemulsions up to 10 times the oil [(R)-(+)-limonene] dissolution capacity. The effects of aqueous-phase dilution, nature of surfactant (hydrophilic-lypophilic balance), and mixed surfactant on solubilization capacity and solubilization efficiency were studied. Structural aspects studied by self-diffusion NMR were correlated to the solubilization capacity, and transformational structural changes were identified.

Health system productivity change in Zambia: A focus on the child health services.

PubMed

Achoki, Tom; Kinfu, Yohannes; Masiye, Felix; Frederix, Geert W J; Hovels, Anke; Leufkens, Hubert G

2017-02-01

Efficiency and productivity improvement have become central in global health debates. In this study, we explored productivity change, particularly the contribution of technological progress and efficiency gains associated with improvements in child survival in Zambia (population 15 million). Productivity was measured by applying the Malmquist productivity index on district-level panel data. The effect of socioeconomic factors was further analyzed by applying an ordinary least squares regression technique. During 2004-2009, overall productivity in Zambia increased by 5.0 per cent, a change largely attributed to technological progress rather than efficiency gains. Within-country productivity comparisons revealed wide heterogeneity in favor of more urbanized and densely populated districts. Improved cooking methods, improved sanitation, and better educated populations tended to improve productive gains, whereas larger household size had an adverse effect. Addressing such district-level factors and ensuring efficient delivery and optimal application of existing health technologies offer a practical pathway for further improving population health.

Sporulation environment influences spore properties in Bacillus: evidence and insights on underlying molecular and physiological mechanisms.

PubMed

Bressuire-Isoard, Christelle; Broussolle, Véronique; Carlin, Frédéric

2018-05-17

Bacterial spores are resistant to physical and chemical insults, which make them a major concern for public health and for industry. Spores help bacteria to survive extreme environmental conditions that vegetative cells cannot tolerate. Spore resistance and dormancy are important properties for applications in medicine, veterinary health, food safety, crop protection, and other domains. The resistance of bacterial spores results from a protective multilayered structure and from the unique composition of the spore core. The mechanisms of sporulation and germination, the first stage after breaking of dormancy, and organization of spore structure have been extensively studied in Bacillus species. This review aims to illustrate how far the structure, composition and properties of spores are shaped by the environmental conditions in which spores form. We look at the physiological and molecular mechanisms underpinning how sporulation media and environment deeply affect spore yield, spore properties like resistance to wet heat and physical and chemical agents, germination, and further growth. For example, spore core water content decreases as sporulation temperature increases, and resistance to wet heat increases. Controlling the fate of Bacillus spores is pivotal to controlling bacterial risks and process efficiencies in, for example, the food industry, and better control hinges on better understanding how sporulation conditions influence spore properties.

Establishing a Measurement Tool for a Nursing Work Environment in Taiwan.

PubMed

Lin, Li-Chiu; Lee, Huan-Fang; Yen, Miaofen

2017-02-01

The nursing work environment is a critical global health care problem. Many health care providers are concerned about the associations between the nursing work environment and the outcomes of organizations, nurses, and patients. Nursing work environment instruments have been assessed in the West but have not been considered in Asia. However, different cultures will affect the factorial structure of the tool. Using a stratified nationwide random sample, we created a measurement tool for the nursing work environment in Taiwan. The Nursing Work Environment Index-Revised Scale and the Essentials of Magnetism scale were used to examine the factorial structure. Item analysis, exploratory factor analysis, and confirmatory factor analysis were used to examine the hypothesis model and generate a new factorial structure. The Taiwan Nursing Work Environment Index (TNWEI) was established to evaluate the nursing work environment in Taiwan. The four factors were labeled "Organizational Support" (7 items), "Nurse Staffing and Resources" (4 items), "Nurse-Physician Collaboration" (4 items), and "Support for Continuing Education" (4 items). The 19 items explained 58.5% of the variance. Confirmatory factor analysis showed a good fit to the model (x2/df = 5.99; p < .05, goodness of fit index [GFI] = .90; RMSEA = .07). The TNWEI provides a comprehensive and efficient method for measuring the nurses' work environment in Taiwan.

Effective seismic acceleration measurements for low-cost Structural Health Monitoring

NASA Astrophysics Data System (ADS)

Pentaris, Fragkiskos; Makris, John P.

2015-04-01

There is increasing demand on cost effective Structural Health Monitoring systems for buildings as well as important and/or critical constructions. The front end for all these systems is the accelerometer. We present a comparative study of two low cost MEMS accelaration sensors against a very sensitive, high dynamic range strong motion accelerometer of force balance type but much more expensive. A real experiment was realized by deploying the three sesnors in a reinforced concrete building of the premises of TEI of Crete at Chania Crete, an earthquake prone region. The analysis of the collected accelararion data from many seismic events indicates that all sensors are able to efficiently reveal the seismic response of the construction in terms of PSD. Furthermore, it is shown that coherence diagrams between excitation and response of the building under study, depict structural characteristics but also the seismic energy distribution. This work is supported by the Archimedes III Program of the Ministry of Education of Greece, through the Operational Program "Educational and Lifelong Learning", in the framework of the project entitled "Interdisciplinary Multi-Scale Research of Earthquake Physics and Seismotectonics at the front of the Hellenic Arc (IMPACT-ARC)" and is co-financed by the European Union (European Social Fund) and Greek national funds.

Managed care and the scale efficiency of US hospitals.

PubMed

Brown, H Shelton; Pagán, José A

2006-12-01

Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals.

[Efficiency indicators to contribute to sustainability of health services in Spain].

PubMed

García, E I; Mira Solves, J J; Guilabert Mora, M

2014-01-01

Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Envisioning an oral healthcare workforce for the future.

PubMed

Nash, David A

2012-10-01

Health is critical to human well-being. Oral health is an integral component of health. One is not healthy without oral health. As health is essential to human flourishing, it is important that an oral healthcare delivery system and workforce be developed and deployed which can help ensure all citizens have the potential to access oral health care. As such access does not generally exist today, it is imperative to advance the realization of this goal and to develop a vision of an oral healthcare workforce to functionally support access. Public funding of basic oral health care is an important element to improving access. However, funding is only economically feasible if a workforce exists that is structured in a manner such that duties are assigned to individuals who have been uniquely trained to fulfill specific clinical responsibilities. An essential element of any cost-effective organizational system must be the shared responsibility of duties. Delegation must occur in the oral health workforce if competent, cost-effective care is to be provided. Desirable members of the oral health team in an efficient and effective system are as follows: generalist dentists who are educated as physicians of the stomatognathic system (oral physicians), specialist dentists, dental therapists, dental hygienists, dually trained hygienists/therapists (oral health therapists), oral prosthetists (denturists), and expanded function dental assistants (dental nurses). © 2012 John Wiley & Sons A/S.

Current National Approach to Healthcare ICT Standardization: Focus on Progress in New Zealand.

PubMed

Park, Young-Taek; Atalag, Koray

2015-07-01

Many countries try to efficiently deliver high quality healthcare services at lower and manageable costs where healthcare information and communication technologies (ICT) standardisation may play an important role. New Zealand provides a good model of healthcare ICT standardisation. The purpose of this study was to review the current healthcare ICT standardisation and progress in New Zealand. This study reviewed the reports regarding the healthcare ICT standardisation in New Zealand. We also investigated relevant websites related with the healthcare ICT standards, most of which were run by the government. Then, we summarised the governance structure, standardisation processes, and their output regarding the current healthcare ICT standards status of New Zealand. New Zealand government bodies have established a set of healthcare ICT standards and clear guidelines and procedures for healthcare ICT standardisation. Government has actively participated in various enactments of healthcare ICT standards from the inception of ideas to their eventual retirement. Great achievements in eHealth have already been realized, and various standards are currently utilised at all levels of healthcare regionally and nationally. Standard clinical terminologies, such as International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) have been adopted and Health Level Seven (HL7) standards are actively used in health information exchanges. The government to New Zealand has well organised ICT institutions, guidelines, and regulations, as well as various programs, such as e-Medications and integrated care services. Local district health boards directly running hospitals have effectively adopted various new ICT standards. They might already be benefiting from improved efficiency resulting from healthcare ICT standardisation.