The impact of global budgets on pharmaceutical spending and utilization: early experience from the alternative quality contract.

PubMed

Afendulis, Christopher C; Fendrick, A Mark; Song, Zirui; Landon, Bruce E; Safran, Dana Gelb; Mechanic, Robert E; Chernew, Michael E

2014-01-01

In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications. © The Author(s) 2014.

Impacts of Solid Noise Barriers and Roadside Vegetation on Near-Road Air Quality

EPA Science Inventory

Public health concerns for populations spending time near high traffic roadways has increased substantially in recent years. Air quality measurements indicate high pollutant concentrations near these large roads. However, roadside features have been shown to substantially affec...

Near-Road Air Quality Monitoring: Factors Affecting Network Design and Interpretation of Data

EPA Science Inventory

The growing number of health studies identifying adverse health effects for populations spending significant amounts of time near large roadways has increased the interest in monitoring air quality in this microenvironment. Designing near-road air monitoring networks or interpret...

The Economics of an Investment in Kaizen

NASA Astrophysics Data System (ADS)

Visuwan, Danupun

2010-10-01

Kaizen has been widely accepted as a continuous process improvement with the gradualist approach. This paper presents the research carried out to explore the pattern of an investment in Kaizen to enhance overall profit. System dynamics-based simulation has been employed with an optimization technique, a Steepest Ascent approach, to improve experimental variables e.g. the amount of spending on prevention and appraisal activities, the time and the amount to reduce the investment which results in maximum Net Present Value (NPV) of profit. The simulation model in this study is based on a Thai automobile manufacturer as a case study company. The result suggests that the investment in Kaizen should spend on activities to eliminate and detect all defects in the early phase and then reduce economically when the process is under controlled. It can be named as the `Hybrid quality improvement', which was proved in this study that it provides greater overall profit than the Stepwise Kaizen and the constant spending. This study also presents the behavior of quality costs and profit against time scale along the different patterns of the investment in Kaizen.

Is Cognitive Development at Three Years of Age Associated with ECEC Quality in Norway?

ERIC Educational Resources Information Center

Eliassen, Erik; Zachrisson, Henrik Daae; Melhuish, Edward

2018-01-01

In countries with universal access to early childhood education and care (ECEC), child participation is high across a range of socioeconomic groups. However, ECEC quality is often varying, and many children spend much time in ECEC settings that are not necessarily high quality. In this observational study, we therefore examined the relationship…

Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.

PubMed

Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen

2014-01-01

Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.

Early Performance of Accountable Care Organizations in Medicare

PubMed Central

McWilliams, J. Michael; Hatfield, Laura A.; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

2016-01-01

BACKGROUND In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was −$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P = 0.02), consistent with a 1.4% savings, but only −$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P = 0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P = 0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups. PMID:27075832

Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

PubMed

Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

2016-09-01

US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

Will the "Fixes" Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending.

PubMed

Hauswald, Erik; Sklar, David

2017-04-01

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models. We conclude with suggestions for how to influence physician behavior through education and payment reform so that their behavior aligns with alternative care models to control spending in the future.

Measuring the Quality of the Website User Experience

ERIC Educational Resources Information Center

Sauro, Jeff

2016-01-01

Consumers spend an increasing amount of time and money online finding information, completing tasks, or making purchases. The quality of the website experience has become a key differentiator for organizations--affecting whether they purchase and their likelihood to return and recommend a website to friends. Two instruments were created to more…

Locating Quality Physical Education in Early Years Pedagogy

ERIC Educational Resources Information Center

Marsden, Elizabeth; Weston, Carrie

2007-01-01

Government Ministers, health care professionals and sporting organisations throughout the UK are presently engaged in the promotion of extending the length of time each school child spends participating in quality physical education. Agendas may differ from a crackdown on obesity and sedentary lifestyles to basking in reflected glory of British…

Indoor Air Quality Basics for Schools.

ERIC Educational Resources Information Center

Environmental Protection Agency, Washington, DC. Office of Radiation and Indoor Air.

This fact sheet details important information on Indoor Air Quality (IAQ) in school buildings, problems associated with IAQ, and various prevention and problem-solving strategies. Most people spend 90 percent of their time indoors, therefore the Environmental Protection Agency ranks IAQ in the top four environmental risks to the public. The…

The Professional Component in Selected Professions.

ERIC Educational Resources Information Center

Smith, David C.; Street, Sue

1980-01-01

Compares the time teachers, pharmacists, civil engineers, and lawyers spend in professional preparation programs. Argues that the time spent on professional preparation of teachers should be expanded and that those programs should be of sufficient quality to achieve genuine professional status for teachers. (IRT)

Is More Time in Head Start Always Better for Children? The Moderating Role of Classroom Quality

ERIC Educational Resources Information Center

Friedman-Krauss, Allison H.; Connors, Maia C.; Morris, Pamela A.

2014-01-01

The 1998 reauthorization of Head Start called for a national evaluation of the Head Start program. The goal of Head Start is to improve the school readiness skills of low-income children. Yet characteristics of Head Start programs, such as their quality and the amount of time children spend in them may influence their effectiveness at achieving…

Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents

PubMed Central

Sharma, Ravi; Lebrun-Harris, Lydie A.; Ngo-Metzger, Quyen

2014-01-01

Objective Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data Sources Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS’ Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA’s Uniform Data System) and number of low-income residents (American Community Survey). Study Design We estimated access to primary care in each HRR by “health center penetration” (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. Principal Findings The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Conclusions Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality. PMID:25243096

Managed care and the quality of substance abuse treatment.

PubMed

Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

2002-12-01

In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that strengthening discharge planning may preserve the benefits of MBHC while avoiding its risks. Since reductions in Medicaid spending were impressive but finite, MBHC may not be the permanent solution to inflation in behavioral health care. MBHC firms should implement quality-monitoring programs to ensure that aggressive utilization management strategies do not compromise quality of care. The impact of managed behavioral health care should ideally be evaluated in randomized controlled studies. In addition, research is needed to establish that the quality measures employed in this evaluation - improved access, enhanced continuity and fewer rapid re-admissions actually correspond to reductions in drug or alcohol use and other favorable outcomes obtained through client self-report or urinalysis.

Who Has the Time? The Relationship between Household Labor Time and Sexual Frequency

ERIC Educational Resources Information Center

Gager, Constance T.; Yabiku, Scott T.

2010-01-01

Motivated by the trend of women spending more time in paid labor and the general speedup of everyday life, the authors explore whether the resulting time crunch affects sexual frequency among married couples. Although prior research has examined the associations between relationship quality and household labor time, few have examined a dimension…

Overseeing Educational Quality: A How-to Guide for Boards of Universities and Colleges

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 2014

2014-01-01

Too often, boards spend too little time discussing student learning, student outcomes, and student success. As stewards of the whole of the institution, the oversight of educational quality is a primary obligation of governing boards. AGB--with support from the Teagle Foundation, an advisory committee, and teams from eight diverse…

Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

PubMed Central

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

2012-01-01

Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers’ ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.) PMID:21751900

Health care spending and quality in year 1 of the alternative quality contract.

PubMed

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; He, Yulei; Ellis, Randall P; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

2011-09-08

In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006-2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group--$15.51 (1.9%) less per quarter (P=0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P=0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers' ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.).

Microenvironment Tracker (MicroTrac) Model helps track air quality

EPA Pesticide Factsheets

MicroTrac is a model that uses global positioning system (GPS) data to estimate time of day and duration that people spend in different microenvironments (e.g., indoors and outdoors at home, work, school).

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending

PubMed Central

Song, Zirui; Rose, Sherri; Chernew, Michael E.; Safran, Dana Gelb

2018-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. PMID:28069849

Couples' Reasons for Cohabitation: Associations with Individual Well-Being and Relationship Quality

ERIC Educational Resources Information Center

Rhoades, Galena K.; Stanley, Scott M.; Markman, Howard J.

2009-01-01

This study uses a new measure to examine how different types of reasons for cohabitation are associated with individual well-being and relationship quality in a sample of 120 cohabiting heterosexual couples (N = 240). Spending more time together and convenience are the most strongly endorsed reasons. The degree to which individuals report…

Early Brain and Child Development: Connections to Early Education and Child Care

ERIC Educational Resources Information Center

Romano, Judith T.

2013-01-01

The vast majority of young children spend time in settings outside of the home, and the nature of those settings directly impacts the child's health and development. The ecobiodevelopmental framework of early brain and child development serve as the backdrop for establishing quality. This article describes the use of quality rating systems,…

The Quality of Experience of Students with and without Special Educational Needs in Everyday Life and When Relating to Peers

ERIC Educational Resources Information Center

Zurbriggen, Carmen L. A.; Venetz, Martin; Hinni, Chantal

2018-01-01

The aim of this paper is to investigate the quality of experience of students with and without SEN in everyday life in general and when relating to peers in particular: (1) How do they experience everyday school life vs. leisure time? (2) How much time per week do they spend with peers outside school? and (3) How do they experience those peer…

LANDSAT-4 Science Characterization Early Results. Volume 4: Applications. [agriculture, soils land use, geology, hydrology, wetlands, water quality, biomass identification, and snow mapping

NASA Technical Reports Server (NTRS)

Barker, J. L. (Editor)

1985-01-01

The excellent quality of TM data allows researchers to proceed directly with applications analyses, without spending a significant amount of time applying various corrections to the data. The early results derived of TM data are discussed for the following applications: agriculture, land cover/land use, soils, geology, hydrology, wetlands biomass, water quality, and snow.

The Impact of Global Budgets on Pharmaceutical Spending and Utilization

PubMed Central

Fendrick, A. Mark; Song, Zirui; Landon, Bruce E.; Safran, Dana Gelb; Mechanic, Robert E.; Chernew, Michael E.

2014-01-01

In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications. PMID:25500751

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

PubMed

Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

2017-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. Project HOPE—The People-to-People Health Foundation, Inc.

Microbial Resistant Test Method Development

EPA Science Inventory

Because humans spend most of their time in the indoor environment, environmental analysis of the quality of indoor air has become an important research topic. A major component of the aerosol in the indoor environment consists of biological particles, called bioaerosols, and fur...

Care for Your Air: A Guide to Indoor Air Quality

EPA Pesticide Factsheets

Understand indoor air in homes, schools, and offices. Most of us spend much of our time indoors. The air that we breathe in our homes, in schools, and in offices can put us at risk for health problems.

Policy Makers Will Need A Way To Update Bundled Payments That Reflects Highly Skewed Spending Growth Of Various Care Episodes

PubMed Central

Rosen, Allison B.; Aizcorbe, Ana; Ryu, Alexander J.; Nestoriak, Nicole; Cutler, David M.; Chernew, Michael E.

2015-01-01

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset. PMID:23650329

Influence of Solid Noise Barriers on Near-Road and On-Road Air Quality

EPA Science Inventory

Public health concerns regarding adverse health effects for populations spending significant amounts of time near high traffic roadways has increased substantially in recent years. Roadside features, including solid noise barriers, have been investigated as potential methods to ...

INDOOR AIR QUALITY IN PUBLIC BUILDINGS. VOLUME 2

EPA Science Inventory

Two separate but closely related studies of exposures to volatile organic compounds (VOCs) in buildings where people spend long periods of time were conducted. The report summarizes results obtained in six buildings: a new hospital, office and nursing home and another office, off...

A tale of trade-offs: the impact of macroeconomic factors on environmental concern.

PubMed

Conroy, Stephen J; Emerson, Tisha L N

2014-12-01

We test whether macroeconomic conditions affect individuals' willingness to pay for environmental quality improvements. Improvements in environmental quality, like everything, come at a cost. Individuals facing difficult economic times may be less willing to make trade-offs required for improvements in environmental quality. Using somewhat different methodologies and shorter time frames, prior investigations have generally found a direct relationship between willingness to pay for environmental improvements and macroeconomic conditions. We use a nearly 40-year span (27 periods) of the General Social Survey (1974-2012) to estimate attitudes toward environmental spending while controlling for U.S. macroeconomic conditions and respondent-specific factors such as age, gender, marital status, number of children, residential location, educational attainment, personal financial condition, political party affiliation and ideology. Macroeconomic conditions include one-year lagged controls for the unemployment rate, the rate of economic growth (percentage change in real GDP), and an indicator for whether the U.S. economy was experiencing a recession. We find that, in general, when economic conditions are unfavorable (i.e., during a recession, or with higher unemployment, or lower GDP growth), respondents are more likely to believe the U.S. is spending too much on "improving and protecting the environment". Interacting lagged macroeconomic controls with respondent's income, we find that these views are at least partially offset by the respondent's own economic condition (i.e., their own real income). Our findings are consistent with the notion that environmental quality is a normal, or procyclical good, i.e., that environmental spending should rise when the economy is expanding and fall during economic contractions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance.

PubMed

Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H

2018-01-31

To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.

Making The Case: A Fact Sheet on Children and Youth on Out-of-School Time

ERIC Educational Resources Information Center

Wellesley Centers for Women, 2006

2006-01-01

Research on school-age children (those between the ages of 5 and 12) indicates that an estimated 4 million regularly spend time without adult supervision. There is growing evidence that quality out-of-school opportunities matter, complementing environments created by schools and families and providing important "nutrients" that deter failure and…

Where Are the Opportunities for Reducing Health Care Spending Within Alternative Payment Models?

PubMed

Rocque, Gabrielle B; Williams, Courtney P; Kenzik, Kelly M; Jackson, Bradford E; Halilova, Karina I; Sullivan, Margaret M; Rocconi, Rod P; Azuero, Andres; Kvale, Elizabeth A; Huh, Warner K; Partridge, Edward E; Pisu, Maria

2018-06-01

The Oncology Care Model (OCM) is a highly controversial specialty care model developed by the Centers for Medicare & Medicaid aimed to provide higher-quality care at lower cost. Because oncologists will be increasingly held accountable for spending as well as quality within new value-based health care models like the OCM, they need to understand the drivers of total spending for their patients. This retrospective cohort study included patients ≥ 65 years of age with primary fee-for-service Medicare insurance who received antineoplastic therapy at 12 cancer centers in the Southeast from 2012 to 2014. Medicare administrative claims data were used to identify health care spending during the prechemotherapy period (from cancer diagnosis to antineoplastic therapy initiation) and during the OCM episodes of care triggered by antineoplastic treatment. Total health care spending per episode includes all types of services received by a patient, including nononcology services. Spending was further characterized by type of service. Average total health care spending in the three OCM episodes of care was $33,838 (n = 3,427), $23,811 (n = 1,207), and $19,241 (n = 678). Antineoplastic drugs accounted for 27%, 32%, and 36% of total health care spending in the first, second, and third episodes. Ten drugs, used by 31% of patients, contributed 61% to drug spending ($18.8 million) in the first episode. Inpatient spending also substantially contributed to total costs, representing 17% to 20% ($30.5 million) of total health care spending. Health care spending was heavily driven by both antineoplastic drugs and hospital use. Oncologists' ability to affect these types of spending will determine their success under alternative payment models.

Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

PubMed

Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

2015-03-01

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Influence of Noise Barriers on Near-Road and On-Road Air Quality: Results from Phoenix

EPA Science Inventory

The presentation describes field study results quantifying the impact of roadside barriers under real-world conditions in Phoenix, Arizona. Public health concerns regarding adverse health effects for populations spending significant amounts of time near high traffic roadways has ...

Indoor Air Quality Science and Technology

EPA Pesticide Factsheets

Understand indoor air in homes, schools, and offices. Most of us spend much of our time indoors. The air that we breathe in our homes, in schools, and in offices can put us at risk for health problems. Some pollutants can be chemicals, gases, and living or

Time Spent Teaching Core Academic Subjects in Elementary Schools. Comparisons across Community, School, Teacher, and Student Characteristics. Statistical Analysis Report.

ERIC Educational Resources Information Center

Perie, Marianne; And Others

The proportion of time that elementary school teachers use to teach core academic subjects (English/reading/language arts, mathematics, social studies, science) is an important aspect of instruction. Spending a large proportion of time teaching core curriculum subjects may be important not only in terms of school quality, but also in terms of…

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

PubMed Central

Kuo, Dennis Z.; Hall, Matt; Agrawal, Rishi; Cohen, Eyal; Feudtner, Chris; Goodman, Denise M.; Neff, John M.; Berry, Jay G.

2015-01-01

BACKGROUND AND OBJECTIVES: Opportunities to improve health care quality and contain spending may differ between high and low resource users. This study’s objectives were to assess health care and spending among children with Medicaid insurance by their resource use. METHODS: Retrospective cross-sectional analysis of 2012 Medicaid health administrative data from 10 states of children ages 11 months to 18 years. Subjects were categorized into 4 spending groups, each representing ∼25% of total spending: the least expensive 80% of children (n = 2 868 267), the next 15% expensive (n = 537 800), the next 4% expensive (n = 143 413), and the top 1% (n = 35 853). We compared per-member-per-month (PMPM) spending across the groups using the Kruskal–Wallis test. RESULTS: PMPM spending was $68 (least expensive 80%), $349 (next 15%), $1200 (next 4%), and $6738 (top 1%). Between the least and most expensive groups, percentages of total spending were higher for inpatient (<1% vs 46%) and mental health (7% vs 24%) but lower for emergency (15% vs 1%) and primary (23% vs 1%) care (all Ps < .001). From the least to most expensive groups, increases in PMPM spending were smallest for primary care (from $15 to $33) and much larger for inpatient ($0.28 to $3129), mental health ($4 to $1609), specialty care ($8 to $768), and pharmacy ($4 to $699). CONCLUSIONS: As resource use increases in children with Medicaid, spending rises unevenly across health services: Spending on primary care rises modestly compared with other health services. Future studies should assess whether more spending on primary care leads to better quality and cost containment for high resource users. PMID:26574588

Using Portable Samplers to Determine the Effect of Roadside Vegetation on Near-Road Air Quality

EPA Science Inventory

Growing evidence exists that populations spending significant amounts of time near major roads face increased risks for several adverse health effects.1 These effects may be attributable to increased exposure to particulate matter (PM), gaseous criteria pollutants, and air toxic...

Reproducing Figured Worlds of Literacy Teaching and Learning: Examining the "Language-in-Use" of an Inservice and Preservice Teacher Enacting the Practice of Literacy Planning

ERIC Educational Resources Information Center

Gelfuso, Andrea; Dennis, Danielle V.

2017-01-01

There are international calls for teacher preparation programs to increase the quantity and quality of field experiences. The belief is that spending additional time in the field being mentored by inservice teachers will develop high-quality preservice teachers. However, the figured worlds of teacher education and the knowledge base of inservice…

Rehabilitation Program for the Quality of Life for Individuals on Highly Active Antiretroviral Therapy in KwaZulu-Natal, South Africa: A Short Report

ERIC Educational Resources Information Center

Maharaj, Sonill S.; Chetty, Verusia

2011-01-01

Patients on highly active antiretroviral therapy (HAART) spend less time on vigorous activities due to lower aerobic capacity with functional limitations that can be attributed to a detraining effect, resulting in a poor quality of life (QoL). The overall aims of rehabilitation are to restore, to maintain, and to enhance the QoL and this…

Insurers' medical loss ratios and quality improvement spending in 2011.

PubMed

Hall, Mark A; McCue, Michael J

2013-03-01

The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.

The Best of Times, the Worst of Times: Rising Standards and Declining Staff Qualifications in Early Childhood Education

ERIC Educational Resources Information Center

French, Robert

2010-01-01

Low pay, meager benefits, poor morale, and high turnover impact the daily experience of many early childhood educators in the United States. While public spending in early childhood education has substantially increased in recent years, it has mainly fueled expansion, not quality enhancement to help programs attract, compensate, and retain…

[Pharmaceutical logistic in turnover of pharmaceutical products of Azerbaijan].

PubMed

Dzhalilova, K I

2009-11-01

Development of pharmaceutical logistic system model promotes optimal strategy for pharmaceutical functioning. The goal of such systems is organization of pharmaceutical product's turnover in required quantity and assortment, at preset time and place, at a highest possible degree of consumption readiness with minimal expenses and qualitative service. Organization of the optimal turnover chain in the region is offered to start from approximate classification of medicaments by logistic characteristics. Supplier selection was performed by evaluation of timeliness of delivery, quality of delivered products (according to the minimum acceptable level of quality) and time-keeping of time spending for orders delivery.

Changing Perceptions of Teacher Candidates in High-Needs Schools

ERIC Educational Resources Information Center

DeJarnette, Nancy K.

2016-01-01

Candidates enter teacher education programs with established beliefs about diversity and urban education. These belief systems impact decisions that teacher candidates make both now and in the future. Providing opportunities for candidates to spend quality time in an urban Professional Development School (PDS) setting with the support and guidance…

The Hearing Environment

ERIC Educational Resources Information Center

Capewell, Carmel

2014-01-01

Glue ear, a condition resulting in intermittent hearing loss in young children, affects about 80% of young children under seven years old. About 60% of children will spend a third of their time unable to hear within normal thresholds. Teachers are unlikely to consider the sound quality in classrooms. In my research young people provided…

Improving Learning Object Quality: Moodle HEODAR Implementation

ERIC Educational Resources Information Center

Munoz, Carlos; Garcia-Penalvo, Francisco J.; Morales, Erla Mariela; Conde, Miguel Angel; Seoane, Antonio M.

2012-01-01

Automation toward efficiency is the aim of most intelligent systems in an educational context in which results calculation automation that allows experts to spend most of their time on important tasks, not on retrieving, ordering, and interpreting information. In this paper, the authors provide a tool that easily evaluates Learning Objects quality…

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

PubMed Central

Phillips, Robert L.; Petterson, Stephen M.; Bazemore, Andrew W.; Wingrove, Peter; Puffer, James C.

2017-01-01

PURPOSE Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODS We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care. RESULTS The unadjusted, annual, per-beneficiary spending difference between physicians trained in high- and low-cost HSAs was $1,644 (95% CI, $1,253–$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians. CONCLUSIONS The “imprint” of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes. PMID:28289113

Need Satisfaction, Work-School Interference and School Dropout: An Application of Self-Determination Theory

ERIC Educational Resources Information Center

Taylor, Genevieve; Lekes, Natasha; Gagnon, Hugo; Kwan, Lisa; Koestner, Richard

2012-01-01

Background: In many parts of the world, it is common for secondary school students to be involved in part-time employment. Research shows that working can have a negative impact on school engagement. However, the majority of studies have focused on the amount of time that students spend working rather than on the "quality" of work experience and…

Pediatric Cancer Patients' Important End-of-Life Issues, Including Quality of Life: A Survey of Pediatric Oncologists and Nurses in Japan.

PubMed

Nagoya, Yuko; Miyashita, Mitsunori; Shiwaku, Hitoshi

2017-05-01

Research into the key themes and concepts of quality of life (QOL) relevant to the end-of-life (EOL) care of pediatric cancer patients in the Japanese context is imperative. This study aimed at identifying the key items and constructive concepts of QOL at EOL of pediatric cancer patients. In 2015, pediatricians and nurses were recruited from 163 pediatric oncology treatment facilities in Japan. The questionnaire was developed on the basis of a previous qualitative study. Items that were rated as "very important" or "important" by at least 80% of the respondents were considered as "common and important" QOL items. Exploratory factor analysis was performed to conceptualize QOL of the pediatric cancer patients during EOL care. A total of 157 pediatricians and 270 nurses participated in this study. Fifty-five items were refined to 35 "common and important" QOL items. On factor analysis, 12 domains (containing 29 items) were identified: playing and learning; fulfilling wishes; spending time with family; receiving relief from physical and psychological suffering; making many wonderful memories; having a good relationship with the medical staff; having a peaceful death in the presence of family; spending time with a minimum of medical treatment; living one's life as usual; spending time in a calm hospital environment; being oneself; and having a close family. Although the respondents in this study were medical care providers rather than the patients or their family members, findings should help medical staff provide better palliative care to Japanese pediatric cancer patients.

Difficult Conversations: As Important to Teach as Math or Science

ERIC Educational Resources Information Center

Sherman, Andrew

2017-01-01

Carl Honoré, a noted author, broadcaster, and lecturer, visited GEMS World Academy Chicago, to discuss the "slow movement," which asks parents to reconsider how they spend time with their children. The concept of slow parenting encourages parents to "slow down" to enjoy the experience, thus enhancing the quality of the time…

Evaluation of Teachers' Opinions Relating Improving Qualification in Teaching Process

ERIC Educational Resources Information Center

Dursun, Fevzi

2017-01-01

Improving quality and providing permanent learning in the teaching process undoubtedly depend on the time that teacher spends and active and voluntary participation of students. This study is important for providing perspectives about new techniques and suggestions to the teachers and related persons by determining actions and thoughts of teachers…

CLASS-Infant: An Observational Measure for Assessing Teacher-Infant Interactions in Center-Based Child Care

ERIC Educational Resources Information Center

Jamison, Kristen Roorbach; Cabell, Sonia Q.; LoCasale-Crouch, Jennifer; Hamre, Bridget K.; Pianta, Robert C.

2014-01-01

Research Findings: The growing body of literature demonstrating the importance of quality interactions with caregivers to infant development coupled with the increasing number of infants spending time in classroom settings highlights the need for a measure of interpersonal relationships between infants and caregivers. This article introduces a new…

Sibling Relationships in Emerging Adulthood and in Adolescence

ERIC Educational Resources Information Center

Scharf, Miri; Shulman, Shmuel; Avigad-Spitz, Limor

2005-01-01

In this study, 116 emerging adults and adolescents completed questionnaires and were interviewed about their relationship with a sibling. Respondents' siblings and their mothers also rated the quality of the sibling relationship. Emerging adults were found to spend less time and to be less involved in joint activities with their siblings than…

Facilitating Interdisciplinary Work: Using Quality Assessment to Create Common Ground

ERIC Educational Resources Information Center

Oberg, Gunilla

2009-01-01

Newcomers often underestimate the challenges of interdisciplinary work and, as a rule, do not spend sufficient time to allow them to overcome differences and create common ground, which in turn leads to frustration, unresolved conflicts, and, in the worst case scenario, discontinued work. The key to successful collaboration is to facilitate the…

Your Tree's Trouble May Be You

Treesearch

USDA Forest Service

1974-01-01

People spend much time, effort and money to plant and maintain trees around their homes, businesses, public buildings and parks. People are attracted by the scenic and recreational qualities of forest environments. Yet people who love trees the most may unknowingly cause them injury, directly or indirectly, as a result of: Building and road construction, Flooding ,Soil...

Facilitating Children's Divorce Adjustment: Guidelines for Parents and Practitioners. Issues in Education.

ERIC Educational Resources Information Center

Langenbrunner, Mary

2000-01-01

Provides guidelines to facilitate children's emotional adjustment to their parents' divorce. Suggestions include avoiding arguing in front of children, allowing children to spend quality time with both parents, keeping children's daily routines as normal as possible, avoiding putting children in the middle or in the "missing parent" role, allowing…

Healing and Empowering Veterans in a Botanic Garden

ERIC Educational Resources Information Center

Kreski, Barbara

2016-01-01

Research supports the common understanding that spending enjoyable time in nature is one of the most reliable ways of reducing stress indicators such as heart rate and blood pressure. This article describes a pilot program in which the Chicago Botanic Garden leveraged nature's stress-reducing qualities to complement a program for veterans in…

The Multi-Billion Dollar Drug-Sensitive Spending Opportunity.

PubMed

Easter, Jon C; Thorpe, Kenneth

2018-01-01

Chronic diseases increase utilization and avoidable drug-sensitive spending, but little is done to optimize medication use and drive value. Value-based approaches to health care financing should shift focus to drug-sensitive spending to balance patient access and quality improvement with cost containment. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

The Early Impact Of The ‘Alternative Quality Contract’ On Mental Health Service Use And Spending In Massachusetts

PubMed Central

Barry, Colleen L.; Stuart, Elizabeth A.; Donohue, Julie M.; Greenfield, Shelly F.; Kouri, Elena; Duckworth, Kenneth; Song, Zirui; Mechanic, Robert E.; Chernew, Michael E.; Huskamp, Haiden A.

2016-01-01

Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in organizations participating in the AQC were slightly less likely to use mental health services and had small declines in total health care spending, but no change was found in mental health spending among all users. The declines in probability of use of mental health services and in total health spending attributable to the AQC were concentrated among enrollees in AQC organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program’s initial years, but organizations are now at varying stages of efforts to improve integration. PMID:26643628

Air-Sense: indoor environment monitoring evaluation system based on ZigBee network

NASA Astrophysics Data System (ADS)

Huang, Yang; Hu, Liang; Yang, Disheng; Liu, Hengchang

2017-08-01

In the modern life, people spend most of their time indoors. However, indoor environmental quality problems have always been affecting people’s social activities. In general, indoor environmental quality is also related to our indoor activities. Since most of the organic irritants and volatile gases are colorless, odorless and too tiny to be seen, because we have been unconsciously overlooked indoor environment quality. Consequently, our body suffer a great health problem. In this work, we propose Air-Sense system which utilizes the platform of ZigBee Network to collect and detect the real-time indoor environment quality. What’s more, Air-Sense system can also provide data analysis, and visualizing the results of the indoor environment to the user.

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity.

PubMed

Wong, Michelle S; Showell, Nakiya N; Bleich, Sara N; Gudzune, Kimberly A; Chan, Kitty S

2017-08-01

To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. Healthcare providers should ensure effective communication with obese parents of obese children. Copyright © 2017 Elsevier B.V. All rights reserved.

Total Quality Management and Applications to the Construction Industry

DTIC Science & Technology

1993-01-01

own total quality management process. The Ritz - Carlton Hotel Company, a 1992 Malcolm Baldrige Award winner, already categorizes its suppliers based on...to spend time away from work. The Ritz - Carlton Hotel Company, a 1992 Baldrige Award winner (see Appendix B), requires its employees to receive 126...W0e ned h7es%’ * 75 _ APPENDIX B * How Ritz - Carlton Won THE BALDRIGE AWARD An unswerving focus on continuous improvement helped this luxury hotel

National Survey of Volunteer Pharmacy Preceptors: effects of region, practice setting, and population density on responses.

PubMed

Skrabal, Maryann Z; Jones, Rhonda M; Walters, Ryan W; Nemire, Ruth E; Soltis, Denise A; Kahaleh, Abby A; Hritcko, Philip M; Boyle, Cynthia J; Assemi, Mitra; Turner, Paul D

2010-06-01

To survey volunteer pharmacy preceptors regarding experiential education and determine whether differences in responses relate to such factors as geographic region, practice setting, and population density. An online survey was sent to 4396 volunteer experiential preceptors. The survey consisted of 41 questions asking the preceptor to comment on the experiential education environment. Experiential education administrators from 9 schools of pharmacy administered the survey to their volunteer preceptors in all regions (Northeast, Midwest, South, and West) of the United States, in various pharmacy practice settings, and areas of differing population densities. A total of 1163 (26.5%) preceptors responded. Regionally, preceptors in the West disagreed more than those in the Midwest and the South that they had enough time to spend with students to provide a quality experience and also required compensation less often than their counterparts in the Northeast and South. Concerning practice settings, hospital preceptors accepted students from more schools, had greater increases in requests, turned away more students, and spent less time with the students compared to preceptors in other settings. Population density differences reflected that preceptors at urban sites took and turned away more students than those at rural sites. Preceptors from rural areas spent more time with students and felt they were spending enough time with their students to provide quality experiences when compared to other preceptors. The results of this national volunteer preceptor survey may assist pharmacy school leaders in understanding how location, practice type, and population density affect experiential education, preceptor time-quality issues, and site compensation so they can take necessary actions to improve quality of student practice experiences.

Health care spending growth: can we avoid fiscal Armageddon?

PubMed

Chernew, Michael

Both private and public payers have experienced a persistent rise in health care spending that has exceeded income growth. The issue now transcends the health care system because health care spending growth threatens the fiscal health of the nation. This paper examines the causes and consequences of health care spending growth. It notes that the determinants of spending growth may differ from the determinants of high spending at a point in time. Specifically, the evidence overwhelmingly suggests that the primary driver ofinflation-adjusted, per capita spending growth over the past decades (and thus premium growth) has been the diffusion of new medical technology. The paper argues that while new technology has provided significant clinical benefit, we can no longer afford the persistent gap between health spending and income growth. In simple terms, if the economy is growing 2%, we cannot afford persistent health care spending growth of 4%. Growth in public spending is particularly important. If not abated, high public spending will require either substantially higher taxes or debt, both of which could lead to fiscal Armageddon. Growth in private spending also threatens economic well-being by forcing more resources toward health care and away from other sectors. For example, since the cost of employer-based coverage is always borne by employees (directly or indirectly), salary increases and health care cost increases cannot continue on together. To avoid economic disaster, payers will be forced to have a greater resolve in the future. Specifically, because neither public nor private payers will be able to finance growing health care spending, the coming decade will likely experience significant changes in health care financing. Consumers may be asked to pay more out of pocket when they seek care and both public and private payers will put increasing pressure on payment rates. Furthermore, payment rates to providers are likely to rise more slowly than in the past, likely by less than inflation, and a new form of payment that bundles reimbursement across providers and services will be implemented. All stakeholders, particularly health care providers, will need to adapt to the pressure. Ideally, this will lead to more efficient care delivery that will require a partnership among major stakeholders to develop systems of managing population health in ways that promote affordable, high-quality outcomes.

Impact of duty-hour restriction on resident inpatient teaching.

PubMed

Mazotti, Lindsay A; Vidyarthi, Arpana R; Wachter, Robert M; Auerbach, Andrew D; Katz, Patricia P

2009-10-01

Education and patient care are essential to academic hospitalists, and residents are key partners in these goals. The Accreditation Council for Graduate Medical Education (ACGME) duty-hour restrictions (DHR) likely impacted aspects of resident teaching, well-being, and patient care practices that affect the duties of academic hospitalists. To determine the impact of DHR on resident teaching time and the factors associated with, and impacts of, time spent teaching. Cross-sectional survey. SETTING AND MEASUREMENTS: A total of 164 internal medicine residents at University of California, San Francisco (UCSF), San Francisco, CA were queried regarding their time spent teaching, completion of administrative tasks, number of hours worked, frequency of emotional exhaustion, and satisfaction with quality of patient care provided after DHR. Regression analyses identified factors associated with decreased teaching time and determined that there were associations between time spent teaching, emotional exhaustion, and satisfaction with quality of patient care. A total of 125 residents (76%) responded; 24% reported spending less time teaching. Less time teaching was associated with being a postgraduate year (PGY)-2 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.56-32.79) or PGY-3 (OR, 8.23; 95% CI, 1.44-47.09), reporting working <80 hours/week (OR, 5.99; 95% CI, 1.11-32.48) and spending a greater percentage of time on administrative tasks (OR, 1.03; 95% CI, 1.00-1.06). Those residents who spent less time teaching also reported less frequent emotional exhaustion (P = 0.003) and more satisfaction with quality of care (P = 0.006). DHR has decreased teaching time for some residents, and those residents are more likely to be less emotionally exhausted and deliver self-perceived higher quality of care. Academic hospitalists should consider these impacts of DHR and make adjustments such as educational and work-life innovations to account for these shifts. Copyright 2009 Society of Hospital Medicine

The Alternative Quality Contract: Impact on Service Use and Spending for Children With ADHD.

PubMed

Joyce, Nina R; Huskamp, Haiden A; Hadland, Scott E; Donohue, Julie M; Greenfield, Shelly F; Stuart, Elizabeth A; Barry, Colleen L

2017-12-01

In 2009, Blue Cross-Blue Shield of Massachusetts (BCBSMA) implemented the alternative quality contract (AQC), which pays provider organizations a global payment for all services used by enrollees. BCBSMA claims for 2006-2011 were used to compare youths enrolled in provider organizations participating in the AQC (7,407 person-years [PYs]) with those not participating (45,398 PYs). Difference-in-differences models estimated changes in mental health and substance abuse treatment service utilization and spending attributable to the AQC. The AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.

Evaluating How Education Faculty Spend Their Time at a Private Research University

ERIC Educational Resources Information Center

Lee, Michelle Silver

2012-01-01

Defining and measuring faculty productivity are among the most central issues for quality and accountability in higher education today, and it is the subject this study seeks to illuminate. This study first examines how the productivity of faculty in the School of Education at a private university differ according to different faculty…

High-Quality After-School Programs Tied to Test-Score Gains

ERIC Educational Resources Information Center

Viadero, Debra

2007-01-01

Disadvantaged students who regularly attend top-notch after-school programs end up, after two years, academically far ahead of peers who spend more out-of-school time in unsupervised activities, according to findings from an eight-state study of those programs. Known as the Promising Afterschool Programs study, the new research examined 35…

How nursing staff spend their time on activities in a nursing home: an observational study.

PubMed

Munyisia, Esther Naliaka; Yu, Ping; Hailey, David

2011-09-01

This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. © 2011 Blackwell Publishing Ltd.

Health insurers' financial performance and quality improvement expenditures in the Affordable Care Act's second year.

PubMed

McCue, Michael J; Hall, Mark

2015-02-01

The Affordable Care Act requires health insurers to rebate any amounts less than 80%-85% of their premiums that they fail to spend on medical claims or quality improvement. This study uses the new comprehensive reporting under this law to examine changes in insurers' financial performance and differences in their quality improvement expenditures. In the ACA's second year (2012), insurers' median medical loss ratios continued to increase and their median administrative cost ratios dropped, producing moderate operating margins in the group markets but a small operating loss in the individual market, at the median. For-profit insurers showed larger changes, in general, than did nonprofits. For quality improvement, insurers reported spending a significantly greater amount per member in their government plans than they did on their self-insured members, with spending on commercial insurance being in between these two extremes. The magnitude and source of these differences varied by corporate ownership. © The Author(s) 2014.

Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis.

PubMed

Makuta, Innocent; O'Hare, Bernadette

2015-09-21

The population in Sub Saharan Africa (SSA) suffers poor health as manifested in high mortality rates and low life expectancy. Economic growth has consistently been shown to be a major determinant of health outcomes. However, even with good economic growth rates, it is not possible to achieve desired improvements in health outcomes. Public spending on health (PSH) has long been viewed as a potential complement to economic growth in improving health. However, the relationship between PSH and health outcomes is inconclusive and this inconclusiveness may, in part, be explained by governance-related factors which mediate the impact of the former on the latter. Little empirical work has been done in this regard on SSA. This paper investigates whether or not the quality of governance (QoG) has a modifying effect on the impact of public health spending on health outcomes, measured by under-five mortality (U5M) and life expectancy at birth (LE), in SSA. Using two staged least squares regression technique on panel data from 43 countries in SSA over the period 1996-2011, we estimated the effect of public spending on health and quality of governance U5M and LE, controlling for GDP per capita and other socio-economic factors. We also interacted PSH and QoG to find out if the latter has a modifying effect on the former's impact on U5M and LE. Public spending on health has a statistically significant impact in improving health outcomes. Its direct elasticity with respect to under-five mortality is between -0.09 and -0.11 while its semi-elasticity with respect to life expectancy is between 0.35 and 0.60. Allowing for indirect effect of PSH spending via interaction with quality of governance, we find that an improvement in QoG enhances the overall impact of PSH. In countries with higher quality of governance, the overall elasticity of PSH with respect to under-five mortality is between -0.17 and -0.19 while in countries with lower quality of governance, it is about -0.09. The corresponding semi elasticities with respect to life expectancy are about 6 in countries with higher QoG and about 3 in countries with lower QoG. Public spending on health improves health outcomes. Its impact is mediated by quality of governance, having the higher impact on health outcomes in countries with higher quality of governance and lower impact in countries with lower quality of governance. This may be due to increased efficiency in the use of available resources and better allocation of the same as QoG improves. Improving QoG would improve health outcomes in SSA. The same increase in PSH is twice as effective in reducing U5M and increasing LE in countries with good QoG when compared with countries with poor QoG.

Vertical Integration of Hospitals and Physicians: Economic Theory and Empirical Evidence on Spending and Quality.

PubMed

Post, Brady; Buchmueller, Tom; Ryan, Andrew M

2017-08-01

Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.

Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries.

PubMed

Heijink, Richard; Koolman, Xander; Westert, Gert P

2013-06-01

Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production functions using avoidable mortality as outcome measure. Avoidable mortality comprises deaths from certain conditions "that should not occur in the presence of timely and effective healthcare". We investigated the relationship between total avoidable mortality and healthcare spending using descriptive analyses and multiple regression models, focussing on within-country variation and growth rates. We aimed to take into account the role of potential confounders and dynamic effects such as time lags. Additionally, we explored a method to estimate macro-level cost-effectiveness. We found an average yearly avoidable mortality decline of 2.6-5.3% across countries. Simultaneously, healthcare spending rose between 1.9 and 5.9% per year. Most countries with above-average spending growth demonstrated above-average reductions in avoidable mortality. The regression models showed a significant association between contemporaneous and lagged healthcare spending and avoidable mortality. The time-trend, representing an exogenous shift of the health production function, reduced the impact of healthcare spending. After controlling for this time-trend and other confounders, i.e. demographic and socioeconomic variables, a statistically significant relationship between healthcare spending and avoidable mortality remained. We tentatively conclude that macro-level healthcare spending increases provided value for money, at least for the disease groups, countries and years included in this study.

Defense.gov Special Report: ESGR Freedom Award

Science.gov Websites

returning from deployment, so service members are able to spend quality time with family. When employees drilling with my unit in Rock Island. Yet, no one on my team thinks twice when I tell them that I cannot work on a specific weekend, even though they are the ones who will pick up the slack when I cannot

When Earning Is Beneficial for Learning: The Relation of Employment and Leisure Activities to Academic Outcomes

ERIC Educational Resources Information Center

Derous, Eva; Ryan, Ann Marie

2008-01-01

The present study investigates the joint effect of the quantity and quality of out-of-school activities (i.e., employment and leisure) on academic outcomes (i.e., well-being, study attitude, and academic performance) among 230 undergraduates. A series of hierarchical regression analyses show that spending too much time in both employment and…

Making Room for New Public Schools: How Innovative School Districts Are Learning to Share Public Education Facilities with Charter Schools

ERIC Educational Resources Information Center

Sazon, Maria C.

2011-01-01

All public school children are entitled to quality public educational facilities--including those who attend public charter schools. Yet charter school leaders often spend substantial time and money searching for a facility. When they find one, they encounter significant costs associated with leasing or purchasing the building. They may have to…

Indoor air quality in public buildings. Volume 2

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

Sheldon, L.; Zelon, H.; Sickles, J.

Two separate but closely related studies of exposures to volatile organic compounds (VOCs) in buildings where people spend long periods of time were conducted. This report summarizes results obtained in six buildings: a new hospital, office and nursing home and another office, office/school, and nursing home. At each building sampling was performed at three indoor locations and a single outdoor location.

Variation in prescription use and spending for lipid-lowering and diabetes medications in the Veterans Affairs Healthcare System.

PubMed

Gellad, Walid F; Good, Chester B; Lowe, John C; Donohue, Julie M

2010-10-01

To examine variation in outpatient prescription use and spending for hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System (VA) and its association with quality measures for these conditions. Cross-sectional. We compared outpatient prescription use, spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal year 2008, including 2.3 million patients dispensed lipid-lowering medications and 981,031 patients dispensed diabetes medications. At each facility, we calculated VAMC-level cost per patient for these medications, the proportion of patients taking brand-name drugs, and Healthcare Effectiveness Data and Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% or not measured). The median cost per patient for lipid-lowering agents in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For diabetes agents, the median cost per patient was $158.34 and varied from $123.34 in the least expensive quartile to $198.31 in the most expensive quartile (P < .001). The proportion of patients dispensed brand-name oral drugs among these classes in the most expensive quartile of VAMCs was twice that in the least expensive quartile (P < .001). There was no correlation between VAMC-level prescription spending and performance on HEDIS measures for lipid-lowering drugs (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10). Despite the existence of a closely managed formulary, significant variation in prescription spending and use of brand-name drugs exists in the VA. Although we could not explicitly risk-adjust, there appears to be no relationship between prescription spending and quality of care.

The Great Recession and Health Spending among Uninsured U.S. Immigrants: Implications for the Affordable Care Act Implementation

PubMed Central

Bustamante, Arturo Vargas; Chen, Jie

2014-01-01

Objective We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. Data Source Uninsured U.S. citizens and noncitizens from the 2005–2006 and 2008–2009 Medical Expenditure Panel Survey. Study Design The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. Principal Findings The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. Conclusions Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation. PMID:24962550

[Comparison of physical activity and favourite ways of spending free time in preschool girls and boys from the Mazowsze region].

PubMed

Merkiel, Sylwia; Chalcarz, Wojciech; Deptuła, Monika

2011-01-01

The aim of this study was to compare physical activity of preschool girls and boys from the Mazowsze region and their favourite ways of spending free time. The studied population included 131 children aged 3 to 7 years. Parents filled in questionnaires about their children's physical activity and favourite ways of spending free time, as well as about general information on the children and their families. Gender had statistically significant influence on the children's birth weight, attending karate outside the preschool and on riding a bicycle, playing with a ball and playing with a dog as favourite ways of spending free time during sunny weather as well as playing on a computer and playing with dolls as favourite ways of spending free time during rainy weather. Gender had little influence on the studied preschoolers' physical activity. However favourite ways of spending free time turned out to be significantly different according to gender. Physical activity level in both girls and boys was low, similarly to their peers from the previous studies.

Perceived Impact on Student Engagement When Learning Middle School Science in an Outdoor Setting

ERIC Educational Resources Information Center

Abbatiello, James

2014-01-01

Human beings have an innate need to spend time outside, but in recent years children are spending less time outdoors. It is possible that this decline in time spent outdoors could have a negative impact on child development. Science teachers can combat the decline in the amount of time children spend outside by taking their science classes…

Optimal savings and health spending over the life cycle.

PubMed

Fioroni, Tamara

2010-08-01

This paper investigates the relationship between saving and health spending in a two-period overlapping generations economy. Individuals work in the first period of life and live in retirement in old age. Health spending is an activity that increases quality of life and longevity. Empirical evidence shows that both health spending and saving behave as luxury goods but their behaviour differs markedly according to the level of per capita GDP. The share of saving on GDP has a concave shape with respect to per capita GDP, whereas the share of health spending on GDP increases more than proportionally with respect to per capita GDP. The ratio of saving to spending is nonlinear with respect to income, i.e. first increasing and then decreasing. This ratio, in the proposed model, is equal to the ratio between the elasticity of the utility function with respect to saving and the elasticity of the utility function with respect to health.

Differences in the volume of services and in prices drive big variations in Medicaid spending among US states and regions.

PubMed

Gilmer, Todd P; Kronick, Richard G

2011-07-01

It is well known that Medicaid spending per beneficiary varies widely across states. However, less is known about the cause of this variation, or about whether increased spending is associated with better outcomes. In this article we describe and analyze sources of interstate variation in Medicaid spending over several years. We find substantial variations both in the volume of services and in prices. Overall, per capita spending in the ten highest-spending states was $1,650 above the average national per capita spending, of which $1,186, or 72 percent, was due to the volume of services delivered. Spending in the ten lowest-spending states was $1,161 below the national average, of which $672, or 58 percent, was due to volume. In the mid-Atlantic region, increased price and volume resulted in the most expensive care among regions, whereas reduced price and volume in the South Central region resulted in the least expensive care among regions. Understanding these variations in greater detail should help improve the quality and efficiency of care-a task that will become more important as Medicaid is greatly expanded under the Affordable Care Act of 2010.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

[The mean timing of periodontic care rendering].

PubMed

Zorina, O A; Abaev, Z M; Domashev, D I; Boriskina, O A

2012-01-01

The time-studies demonstrated that the periodontologist spend 30.3 +/- 2.6 minutes on the primary ambulatory visit of patient and 16.4 +/- 0.9 minutes on the revisit of patient (non-registering time spending on preventive and curative activities). Time spending on curative preventive activities in each group of patients with periodontal diseases depended on both the severity of inflammatory destructive processes in periodontium and therapy stage.

Global case management: Scotland. Real-time monitoring of patient flow as an instrument to optimize quality of care in acute receiving units.

PubMed

Thuemmler, Christoph; Morris, Carole

2005-01-01

Recent audits within our hospital suggest that especially during peak phases the patient flow from our acute admission units downstream into hospital beds is not directed in the most efficient way and patients may be placed inappropriately. This inevitably causes time delays and potentially increases the risk of malpractice as patients have to spend an extended period of time in admission areas with a high workload and very busy staff. Using latest information technology, such as wireless local area networks and handheld devices, can improve the efficiency of patient management and can increase the quality of care by helping to avoid unnecessary treatment delays in overcrowded admission areas.

Current Indoor Air Quality in Japan.

PubMed

Jinno, Hideto

2016-01-01

People spend more than two thirds of their daily time indoors. Hence, maintaining a healthy indoor environment is indispensable for the prevention of building related illness. In Japan, guidelines for indoor air quality have been established for 13 volatile/semi-volatile organic compounds (VOCs/SVOCs). These guidelines are now under revision by the Committee on Sick House Syndrome: Indoor Air Pollution. In order to gain information on the current indoor air pollutants and their levels, we carried out a nation-wide survey of VOCs and aldehydes in indoor residential air during 2012-2013. In this review, I concisely summarized the current indoor air quality of Japan.

Grantmakers and Thought Leaders on Out-of-School Time: Survey & Interview Report

ERIC Educational Resources Information Center

Traphagen, Kathleen

2014-01-01

It is often noted that children spend most of their waking hours out of school. What they do during non-school hours is important, because access to high-quality learning, both in and out-of-school, is key to cognitive, social-emotional, and physical development. In the United States today, demand for after-school programs outstrips supply: 8.4…

Balancing quality with productivity.

PubMed

Castille, Karen; Robinson, Jane

2011-05-01

Nurses are often forced to defend themselves about whether they provide value for money. The issue prompted the authors to explore how nurses spend their time and to identify their unique contribution to leading and providing care for patients. This article describes the methodology used and reports the findings. Results were compared with other acute NHS and international organisations and the information is being used to determine how to make best use of nursing time, provide value for money and focus on improving the patient experience.

New analysis reexamines the value of cancer care in the United States compared to Western Europe.

PubMed

Soneji, Samir; Yang, JaeWon

2015-03-01

Despite sharp increases in spending on cancer treatment since 1970 in the United States compared to Western Europe, US cancer mortality rates have decreased only modestly. This has raised questions about the additional value of US cancer care derived from this additional spending. We calculated the number of US cancer deaths averted, compared to the situation in Western Europe, between 1982 and 2010 for twelve cancer types. We also assessed the value of US cancer care, compared to that in Western Europe, by estimating the ratio of additional spending on cancer to the number of quality-adjusted life-years saved. Compared to Western Europe, for three of the four costliest US cancers-breast, colorectal, and prostate-there were approximately 67,000, 265,000, and 60,000 averted US deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer-amounts that exceed most accepted thresholds for cost-effective medical care. The United States lost quality-adjusted life-years despite additional spending for lung cancer: -$19,000 per quality-adjusted life-year saved. Our results suggest that cancer care in the United States may provide less value than corresponding cancer care in Western Europe for many leading cancers. Project HOPE—The People-to-People Health Foundation, Inc.

Radiofrequency identification: exploiting an old technology for measuring nurse time and motion.

PubMed

Jones, Terry L

2012-09-01

A national campaign is underway to increase the amount of time staff nurses spend at the bedside of hospitalized patients through redesign of the work environment. This kind of work redesign requires robust data depicting what nurses do and how they spend their time. Historically, these kinds of data have been difficult, costly, and time consuming to collect. Wireless capture of data on the movement of humans within the work environment (ie, time and motion) is now possible through radiofrequency identification technology. When small tracking devices the size of a quarter are affixed to their clothing, the movement of nurses throughout a patient care unit can be monitored. The duration and frequency of patient interaction are captured along with the duration of time spent in other locations of interest to include nurses' station, supply room, medication room, doctors' station, electronic documentation stations, family waiting rooms, and the hallway. Patterns of nurse movement and time allocation can be efficiently identified, and the effects of staffing practices, workflows, and unit layout evaluated. Integration of radiofrequency identification time and motion data with other databases enables nurse leaders to link nursing time to important cost and quality outcomes. Nurse leaders should explore the usefulness of radiofrequency identification technology in addressing data needs for nurse time and motion.

Observations on School District and Service Consolidation in Michigan. Working Paper #17

ERIC Educational Resources Information Center

Arsen, David

2011-01-01

School district consolidation enjoys a unique status among strategies to reduce education costs. It promises to cut spending, without lowering service quality, by improving the efficiency of service delivery. In contrast to strategies aimed at lowering employee salaries or benefits--which are hard to avoid when cutting spending in any labor…

Do Physicians Spend More Time with Non-English-Speaking Patients?

PubMed Central

Tocher, Thomas M; Larson, Eric B

1999-01-01

OBJECTIVE To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians’ perceptions of their time use with a questionnaire. SETTING Primary care internal medicine clinic at a county hospital. PATIENTS/PARTICIPANTS One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians. MEASUREMENTS AND MAIN RESULTS Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90.4%), (both p < .01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients. CONCLUSIONS There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients’ satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers. PMID:10337040

Radiofrequency Identification

PubMed Central

Jones, Terry L.

2017-01-01

A national campaign is underway to increase the amount of time staff nurses spend at the bedside of hospitalized patients through redesign of the work environment. This kind of work redesign requires robust data depicting what nurses do and how they spend their time. Historically, these kinds of data have been difficult, costly, and time consuming to collect. Wireless capture of data on the movement of humans within the work environment (ie, time and motion) is now possible through radiofrequency identification technology. When small tracking devices the size of a quarter are affixed to their clothing, the movement of nurses throughout a patient care unit can be monitored. The duration and frequency of patient interaction are captured along with the duration of time spent in other locations of interest to include nurses’ station, supply room, medication room, doctors’ station, electronic documentation stations, family waiting rooms, and the hallway. Patterns of nurse movement and time allocation can be efficiently identified, and the effects of staffing practices, workflows, and unit layout evaluated. Integration of radiofrequency identification time and motion data with other databases enables nurse leaders to link nursing time to important cost and quality outcomes. Nurse leaders should explore the usefulness of radiofrequency identification technology in addressing data needs for nurse time and motion. PMID:22592451

Supporting Social and Emotional Development through Quality Afterschool Programs. Beyond the Bell: Research to Practice in the Afterschool and Expanded Learning Field

ERIC Educational Resources Information Center

Devaney, Elizabeth

2015-01-01

During the past 20 years, the afterschool field has been held accountable in varying ways--first, on the ability to provide safe places for young people to spend time while their parents work; then, on success in helping to improve participants' academic achievement as a supplement to the school day. Today, measuring success in afterschool…

The Efficacy of ’Don’t Ask, Don’t Tell’

DTIC Science & Technology

2009-01-01

psychologists explored the concepts, experimental and cor- relation evidence supported dividing cohesion into two distinct types: social cohesion and task...cohesion. Social cohesion is the nature and quality of the emotional bonds within a group—the degree to which members spend time together, like...along (that is, has high social cohesion ) would perform better. Almost counterintuitively, it has been shown that in some situations, high social

Health and well-being benefits of spending time in forests: systematic review.

PubMed

Oh, Byeongsang; Lee, Kyung Ju; Zaslawski, Chris; Yeung, Albert; Rosenthal, David; Larkey, Linda; Back, Michael

2017-10-18

Numerous studies have reported that spending time in nature is associated with the improvement of various health outcomes and well-being. This review evaluated the physical and psychological benefits of a specific type of exposure to nature, forest therapy. A literature search was carried out using MEDLINE, PubMed, ScienceDirect, EMBASE, and ProQuest databases and manual searches from inception up to December 2016. Key words: "Forest" or "Shinrin -Yoku" or "Forest bath" AND "Health" or "Wellbeing". The methodological quality of each randomized controlled trials (RCTs) was assessed according to the Cochrane risk of bias (ROB) tool. Six RCTs met the inclusion criteria. Participants' ages ranged from 20 to 79 years. Sample size ranged from 18 to 99. Populations studied varied from young healthy university students to elderly people with chronic disease. Studies reported the positive impact of forest therapy on hypertension (n = 2), cardiac and pulmonary function (n = 1), immune function (n = 2), inflammation (n = 3), oxidative stress (n = 1), stress (n = 1), stress hormone (n = 1), anxiety (n = 1), depression (n = 2), and emotional response (n = 3). The quality of all studies included in this review had a high ROB. Forest therapy may play an important role in health promotion and disease prevention. However, the lack of high-quality studies limits the strength of results, rendering the evidence insufficient to establish clinical practice guidelines for its use. More robust RCTs are warranted.

In-Cabin Air Quality during Driving and Engine Idling in Air-Conditioned Private Vehicles in Hong Kong.

PubMed

Barnes, Natasha Maria; Ng, Tsz Wai; Ma, Kwok Keung; Lai, Ka Man

2018-03-27

Many people spend lengthy periods each day in enclosed vehicles in Hong Kong. However, comparably limited data is available about in-cabin air quality in air-conditioned private vehicles, and the car usage that may affect the air quality. Fifty-one vehicles were tested for particulate matter (PM 0.3 and PM 2.5 ), total volatile organic compounds (TVOCs), carbon monoxide (CO), carbon dioxide (CO₂), airborne bacteria, and fungi levels during their routine travel journey. Ten of these vehicles were further examined for PM 0.3 , PM 2.5 , TVOCs, CO, and CO₂ during engine idling. In general, during driving PM 2.5 levels in-cabin reduced overtime, but not PM 0.3 . For TVOCs, 24% vehicles exceeded the recommended Indoor Air Quality (IAQ) level in offices and public places set by the Hong Kong Environmental Protection Department. The total volatile organic compounds (TVOC) concentration positively correlated with the age of the vehicle. Carbon monoxide (CO) levels in all of the vehicles were lower than the IAQ recommendation, while 96% vehicles exceeded the recommended CO₂ level of 1000 ppmv; 16% vehicles >5000 ppmv. Microbial counts were relatively low. TVOCs levels at idle engine were higher than that during driving. Although the time we spend in vehicles is short, the potential exposure to high levels of pollutants should not be overlooked.

In-Cabin Air Quality during Driving and Engine Idling in Air-Conditioned Private Vehicles in Hong Kong

PubMed Central

Barnes, Natasha Maria; Ng, Tsz Wai; Ma, Kwok Keung; Lai, Ka Man

2018-01-01

Many people spend lengthy periods each day in enclosed vehicles in Hong Kong. However, comparably limited data is available about in-cabin air quality in air-conditioned private vehicles, and the car usage that may affect the air quality. Fifty-one vehicles were tested for particulate matter (PM0.3 and PM2.5), total volatile organic compounds (TVOCs), carbon monoxide (CO), carbon dioxide (CO2), airborne bacteria, and fungi levels during their routine travel journey. Ten of these vehicles were further examined for PM0.3, PM2.5, TVOCs, CO, and CO2 during engine idling. In general, during driving PM2.5 levels in-cabin reduced overtime, but not PM0.3. For TVOCs, 24% vehicles exceeded the recommended Indoor Air Quality (IAQ) level in offices and public places set by the Hong Kong Environmental Protection Department. The total volatile organic compounds (TVOC) concentration positively correlated with the age of the vehicle. Carbon monoxide (CO) levels in all of the vehicles were lower than the IAQ recommendation, while 96% vehicles exceeded the recommended CO2 level of 1000 ppmv; 16% vehicles >5000 ppmv. Microbial counts were relatively low. TVOCs levels at idle engine were higher than that during driving. Although the time we spend in vehicles is short, the potential exposure to high levels of pollutants should not be overlooked. PMID:29584686

Geographic variation in public health spending: correlates and consequences.

PubMed

Mays, Glen P; Smith, Sharla A

2009-10-01

To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

When Kids Want Too Much: Curing a Case of the "Gimmies."

ERIC Educational Resources Information Center

Villaire, Ted

2001-01-01

Asserts that as parents spend less time with their children and try to assuage their guilt by buying children things, the many effects of materialism must be prevented. Children need help understanding that spending time with friends and family is more rewarding than spending money. They need to be taught the strategies of media literacy while…

Impact of a Usual Source of Care on Health Care Use, Spending, and Quality Among Adults With Mental Health Conditions.

PubMed

Fullerton, Catherine A; Witt, Whitney P; Chow, Clifton M; Gokhale, Manjusha; Walsh, Christine E; Crable, Erika L; Naeger, Sarah

2018-05-01

Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions.

Consumerism and the Decision Making Process. Project Quest [Quality Urban Environmental Study Training].

ERIC Educational Resources Information Center

Cardone, Kenneth; Paine, Mary

Activities for grades 4, 5, 6, and junior high acquaint students with consumer and economic problems, particularly how people spend money and methods used in advertising. The guide opens with a vocabulary list. Then, five objectives, using hypothetical situations, introduce the student to the decisions involved in spending money wisely. For…

Effect of insurance parity on substance abuse treatment.

PubMed

Azzone, Vanessa; Frank, Richard G; Normand, Sharon-Lise T; Burnam, M Audrey

2011-02-01

This study examined the impact of insurance parity on the use, cost, and quality of substance abuse treatment. The authors compared substance abuse treatment spending and utilization from 1999 to 2002 for continuously enrolled beneficiaries covered by Federal Employees Health Benefit (FEHB) plans, which require parity coverage of mental health and substance use disorders, with spending and utilization among beneficiaries in a matched set of health plans without parity coverage. Logistic regression models estimated the probability of any substance abuse service use. Conditional on use, linear models estimated total and out-of-pocket spending. Logistic regression models for three quality indicators for substance abuse treatment were also estimated: identification of adult enrollees with a new substance abuse diagnosis, treatment initiation, and treatment engagement. Difference-in-difference estimates were computed as (postparity - preparity) differences in outcomes in plans without parity subtracted from those in FEHB plans. There were no significant differences between FEHB and non-FEHB plans in rates of change in average utilization of substance abuse services. Conditional on service utilization, the rate of substance abuse treatment out-of-pocket spending declined significantly in the FEHB plans compared with the non-FEHB plans (mean difference=-$101.09, 95% confidence interval [CI]=-$198.06 to -$4.12), whereas changes in total plan spending per user did not differ significantly. With parity, more patients had new diagnoses of a substance use disorder (difference-in-difference risk=.10%, CI=.02% to .19%). No statistically significant differences were found for rates of initiation and engagement in substance abuse treatment. Findings suggest that for continuously enrolled populations, providing parity of substance abuse treatment coverage improved insurance protection but had little impact on utilization, costs for plans, or quality of care.

Are the Affordable Care Act Restrictions Warranted? A Contemporary Statewide Analysis of Physician-Owned Hospitals.

PubMed

Lundgren, Daniel K; Courtney, Paul M; Lopez, Joshua A; Kamath, Atul F

2016-09-01

The Affordable Care Act placed a moratorium on physician-owned hospital (POH) expansion. Concern exists that POHs increase costs and target healthier patients. However, limited historical data support these claims and are not weighed against contemporary measures of quality and patient satisfaction. The purpose of this study was to investigate the quality, costs, and efficiency across hospital types. One hundred forty-five hospitals in a single state were analyzed: 8 POHs; 16 proprietary hospitals (PHs); and 121 general, full-service acute care hospitals (ACHs). Multiyear data from the Centers for Medicare and Medicaid Services Medicare Cost Report and the statewide Health Care Cost Containment Council were analyzed. ACHs had a higher percentage of Medicare patients as a share of net patient revenue, with similar Medicare volume. POHs garnered significantly higher patient satisfaction: mean Hospital Consumer Assessment of Healthcare Providers and Systems summary rating was 4.86 (vs PHs: 2.88, ACHs: 3.10; P = .002). POHs had higher average total episode spending ($22,799 vs PHs: $18,284, ACHs: $18,856), with only $1435 of total spending on post-acute care (vs PHs: $3867, ACHs: $3378). Medicare spending per beneficiary and Medicare spending per beneficiary performance rates were similar across all hospital types, as were complication and readmission rates related to hip or knee surgery. POHs had better patient satisfaction, with higher total costs compared to PHs and ACHs. A focus on efficiency, patient satisfaction, and ratio of inpatient-to-post-acute care spending should be weighted carefully in policy decisions that might impact access to quality health care. Copyright © 2016 Elsevier Inc. All rights reserved.

Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

PubMed

Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

2015-08-01

In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

High Spending on Maternity Care in India: What Are the Factors Explaining It?

PubMed

Goli, Srinivas; Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

2016-01-01

High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US$ 149 in constant price) is much higher than previous estimates (US$ 50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study.

Modifying Endowment Spending Rules: Is it the Cure for Overspending?

ERIC Educational Resources Information Center

Kaufman, Roger T.; Woglom, Geoffrey

2005-01-01

In this article we analyze the dynamics of endowment spending and real endowment values using rules that tie endowment spending to inflation. Numerical examples demonstrate that under a pure inflation rule, spending rates tend to drift away over time from the appropriate rate, leading to either rising or falling real endowment values. Under a…

Heterogeneity in spending change at retirement

PubMed Central

Hurd, Michael D.; Rohwedder, Susann

2014-01-01

The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates at retirement, rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. We find substantial heterogeneity in spending change at retirement: in the upper half of the wealth distribution spending increased. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be early retirement due to poor health, possibly augmented by a short planning horizon by a minority of the population. PMID:24524026

Harnessing naturally occurring data to measure the response of spending to income

PubMed Central

Gelman, Michael; Kariv, Shachar; Shapiro, Matthew D.; Silverman, Dan; Tadelis, Steven

2016-01-01

This paper presents a new data infrastructure for measuring economic activity. The infrastructure records transactions and account balances, yielding measurements with scope and accuracy that have little precedent in economics. The data are drawn from a diverse population that overrepresents males and younger adults but contains large numbers of underrepresented groups. The data infrastructure permits evaluation of a benchmark theory in economics that predicts that individuals should use a combination of cash management, saving, and borrowing to make the timing of income irrelevant for the timing of spending. As in previous studies and in contrast to the predictions of the theory, there is a response of spending to the arrival of anticipated income. The data also show, however, that this apparent excess sensitivity of spending results largely from the coincident timing of regular income and regular spending. The remaining excess sensitivity is concentrated among individuals with less liquidity. PMID:25013075

Effects of bedding quality on lying behavior of dairy cows.

PubMed

Fregonesi, J A; Veira, D M; von Keyserlingk, M A G; Weary, D M

2007-12-01

Cows prefer to spend more time lying down in free stalls with more bedding, but no research to date has addressed the effects of bedding quality. Bedding in stalls often becomes wet either from exposure to the elements or from feces and urine. The aim of this study was to test the effect of wet bedding on stall preference and use. Four groups of 6 nonlactating Holstein cows were housed in free stalls bedded daily with approximately 0.1 m of fresh sawdust. Following a 5-d adaptation period, each group of cows was tested sequentially with access to stalls with either dry or wet sawdust bedding (86.4 +/- 2.1 vs. 26.5 +/- 2.1% dry matter), each for 2 d. These no-choice phases were followed by a 2-d free-choice phase during which cows had simultaneous access to stalls containing either wet or dry bedding. Stall usage was assessed by using 24-h video recordings scanned at 10-min intervals, and responses were analyzed by using a mixed model, with group (n = 4) as the observational unit. The minimum and maximum environmental temperatures during the experiment were 3.4 +/- 2.2 and 6.8 +/- 2.5 degrees C, respectively. When cows had access only to stalls with wet bedding, they spent 8.8 +/- 0.8 h/d lying down, which increased to 13.8 +/- 0.8 h/d when stalls with dry bedding were provided. Cows spent more time standing with their front 2 hooves in the stall when provided with wet vs. dry bedding (92 +/- 10 vs. 32 +/- 10 min/d). During the free-choice phase, all cows spent more time lying down in the dry stalls, spending 12.5 +/- 0.3 h/d in the dry stalls vs. 0.9 +/- 0.3 h/ d in stalls with wet bedding. In conclusion, dairy cows show a clear preference for a dry lying surface, and they spend much more time standing outside the stall when only wet bedding is available.

Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009.

PubMed

Verma, Reetu; Clark, Samantha; Leider, Jonathon; Bishai, David

2017-02-01

To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009. This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho. Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis. Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending. Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States. © Health Research and Educational Trust.

Parents’ time with a partner in a cross-national context: A comparison of the United States, Spain, and France

PubMed Central

Roman, Joan Garcia; Flood, Sarah M.; Genadek, Katie R.

2017-01-01

BACKGROUND Time shared with a partner is an indicator of marital well-being and couples want to spend time together. However, time with a partner depends on work and family arrangements as well as the policies, norms, and values that prevail in society. Contrary to time spent with children, couples’ shared time in cross-national context is relatively unstudied. Previous studies from specific countries show that dual-earner couples spend less time together and that parents spend less time alone together. OBJECTIVE The aim of our study is to investigate partnered parents’ shared time across countries to understand how social conditions, cultural norms, and policy contexts are related to the amount and nature of couples’ shared time. Specifically, we compare time with a partner in the US, France, and Spain. METHODS We use data from national time use surveys conducted in the US, France, and Spain. We leverage information about with whom activities are done to examine three types of time shared with a partner for parents with children under age 10: total time with a partner indicates the minutes per day spent in the presence of a partner; exclusive time corresponds to the minutes per day spent alone with a partner when no one else is present; and family time indicates the minutes per day spent with a partner and a child at the same time. RESULTS Our results show that American couples spend the least time together, and Spanish couples spend the most time together. Parents in France spend the most time alone together. The most striking difference across countries is in time with a partner and children, which is much higher among Spanish families. CONCLUSION Paid work constraints explain a small part of the differences in couples’ shared time that we observe between countries. Differences in couples’ shared time across countries seem to be related to social norms surrounding family and general time use. PMID:29416440

Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives.

PubMed

Afendulis, Christopher C; Hatfield, Laura A; Landon, Bruce E; Gruber, Jonathan; Landrum, Mary Beth; Mechanic, Robert E; Zinner, Darren E; Chernew, Michael E

2017-03-01

In 2011 CareFirst BlueCross BlueShield, a large mid-Atlantic health insurance plan, implemented a payment and delivery system reform program. The model, called the Total Care and Cost Improvement Program, includes enhanced payments for primary care, significant financial incentives for primary care physicians to control spending, and care coordination tools to support progress toward the goal of higher-quality and lower-cost patient care. We conducted a mixed-methods evaluation of the initiative's first three years. Our quantitative analyses used spending and utilization data for 2010-13 to compare enrollees who received care from participating physician groups to similar enrollees cared for by nonparticipating groups. Savings were small and fully shared with providers, which suggests no significant effect on total spending (including bonuses). Our qualitative analysis suggested that early in the program, many physicians were not fully engaged with the initiative and did not make full use of its tools. These findings imply that this and similar payment reforms may require greater time to realize significant savings than many stakeholders had expected. Patience may be necessary if payer-led reform is going to lead to system transformation. Project HOPE—The People-to-People Health Foundation, Inc.

Dying of corruption.

PubMed

Holmberg, Sören; Rothstein, Bo

2011-10-01

In many poor countries, over 80% of the population have experienced corrupt practices in the health sector. In rich countries, corruption takes other forms such as overbilling. The causal link between low levels of the quality of government (QoG) and population health can be either direct or indirect. Using cross-sectional data from more than 120 countries, our findings are that more of a QoG variable is positively associated with higher levels of life expectancy, lower levels of mortality rates for children and mothers, higher levels of healthy life expectancies and higher levels of subjective health feelings. In contrast to the strong relationships between the QoG variables and the health indicators, the relationship between the health-spending measures and population health are rather weak most of the time and occasionally non-existent. Moreover, for private health spending as well as for private share of total health spending, the relation to good health is close to zero or slightly negative. The policy recommendation coming out of our study to improve health levels around the world, in rich countries as well as in poor countries, is to improve the QoG and to finance health care with public, not private, money.

National health spending trends in 1996. National Health Accounts Team.

PubMed

Levit, K R; Lazenby, H C; Braden, B R

1998-01-01

The National Health Accounts, produced annually by the Health Care Financing Administration's Office of the Actuary, present estimates for 1960-1996 of nationwide spending for health care and the sources funding that care. This year's estimates set two records: Spending topped $1 trillion for the first time, and expenditure growth slowed to the lowest rate seen in thirty-seven years of measuring health care spending--4.4 percent. The combination of decelerating health spending and a growing economy has kept national health spending as a share of the nation's gross domestic product unchanged for the fourth consecutive year.

Curbing the costly trend: exploring the need for a progressive approach to the management of specialty pharmaceuticals under the medical benefit.

PubMed

Jacobs, Michael S; Johnson, Kjel A

2012-07-01

Specialty injectables and protein-based biologic therapies represent the fastest growing segment of the drug trend for many plan sponsors. Coupled with the decline in spending on traditional pharmaceuticals and so-called blockbuster drugs coming off patent, the upward trend of specialty drug spending continues at an unprecedented rate, precipitating a shift in the focus of payers who manage prescription drugs. To characterize the current and future specialty drug spending and describe contemporary trends among payers for managing cost and quality in this segment, as well as to elucidate the shortcomings of the current efforts and to explore a comprehensive approach for addressing the cost and quality concerns directly associated with specialty injectables and protein-based biologics through interrelated management interventions. Although a notable decrease in spending on traditional pharmaceuticals was realized in 2010, disproportionate increases in specialty drug utilization and cost per unit fueled the continuing growth of the injectable and biologic markets. Each course of these therapies can cost in the tens of thousands of dollars, and this upward trend of specialty spending represents an escalation of an already significant spending for payers, employers, and members. Beyond the high cost and growing utilization of specialty pharmaceuticals, current management efforts have been met with variable degrees of success and have often proved challenging and, in some cases, even counterproductive. Common interventions used by payers nationwide for addressing specialty drug spending trend include specialty drug formularies, provider reimbursement strategies, distribution channel management, benefit design modifications, utilization management, and operational and administrative improvements such as postclaim edits. Although often overlooked, appropriate implementation of these tactics, and the extent to which they are integrated with overall drug benefit management, are key to the success of the pharmaceutical management program. Conventional specialty pharmaceutical management initiatives offer promise in various areas, but incentives for the best protocols may be misaligned when they are applied individually. Conversely, a comprehensive approach that integrates effective components of the specialty pharmaceutical management interventions can improve the quality of care and control costs associated with these agents, with significant specialty drug management expertise and access to benchmarking data serving as the foundation for appropriate decision-making.

The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

PubMed

Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G

2017-08-01

To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.

The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement.

PubMed

Ribera, Aida; Slof, John; Ferreira-González, Ignacio; Serra, Vicente; García-Del Blanco, Bruno; Cascant, Purificació; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de laTassa, César; Mota, Pedro; Oteo, Juan Francisco; Tornos, Pilar; García-Dorado, David

2017-11-23

The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.

Guidelines for reading literature reviews.

PubMed Central

Oxman, A D; Guyatt, G H

1988-01-01

One strategy for dealing with the burgeoning medical literature is to rely on reviews of the literature. Although this strategy is efficient, readers may be misled if the review does not meet scientific standards. Therefore, guidelines that will help readers assess the scientific quality of the review are proposed. The guidelines focus on the definition of the question, the comprehensiveness of the search strategy, the methods of choosing and assessing the primary studies, and the methods of combining the results and reaching appropriate conclusions. Application of the guidelines will allow clinicians to spend their valuable reading time on high-quality material and to judge the validity of an author's conclusions. PMID:3355948

Human Milk Management Redesign: Improving Quality and Safety and Reducing Neonatal Intensive Care Unit Nurse Stress.

PubMed

Settle, Margaret Doyle; Coakley, Amanda Bulette; Annese, Christine Donahue

2017-02-01

Human milk provides superior nutritional value for infants in the neonatal intensive care unit and is the enteral feeding of choice. Our hospital used the system engineering initiative for patient safety model to evaluate the human milk management system in our neonatal intensive care unit. Nurses described the previous process in a negative way, fraught with opportunities for error, increased stress for nurses, and the need to be away from the bedside and their patients. The redesigned process improved the quality and safety of human milk management and created time for the nurses to spend with their patients.

Franchising Education: Challenges and Opportunities for Coping with the Economic Recession and the Provision of Higher Education in the United Kingdom

ERIC Educational Resources Information Center

Miller, Paul; Shotte, Gertrude

2010-01-01

When the global economic recession hit the world some 18 months ago, very few could predict the impact this would have on government spending on higher education. Higher education institutions in the United Kingdom face spending cuts. Notwithstanding, they are expected to deliver quality education with fewer resources. This article discusses…

High Spending on Maternity Care in India: What Are the Factors Explaining It?

PubMed Central

Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

2016-01-01

Background and Objectives High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Methods and Findings Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US$ 149 in constant price) is much higher than previous estimates (US$ 50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Conclusion Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study. PMID:27341520

Energy Efficiency Improvement and Cost Saving Opportunities for Breweries: An ENERGY STAR(R) Guide for Energy and Plant Managers

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

Galitsky, Christina; Martin, Nathan; Worrell, Ernst

2003-09-01

Annually, breweries in the United States spend over $200 million on energy. Energy consumption is equal to 38 percent of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findingsmore » suggest that given available technology, there are still opportunities to reduce energy consumption cost-effectively in the brewing industry. Brewers value highly the quality, taste and drinkability of their beer. Brewing companies have and are expected to continue to spend capital on cost-effective energy conservation measures that meet these quality, taste and drinkability requirements. For individual plants, further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies.« less

Health Policy 2016 – Implications for Geriatric Urology

PubMed Central

Suskind, Anne M.; Clemens, J. Quentin

2016-01-01

Purpose of Review The U.S. healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. Recent Findings The Affordable Care Act (ACA) has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Summary Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination, risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues. PMID:26765043

Health policy 2016: implications for geriatric urology.

PubMed

Suskind, Anne M; Clemens, J Quentin

2016-03-01

The US healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore, will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. The Affordable Care Act has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination and risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues.

Hospital Spending and Inpatient Mortality: Evidence from California

PubMed Central

Romley, John A.; Jena, Anupam B.; Goldman, Dana P.

2013-01-01

Background Evidence shows that high Medicare spending is not associated with better health outcomes at a regional level, and that high spending in hospitals is not associated with better process quality. But the relationship between hospital spending and inpatient mortality is less well understood. Objective To determine the association between hospital spending and risk-adjusted inpatient mortality. Design Retrospective cohort study. Setting Database of discharge records from 1999–2008 for 208 California hospitals included in the Dartmouth Atlas of Health Care Patients 2,545,352 patients hospitalized during 1999–2008 with one of six major medical conditions. Measurements Inpatient mortality rates among patients admitted to hospitals with varying levels of end-of-life hospital spending. Results For each of six admitting diagnoses – acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia – patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. During 1999–2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than those admitted to hospitals in the lowest quintile (odds ratio of mortality 0.862, 95% confidence interval 0.742–0.983). Predicted inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. The association between hospital spending and inpatient mortality did not vary by geographic region or hospital size. Limitations Unobserved predictors of mortality create uncertainty about whether greater inpatient hospital spending leads to lower inpatient mortality. Conclusion Hospitals that spend more at the end of life have lower inpatient mortality for a variety of major admitting medical conditions. Primary funding source National Institute on Aging, RAND Bing Center for Health Economics PMID:21282695

Microeconomics. Harnessing naturally occurring data to measure the response of spending to income.

PubMed

Gelman, Michael; Kariv, Shachar; Shapiro, Matthew D; Silverman, Dan; Tadelis, Steven

2014-07-11

This paper presents a new data infrastructure for measuring economic activity. The infrastructure records transactions and account balances, yielding measurements with scope and accuracy that have little precedent in economics. The data are drawn from a diverse population that overrepresents males and younger adults but contains large numbers of underrepresented groups. The data infrastructure permits evaluation of a benchmark theory in economics that predicts that individuals should use a combination of cash management, saving, and borrowing to make the timing of income irrelevant for the timing of spending. As in previous studies and in contrast to the predictions of the theory, there is a response of spending to the arrival of anticipated income. The data also show, however, that this apparent excess sensitivity of spending results largely from the coincident timing of regular income and regular spending. The remaining excess sensitivity is concentrated among individuals with less liquidity. Copyright © 2014, American Association for the Advancement of Science.

Understanding Trends in Medicare Spending, 2007-2014.

PubMed

Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B

2018-03-06

To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.

Experiences of incontinence and pelvic floor muscle training after gynaecologic cancer treatment.

PubMed

Lindgren, Anna; Dunberger, G; Enblom, A

2017-01-01

The purpose of the present study is to describe how gynaecological cancer survivors (GCS) experience incontinence in relation to quality of life, their possibilities for physical activity and exercise and their perceptions and experiences of pelvic floor muscle training. This qualitative interview content analysis study included 13 women (48-82 age) with urinary (n = 10) or faecal (n = 3) incontinence after radiation therapy (n = 2), surgery (n = 5) and surgery and radiation therapy (n = 6) for gynaecological cancer, 0.5-21 years ago. Symptoms related to incontinence and restrictions in daily activities reduced physical quality of life. Emotions related to incontinence reduced psychological quality of life and social and existential quality of life, due to restrictions in activity and feelings of exclusion. Practical and mental strategies for maintaining quality of life were described, such as always bringing a change of clothes and accepting the situation. Possibilities for sexual and physical activity as well as exercise were also restricted by incontinence. The women had little or no experience of pelvic floor muscle training but have a positive attitude towards trying it. They also described a lack of information about the risk of incontinence. The women were willing to spend both money and time on an effective treatment for their incontinence. Nine out of 10 were willing to spend at least 7 h a week. GCS experienced that incontinence reduced quality of life and limited possibilities for sexual and physical activity as well as exercise. Coping strategies, both practical and emotional, facilitated living with incontinence. The women had a positive attitude towards pelvic floor muscle training. Lack of information had a negative impact on their way of dealing with the situation.

The U.S. employment effects of military and domestic spending priorities.

PubMed

Pollin, Robert; Garrett-Peltier, Heidi

2009-01-01

This study focuses on the employment effects of military spending versus alternative domestic spending priorities. The authors begin by introducing the basic input-output modeling technique for considering issues such as these in a systematic way. They then present some simple alternative spending scenarios-namely, devoting $1 billion to the military versus the same amount of money spent for five alternatives: tax cuts that produce increased levels of personal consumption; health care; education; mass transit; and construction targeted at home weatherization and infrastructure repair. The first conclusion in assessing such relative employment effects is straightforward: $1 billion spent on personal consumption, health care, education, mass transit, and construction for home weatherization/infrastructure will all create more jobs in the U.S. economy than would the same $1 billion spent on the military. The authors then examine the pay level of jobs created through these alternative spending priorities and assess the overall welfare effects of the alternative employment outcomes. Combining these alternative domestic spending categories in an effective way can also generate a higher level of compensation for working people in the United States and a better average quality ofjobs.

First Births to Maltreated Adolescent Girls: Differences Associated With Spending Time in Foster Care.

PubMed

King, Bryn

2017-05-01

Few studies have examined early parenting among girls receiving child welfare services (CWS) or disentangled the relationship between maltreatment, spending time in foster care, and adolescent childbirth. Using population-based, linked administrative data, this study calculated birth rates among maltreated adolescent girls and assessed differences in birth rates associated with spending time in foster care. Of the 85,766 girls with substantiated allegations of maltreatment during adolescence, nearly 18% subsequently gave birth. Among girls who spent time in foster care, the proportion was higher (19.5%). Significant variations ( p < .001) were observed in the rate of childbirth across demographic characteristics and maltreatment experiences. When accounting for all of the covariates, spending time in foster care was associated with a modestly higher rate of a first birth (Hazard Ratio [HR] = 1.10; 95% confidence interval = [1.06, 1.14]). While age at first substantiated allegation of maltreatment and race/ethnicity were significant predictors of adolescent childbirth, specific maltreatment experiences were associated with minimal or no differences in birth rates. The findings of this study suggest that the experience of spending time in care may not be a meaningful predictor of giving birth as a teen among CWS-involved adolescent girls and highlight subgroups of this population who may be more vulnerable to early childbirth.

Effect of exercise training on sports enjoyment and leisure-time spending in adolescents with complex congenital heart disease: the moderating effect of health behavior and disease knowledge.

PubMed

Dulfer, Karolijn; Duppen, Nienke; Blom, Nico A; van Dijk, Arie P J; Helbing, Wim A; Verhulst, Frank C; Utens, Elisabeth M W J

2014-01-01

The aim of this study was to evaluate the effects of a standardized exercise program on sports enjoyment and leisure-time spending in adolescents with congenital heart disease and to know what the moderating impact of their baseline health behavior and disease knowledge is. Included were 93 patients, aged 10 to 25, with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology, of 5 participating centers of pediatric cardiology in The Netherlands. They were randomly allocated, stratified for age, gender, and type of congenital heart disease to a 12-week period with either: (1) three times per week standardized exercise training or (2) care as usual (randomization ratio 2:1). At baseline and after 12 weeks, participants completed Web-based questionnaires and were interviewed by phone. Primary analyses tested changes from baseline to follow-up in sports enjoyment and leisure-time spending in the exercise group vs. control group. Secondary analyses concerned the moderating influence of baseline health behavior and disease knowledge on changes from baseline to follow-up, and comparison with normative data. At follow-up, the exercise group reported a decrease in passive leisure-time spending (watching television and computer usage) compared with controls. Exercise training had no effect on sports enjoyment and active leisure-time spending. Disease knowledge had a moderating effect on improvement in sports enjoyment, whereas health behavior did not. Compared with normative data, patients obtained similar leisure time scores and lower frequencies as to drinking alcohol and smoking. Exercise training decreased passive, but not active, leisure-time spending. It did not influence sports enjoyment. © 2013 Wiley Periodicals, Inc.

How do disabled individuals spend their leisure time?

PubMed

Pagán-Rodríguez, Ricardo

2014-04-01

Despite the important role that leisure time plays in individuals' health, wellness and quality of life, the disability studies addressing leisure remain extremely limited. Examine how people with disabilities allocate their time to leisure activities as compared to their non-disabled counterparts. Using data at an individual level from the Time Use Survey for Spain in 2002-2003 and the social model of disability as a framework, we estimate the determinants of time (minutes per day) spent on three aggregate categories (active, passive and social activities) for non-disabled, non-limited disabled and limited disabled individuals. Individuals who are limited in their daily activities are more likely to allocate their time to passive leisure (e.g., reading, television, video, and radio) and less likely to spend their time in social entertainment (e.g., theater, culture, and social events) as compared to non-disabled individuals. In addition, we find significant differences in minutes per day spent on leisure activities by gender, age, marital status and number of children. Accessible facilities and leisure installations as well as actions aimed at combating barriers and discrimination practices are needed to encourage participation in physical activity and social entertainment of people with disabilities. It is necessary to define, adapt and implement specific leisure activities that allow people with disabilities to fully participate in these activities and increase their levels of social integration and life satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic.

PubMed

Smith, Chad; Wood, Suzanne; Beauvais, Bradley

2011-01-01

The timely coordination of care in clinics that require frequent assessments by multiple specialists can be challenging for both patients and providers. The cornerstone of care at cystic fibrosis (CF) centers with superior clinical outcomes, as with reduced acuity of episodic disease and incidence of hospitalizations, is frequent clinical encounters coupled with aggressive therapies. However, inefficiencies in the clinical practice structure prevent optimal utilization of resources. To decrease non-value-added time, defined as time a patient spends alone in an examination room, without altering the time providers spend caring for a patient, the application of Lean methods was used to see whether reducing variation could significantly decrease lead time, considered the length of a patient visit, within a CF clinic setting. Baseline capability analyses revealed only 19.3% of patient visits were completed in 60min or less, with mean and median visit times of 84 and 81min, respectively. Final capability analyses demonstrated that 41.5% of patient visits were completed in 60min or less, 23% greater than the baseline capability. Mean and median visit times decreased by 10min per visit. Research efforts increased the available capacity by 500 patient visits per year, representing additional revenue of over US$165,000 annually with no additional administrative costs incurred. © 2011 National Association for Healthcare Quality.

20 CFR 220.142 - General information about work activity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... gainful activity. (e) Time spent in work. While the time the claimant spends in work is important, the... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false General information about work activity. 220... of whether the claimant spends more time or less time at the job than workers who are not impaired...

Economic Impacts from Spending by Marina Slip Reenter at Raystown Lake

DTIC Science & Technology

2008-02-01

Impacts from Spending by Marina Slip Renters at Raystown Lake Wen-Huei Chang, Richard Kasul, LiChu Lee, and Kathleen Perales Environmental ...water quality, social or environmental impacts , or the like. This study did not include changes in use based on increases in gasoline prices or...1997. Classifcation of Corps of Engineers Projects for Economic Impact Assesment . Unpublished MS Thesis. East Lansing, MI: Department of Park

Additional reductions in Medicare spending growth will likely require shifting costs to beneficiaries.

PubMed

Chernew, Michael E

2013-05-01

Policy makers have considerable interest in reducing Medicare spending growth. Clarity in the debate on reducing Medicare spending growth requires recognition of three important distinctions: the difference between public and total spending on health, the difference between the level of health spending and rate of health spending growth, and the difference between growth per beneficiary and growth in the number of beneficiaries in Medicare. The primary policy issue facing the US health care system is the rate of spending growth in public programs, and solving that problem will probably require reforms to the entire health care sector. The Affordable Care Act created a projected trajectory for Medicare spending per beneficiary that is lower than historical growth rates. Although opportunities for one-time savings exist, any long-term savings from Medicare, beyond those already forecast, will probably require a shift in spending from taxpayers to beneficiaries via higher beneficiary premium contributions (overall or via means testing), changes in eligibility, or greater cost sharing at the point of service.

Some Determinants of Commitment Levels in Premarital Relationships.

ERIC Educational Resources Information Center

Kramer, Robert M.; And Others

Premarital dating couples (N=61) were asked to answer questions concerning their perceived commitment to their relationship, the amount of time they spend with their partner, the amount of time they spend arguing, their partner's attractiveness, the length of their relationship, and their desire to continue the relationship. Time spent together…

Check in the Mail or More in the Paycheck: Does the Effectiveness of Fiscal Stimulus Depend on How It Is Delivered?†

PubMed Central

Sahm, Claudia R.; Shapiro, Matthew D.; Slemrod, Joel

2013-01-01

Recent fiscal policies, including the 2008 stimulus payments and the 2009 Making Work Pay Tax Credit, aimed to increase household spending. This paper quantifies the spending response to these policies and examines differences in spending by whether the stimulus was delivered as a one-time payment or as a flow of payments from reduced withholding. Based on responses from a representative sample of households in the Thomson Reuters University of Michigan Surveys of Consumers, the paper finds that the reduction in withholding in 2009 boosted spending at roughly half the rate (13 percent) as the one-time payments (25 percent) in 2008. PMID:23970951

Understanding the underlying drivers of inpatient cost growth: a literature review.

PubMed

Goetghebeur, Mireille M; Forrest, Sharon; Hay, Joel W

2003-06-01

After the declining growth in inpatient hospital spending that occurred from 1994 through 1998, the recent trend in increased spending has been of concern to many. Understanding the underlying reasons for this new growth will aid decision makers in finding best means to manage inpatient costs. To identify potential contributors to recent growth in inpatient spending. Literature review. Healthcare and economic databases, prominent Web sites, and key journals were searched to identify potential drivers for the 1999-2001 rise in inpatient spending. Initial literature review and state-level regression analyses published in a companion paper were used to identify key explanatory factors, which were further explored. Although many of the contributors to the rise in inpatient costs overlap and are interrelated, the major cost drivers were identified as (1) workforce shortage; (2) new technology; (3) less tightly managed care; and (4) shifting hospital business directions. Underlying factors such as legislation, quality of care, limited access to noninpatient care, pressures on the safety net, population aging, and increasing chronic illness prevalence were found to influence the contributors and healthcare spending in general. Future trends in inpatient spending will depend on the response of the healthcare system to these cost drivers and underlying factors. Potential avenues to control inpatient spending include expanding access to primary care, encouraging cost-effective technology and more efficient hospital market structures, and developing incentives for the healthcare workforce.

The Impact of Internet and Television Use on the Reading Habits and Practices of College Students

ERIC Educational Resources Information Center

Mokhtari, Kouider; Reichard, Carla A.; Gardner, Anne

2009-01-01

How much time do college students spend reading for recreational and academic purposes? Do Internet and television use displace or interfere with reading time? In this study, we used an innovative time-diary survey method to explore whether the time students spend on the Internet or watching television displaces time that would be spent reading…

The Timing of Maternal Work and Time with Children. Working Paper 425

ERIC Educational Resources Information Center

Stewart, Jay

2009-01-01

I use data from the American Time Use Survey to examine how maternal employment affects when during the day that mothers of pre-school-age children spend doing enriching childcare and whether they adjust their schedules to spend time with their children at more-desirable times of day. I find that employed mothers shift enriching childcare time…

Do Our Engineering Students Spend Enough Time Studying?

ERIC Educational Resources Information Center

Kolari, S.; Savander-Ranne, C.; Viskari, E.-L.

2006-01-01

In higher education one of the most important learning goals is deep understanding. Achieving this goal needs time and effort. The authors discuss their observations of student time use on the basis of several case studies which they have conducted in the field of engineering education in Finland. The time that the students spend studying is…

Children's Time Use: Labor Divisions and Schooling in Indonesia

ERIC Educational Resources Information Center

Hsin, Amy

2007-01-01

Data from the Worker and Iron Status Evaluation are used to examine gendered patterns in children's time in market and nonmarket work, schooling, and leisure in Indonesia (N = 2,929). Boys spend more time in market work; girls spend more time in nonmarket work. Work responsibilities increase with age as well as gender differentials in children's…

Time Investment and Time Management: An Analysis of Time Students Spend Working at Home for School

ERIC Educational Resources Information Center

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

This paper deals with the time students spend working at home for school. In Study 1, we investigated amount and regulation of time. Study 2 serves to validate the results of Study 1 and, in addition, investigates the duration of the time units students used and their relation to scholastic success. In Study 1, the participants were 332 students…

Dot-gov: market failure and the creation of a national health information technology system.

PubMed

Kleinke, J D

2005-01-01

The U.S. health care marketplace's continuing failure to adopt information technology (IT) is the result of economic problems unique to health care, business strategy problems typical of fragmented industries, and technology standardization problems common to infrastructure development in free-market economies. Given the information intensity of medicine, the quality problems associated with inadequate IT, the magnitude of U.S. health spending, and the large federal share of that spending, this market failure requires aggressive governmental intervention. Federal policies to compel the creation of a national health IT system would reduce aggregate health care costs and improve quality, goals that cannot be attained in the health care marketplace.

How College Students Spend Their Time Communicating

ERIC Educational Resources Information Center

Emanuel, Richard; Adams, Jim; Baker, Kim; Daufin, E. K.; Ellington, Coke; Fitts, Elizabeth; Himsel, Jonathan; Holladay, Linda; Okeowo, David

2008-01-01

This study sought to assess how college students spend their time communicating and what impact, if any, communications devices may be having on how that time is spent. Undergraduates (N = 696) at four southeastern colleges were surveyed. Results revealed that listening comprises 55.4% of the total average communication day followed by reading…

Full-Day Kindergarten: Indicators on Children and Youth

ERIC Educational Resources Information Center

Child Trends, 2015

2015-01-01

Overall, children who spend time in full-day kindergarten programs are more likely than children who spend time in half-day kindergarten programs to devote time every day to reading, mathematics, and social studies. Research is inconclusive on longer-term impacts. Trends identified in this report include: (1) since 1977, the percentage of…

Vitamin D

MedlinePlus

... body that produces vitamin D. As many of us spend more and more time on computers and game consoles, we're not outdoors as much as we once were. And, when we do spend time in the sun, more of us are making the wise decision to use sunscreen ...

Spending on Children’s Personal Health Care in the United States, 1996–2013

PubMed Central

Bui, Anthony L.; Dieleman, Joseph L.; Hamavid, Hannah; Birger, Maxwell; Chapin, Abigail; Duber, Herbert C.; Horst, Cody; Reynolds, Alex; Squires, Ellen; Chung, Paul J.; Murray, Christopher J. L.

2017-01-01

IMPORTANCE Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. OBJECTIVE To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. EVIDENCE REVIEW Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars. FINDINGS From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1–155.5) billion to $233.5 (UI, 226.9–239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799–12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845–1991) in 1996 to $2777 (UI, 2698–2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions. CONCLUSIONS AND RELEVANCE These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions. PMID:28027344

Supplemental Coverage Associated With More Rapid Spending Growth For Medicare Beneficiaries

PubMed Central

Golberstein, Ezra; Walsh, Kayo; He, Yulei; Chernew, Michael E.

2013-01-01

Lowering both Medicare spending and the rate of Medicare spending growth is important for the nation’s fiscal health. Policy makers in search of ways to achieve these reductions have looked at the role that supplemental coverage for Medicare beneficiaries plays in Medicare spending. Supplemental coverage makes health care more affordable for beneficiaries but also makes beneficiaries insensitive to the cost of their care, thereby increasing the demand for care. Ours is the first empirical study to investigate whether supplemental Medicare coverage is associated with higher rates of spending growth over time. We found that supplemental insurance coverage was associated with significantly higher rates of overall spending growth. Specifically, employer-sponsored and self-purchased supplemental coverage were associated with annual total spending growth rates of 7.17 percent and 7.18 percent, respectively, compared to 6.08 percent annual growth for beneficiaries without supplemental coverage. Results for Medicare program spending were more equivocal, however. Our results are consistent with the belief that current trends away from generous employer-sponsored supplemental coverage and efforts to restrict the generosity of supplemental coverage may slow spending growth. PMID:23650320

Trends in College Spending 1998-2008: Where Does the Money Come from? Where Does It Go? What Does It Buy? A Report of the Delta Cost Project

ERIC Educational Resources Information Center

Desrochers, Donna M.; Lenihan, Colleen M.; Wellman, Jane V.

2010-01-01

"Trends in College Spending, 1998-2008: Where does the money come from? Where does it go? What does it buy?" is the third in a series of reports on college and university spending from the Delta Cost Project. The findings presented in this report concentrate on the 1998 to 2008 time period--the last academic year for which spending data are…

Time Students Spend Working at Home for School

ERIC Educational Resources Information Center

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

The paper presents three studies which deal with the time students spend working at home for school. In addition, the paper focuses on the distribution of time investment over the course of a week and on the relationship between academic achievement and time spent working at home for school. In sum, 824 students with an average age of 15 years…

Working on the Weekend: Fathers' Time with Family in the United Kingdom

ERIC Educational Resources Information Center

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends, spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United…

Household spending on health care.

PubMed

Chaplin, R; Earl, L

2000-10-01

This article examines changes in household spending on health care between 1978 and 1998. It also provides a detailed look at household spending on health care in 1998. Data on household spending are from Statistics Canada's Family Expenditure Survey for survey years between 1978 and 1996, and from the annual Survey of Household Spending for 1997 and 1998. Proportion of after-tax spending was calculated by subtracting average personal income taxes from average total expenditures and then dividing health care expenditures by this figure. Per capita spending was calculated by dividing average household spending by average household size. Constant dollar figures and adjustments for inflation were calculated using the Consumer Price Index (1998 = 100) to control for the effect of inflation over time. Almost every Canadian household (98.2%) reported health care expenditures in 1998, spending an average of close to $1,200, up from around $900 in 1978. In 1998, households dedicated a larger share of their average after-tax spending (2.9%) to health care than they did 20 years earlier (2.3%). Health insurance premiums claimed the largest share (29.8%) of average health care expenditures, followed by dental care, then prescription medications and pharmaceutical products.

Life satisfaction across nations: the effects of women's political status and public priorities.

PubMed

York, Richard; Bell, Shannon Elizabeth

2014-11-01

Feminist scholars suggest that improving the quality of life of individuals living in nations around the world may be more readily achieved by increasing women's political power and by reorienting public-policy priorities, than by focusing primarily on economic growth. These considerations raise the question of which characteristics of societies are associated with the quality of life of the people in those societies. Here, we address this issue empirically by statistically analyzing cross-national data. We assess the effects of gender equality in the political sphere, as well as a variety of other factors, on the subjective well-being of nations, as indicated by average self-reported levels of life satisfaction. We find that people report the highest levels of life satisfaction in nations where women have greater political representation, where military spending is low, and where health care spending is high, controlling for a variety of other factors. GDP per capita, urbanization, and natural resource exploitation are not clearly associated with life satisfaction. These findings suggest that nations may be able to improve the subjective quality of life of people without increasing material wealth or natural resource consumption by increasing gender equality in politics and changing public spending priorities. Copyright © 2014 Elsevier Inc. All rights reserved.

Working at the Weekend: Fathers' Time with Family in the United Kingdom.

PubMed

Hook, Jennifer L

2012-08-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom's National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers' weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple.

Working at the Weekend: Fathers’ Time with Family in the United Kingdom

PubMed Central

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom’s National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers’ weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple. PMID:22844157

Cost analysis in a CMHC: determining the cost of staff time.

PubMed

Haring, A; Eckert, C

1979-06-01

The program evaluation and research unit of a community mental health center developed and field-tested a survey form to measure how employees spend their time. The form is divided into direct patient care activities, which include interviewing and testing, conducting therapy, and prescribing medications, and administrative or support activities, which include filling out charts, attending meetings, and training staff. All staff record daily, for one week, the hours and minutes they spend in each activity. Using that data as a base, the evaluation unit can determine the percentage of time staff spend in each activity and the cost of each activity based on staff members' paychecks.

Decentralization and centralization of healthcare resources: investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in Japan.

PubMed

Park, Sungchul; Lee, Jason; Ikai, Hiroshi; Otsubo, Tetsuya; Imanaka, Yuichi

2013-11-01

To investigate the associations of hospital competition and number of cardiologists per hospital (indicating the decentralization and centralization of healthcare resources, respectively) with 30-day in-hospital mortality, healthcare spending, and length of stay (LOS) among patients with acute myocardial infarction (AMI) in Japan. We collected data from 23,197 AMI patients admitted to 172 hospitals between 2008 and 2011. Hospital competition and number of cardiologists per hospital were analyzed as exposure variables in multilevel regression models for in-hospital mortality, healthcare spending, and LOS. Other covariates included patient, hospital, and regional variables; as well as the use of percutaneous coronary intervention (PCI). Hospitals in competitive regions and hospitals with a higher number of cardiologists were both associated lower in-hospital mortality. Additionally, hospitals in competition regions were also associated with longer LOS durations, whereas hospitals with more cardiologists had higher spending. The use of PCI was also associated with reduced mortality, increased spending and increased LOS. Centralization of cardiologists at the hospital level and decentralization of acute hospitals at the regional level may be contributing factors for improving the quality of care in Japan. Policymakers need to strike a balance between these two approaches to improve healthcare provision and quality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Should Cursive Handwriting Still Be Taught in Schools? Information Capsule. Volume 0916

ERIC Educational Resources Information Center

Blazer, Christie

2010-01-01

Elementary school students spend less time learning cursive handwriting than they did in years past. The declining emphasis on cursive writing has been attributed to the increasing use of technology, the growing proportion of class time spent preparing for standardized tests, and the perception that the time students spend learning to write in…

Parents' Working Hours: Adolescent Children's Views and Experiences

ERIC Educational Resources Information Center

Lewis, Jane; Noden, Philip; Sarre, Sophie

2008-01-01

As dual-earner families have become the norm, the different kinds of "time" children spend with parents has become an important issue. We use the 2000 Time Use Survey to identify adolescent children spending time alone at home, and interviews with 50 children aged 14 and 15 to explore young people's experiences. We investigate their views on their…

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

PubMed

Butler, Rachel; Monsalve, Mauricio; Thomas, Geb W; Herman, Ted; Segre, Alberto M; Polgreen, Philip M; Suneja, Manish

2018-04-09

Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined. Copyright © 2018 Elsevier Inc. All rights reserved.

Improving indoor air quality through botanical air filtration in energy efficient residences

NASA Astrophysics Data System (ADS)

Newkirk, Daniel W.

According to the U.S. EPA, the average American spends 90% of their time indoors where pollutants are two to five times more prevalent than outside. The consequences of these pollutants are estimated to cost the U.S. 125 billion dollars in lost health and productivity. Background literature suggests botanical air filtration may be able to solve this problem by leveraging the natural ability of plants to purify indoor air. By improving indoor air quality, energy consumption can also be reduced by bringing in less outside air to dilute contaminants within the space. A botanical air filter, called the Biowall, was designed and grown aeroponically in a sealed environmental chamber. Precise measurements of air temperature, air humidity, air quality and energy consumption were made under various lighting levels, plant species and watering strategies to optimize its performance. It was found to reduce indoor air pollutants 60 percent and has the potential to reduce heating and cooling energy consumption by 20 to 30 percent.

Feasibility of solar powered traffic signs in Houston : a step toward sustainable control devices.

DOT National Transportation Integrated Search

2012-08-01

"With the economy fluctuating all the time, the federal and some city governments at times spend more : money than they take in from taxes. It is important for these governments to find ways to reduce : spending while still providing sufficient opera...

Are Your Kids Too Tuned In?

ERIC Educational Resources Information Center

De Franco, Ellen B.

1989-01-01

Provides ideas to help parents determine whether their children are spending too much time with electronic media, noting children learn both good and bad from every device they use. Parents are encouraged to offer their children interest, support, and suggestions for alternate ways to spend their time. (SM)

National Health Expenditures, 1996

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Braden, Bradley R.; Cowan, Cathy A.; Sensenig, Arthur L.; McDonnell, Patricia A.; Stiller, Jean M.; Won, Darleen K.; Martin, Anne B.; Sivarajan, Lekha; Donham, Carolyn S.; Long, Anna M.; Stewart, Madie W.

1997-01-01

The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities. PMID:10179997

Parental Control of the Time Preadolescents Spend on Social Media: Links with Preadolescents' Social Media Appearance Comparisons and Mental Health.

PubMed

Fardouly, Jasmine; Magson, Natasha R; Johnco, Carly J; Oar, Ella L; Rapee, Ronald M

2018-07-01

Time spent on social media and making online comparisons with others may influence users' mental health. This study examined links between parental control over the time their child spends on social media, preadolescents' time spent browsing social media, preadolescents' appearance comparisons on social media, and preadolescents' appearance satisfaction, depressive symptoms, and life satisfaction. Preadolescent social media users (N = 284, 49.1% female; aged 10-12) and one of their parents completed online surveys. Preadolescents, whose parents reported greater control over their child's time on social media, reported better mental health. This relationship was mediated by preadolescents spending less time browsing and making fewer appearance comparisons on social media. Parental control over time spent on social media may be associated with benefits for mental health among preadolescents.

Could Trends in Time Children Spend with Parents Help Explain the Black-White Gap in Human Capital? Evidence from the American Time Use Survey

ERIC Educational Resources Information Center

Patterson, Richard W.

2017-01-01

It is widely believed that the time children spend with parents significantly impacts human capital formation. If time varies significantly between black and white children, this may help explain the large racial gap in test scores and wages. In this study, I use data from the American Time Use Survey to examine the patterns in the time black and…

Addressing data access challenges in seismology

NASA Astrophysics Data System (ADS)

Trabant, C. M.; Ahern, T.; Weertman, B.; Benson, R. B.; Van Fossen, M.; Weekly, R. T.; Casey, R. E.; Suleiman, Y. Y.; Stults, M.

2016-12-01

The development of web services at the IRIS Data Management Center (DMC) over the last 6 years represents the most significant enhancement of data access ever introduced at the DMC. These web services have allowed the us to focus our internal operations around a single, consistent data access layer while facilitating development of a new generation of tools and methods for researchers to conduct their work. This effort led the DMC to propose standardized web service interfaces within the International Federation of Digital Seismograph Networks (FDSN), enabling other seismological data centers to offer data using compatible interfaces. With this new foundation, we now turn our attention to more advanced data access challenges. In particular, we will present the status of two developments intending to address 1) access to data of consistent quality for science and 2) discovery and access of data from multiple data centers. To address the challenge of requesting high or consistent quality data we will introduce our Research-Ready Data Sets (RRDS) initiative. The purpose of the RRDS project is to reduce the time a researcher spends culling and otherwise identifying data appropriate for given study. RRDS will provide users with additional criteria related to data quality that can be specified when requesting data. Leveraging the data quality measurements provided by our MUSTANG system, these criteria will include ambient noise, completeness, dead channel identification and more. To address the challenge of seismological data discovery and access, we have built and continue to improve the IRIS Federator. The Federator takes advantage of the FDSN-standard web services at various data centers to help a user locate specific channels, wherever they may be offered globally. The search interface provides results that are pre-formatted requests, ready for submission to each data center that serves that data. These two developments are aimed squarely at reducing the time researchers spend searching for, collecting and preparing data for processing.

Report: EPA Needs to Track Whether Its Major Municipal Settlements for Combined Sewer Overflows Benefit Water Quality

EPA Pesticide Factsheets

Report #15-P-0280, September 16, 2015. By tracking environmental results, the EPA can show how the $32 billion that communities are spending to address discharges of untreated sewage and contaminated storm water improves water quality.

How Do Pre-Kindergarteners Spend Their Time? Gender, Ethnicity, and Income as Predictors of Experiences in Pre-Kindergarten Classrooms

ERIC Educational Resources Information Center

Early, Diane M.; Iruka, Iheoma U.; Ritchie, Sharon; Barbarin, Oscar A.; Winn, Donna-Marie C.; Crawford, Gisele M.; Frome, Pamela M.; Clifford, Richard M.; Burchinal, Margaret; Howes, Carollee; Bryant, Donna M.; Pianta, Robert C.

2010-01-01

The current paper considers how children spend their time in state-funded pre-kindergarten programs and how time use relates to ethnicity, gender, and family income, based on the assumption that how time is spent in pre-kindergarten is relevant for the programs' success in narrowing achievement gaps. Classroom observations of 2061 children in 652…

Examining the Factors That Contribute to Successful Database Application Implementation Using the Technology Acceptance Model

ERIC Educational Resources Information Center

Nworji, Alexander O.

2013-01-01

Most organizations spend millions of dollars due to the impact of improperly implemented database application systems as evidenced by poor data quality problems. The purpose of this quantitative study was to use, and extend, the technology acceptance model (TAM) to assess the impact of information quality and technical quality factors on database…

Incorporating High Value Care into Undergraduate Medical Education

ERIC Educational Resources Information Center

Faber, Erik; Wells, Daniel

2017-01-01

Identified Need: The United States spends the most per capita on healthcare, but ranks much lower than most industrialized nations in quality and many health metrics. Studies have shown higher costs do not translate to high quality care, and may indeed translate to lower quality care and patient experience. Teaching high value care (HVC) is only…

Energy efficiency opportunities in the brewery industry

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

Worrell, Ernst; Galitsky, Christina; Martin, Nathan

2002-06-28

Breweries in the United States spend annually over $200 Million on energy. Energy consumption is equal to 3-8% of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findings suggestmore » that there may still be opportunities to reduce energy consumption cost-effectively for breweries. Major brewing companies have and will continue to spend capital on cost effective measures that do not impact the quality of the beer. Further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies at individual breweries.« less

Who is bearing the financial burden of non-communicable diseases in Mongolia?

PubMed Central

Dugee, Otgontuya; Palam, Enkhtuya; Dorjsuren, Bayarsaikhan; Mahal, Ajay

2018-01-01

Background Non-communicable diseases (NCDs) pose a formidable health and development challenge for low- and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of-pocket (OOP) spending on the major NCDs. Methods Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records. Results NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care. Conclusion A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals. PMID:29564086

Hospitalization for primary care susceptible conditions, health spending and Family Health Strategy: an analysis of trends.

PubMed

Morimoto, Tissiani; Costa, Juvenal Soares Dias da

2017-03-01

The goal of this study was to analyze the trend over time of hospitalizations due to conditions susceptible to primary healthcare (HCSPC), and how it relates to healthcare spending and Family Health Strategy (FHS) coverage in the city of São Leopoldo, Rio Grande do Sul State, Brazil, between 2003 and 2012. This is an ecological, time-trend study. We used secondary data available in the Unified Healthcare System Hospital Data System, the Primary Care Department and Public Health Budget Data System. The analysis compared HCSPC using three-year moving averages and Poisson regressions or negative binomials. We found no statistical significance in decreasing HCSPC indicators and primary care spending in the period analyzed. Healthcare spending, per-capita spending and FHS coverage increased significantly, but we found no correlation with HCSPC. The results show that, despite increases in the funds invested and population covered by FHS, they are still insufficient to deliver the level of care the population requires.

It's the recipient that counts: spending money on strong social ties leads to greater happiness than spending on weak social ties.

PubMed

Aknin, Lara B; Sandstrom, Gillian M; Dunn, Elizabeth W; Norton, Michael I

2011-02-10

Previous research has shown that spending money on others (prosocial spending) increases happiness. But, do the happiness gains depend on who the money is spent on? Sociologists have distinguished between strong ties with close friends and family and weak ties--relationships characterized by less frequent contact, lower emotional intensity, and limited intimacy. We randomly assigned participants to reflect on a time when they spent money on either a strong social tie or a weak social tie. Participants reported higher levels of positive affect after recalling a time they spent on a strong tie versus a weak tie. The level of intimacy in the relationship was more important than the type of relationship; there was no significant difference in positive affect after recalling spending money on a family member instead of a friend. These results add to the growing literature examining the factors that moderate the link between prosocial behaviour and happiness.

Economics' Fall from Grace

ERIC Educational Resources Information Center

Rudolph, Lloyd I.; Rudolph, Susanne Hoeber

2010-01-01

Not long ago, many political scientists suffered from economics envy. Some still do. They view economics as the queen of the social sciences, claiming that it is "scientific," like physics. Physicists and other natural scientists spend most of their time trying to explain phenomena, but non-behavioral micro-economists spend most of their time on…

After the Blackbird Whistles: Listening to Silence in Classrooms

ERIC Educational Resources Information Center

Schultz, Katherine

2010-01-01

Background/Context: Students spend a large part of their time in schools in silence. However, teachers tend to spend most of their time attending to student talk. Anthropological and linguistic research has contributed to an understanding of silence in particular communities, offering explanations for students' silence in school. This research…

Webinar Presentation: Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time

EPA Pesticide Factsheets

This presentation, Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome.

Alaska's Dependence on State Spending. ISER Fiscal Policy Papers, No. 5.

ERIC Educational Resources Information Center

Goldsmith, Scott; And Others

Alaska will face a large fiscal gap and growing budget deficits in the near future. The timing of such fiscal gap open hinges on the joint effect of state budget growth and the oil price change. This paper explains Alaska's dependence on state spending and offers policy options addressing the fiscal gap. State spending: (1) supports nearly one in…

How to Hit a Home Run with Bundled Payments.

PubMed

Kaldy, Joanne

2015-09-01

As health care payment reform continues to evolve, reimbursement increasingly is being linked to outcomes as well as to expenditures. Toward this end, the Centers for Medicare & Medicaid Services has established models for "bundled" payments to long-term care providers, using predetermined payments based on historical spending rates, in a new pay-for-performance landscape. The goal is to reward providers for quality and cost-effective care as well as penalize them for adverse patient outcomes and hospital readmissions based on the target spending rates. Pharmacists have a role in these new models of care, but need to broaden their partnerships and relationships with providers and be prepared to prove they are contributing both to quality care and to reducing costs.

Dietary assessment in children and adolescents: issues and recommendations.

PubMed

Pérez-Rodrigo, Carmen; Artiach Escauriaza, Belén; Artiach Escauriaza, Javier; Polanco Allúe, Isabel

2015-02-26

The assessment of dietary intake in children and adolescents is of great interest for different purposes. The characteristics of each developmental stage and associated cognitive abilities are two factors that influence the ability of children to provide valid and reliable information on food consumption. The ability to remember, limitations of vocabulary or the ability to identify different foods are some of the relevant aspects. In addition, often parents or caregivers provide surrogate information and their degree of knowledge depends on the time they spend with the child and on whether they share meals. As children grow they become more independent and increasingly spend more time away from their parents. Children also have limitations to recognize food models and photographs and associate them with different amounts of food consumed. On the other hand, often children and adolescents perceive long interviews or self-administered questionnaires they as long and boring. The use of new technologies is contributing to the development of new tools adapting dietary assessment the methods to the cognitive abilities of children, introducing gaming environments and narrative structures that attract their interest and improve the quality of information they report.. Copyright AULA MEDICA EDICIONES 2015. Published by AULA MEDICA. All rights reserved.

Evaluation of Mental Workload among ICU Ward's Nurses.

PubMed

Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

2015-01-01

High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor-mance obstacles in ICUs. This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs.

Dry eye syndrome among computer users

NASA Astrophysics Data System (ADS)

Gajta, Aurora; Turkoanje, Daniela; Malaescu, Iosif; Marin, Catalin-Nicolae; Koos, Marie-Jeanne; Jelicic, Biljana; Milutinovic, Vuk

2015-12-01

Dry eye syndrome is characterized by eye irritation due to changes of the tear film. Symptoms include itching, foreign body sensations, mucous discharge and transitory vision blurring. Less occurring symptoms include photophobia and eye tiredness. Aim of the work was to determine the quality of the tear film and ocular dryness potential risk in persons who spend more than 8 hours using computers and possible correlations between severity of symptoms (dry eyes symptoms anamnesis) and clinical signs assessed by: Schirmer test I, TBUT (Tears break-up time), TFT (Tear ferning test). The results show that subjects using computer have significantly shorter TBUT (less than 5 s for 56 % of subjects and less than 10 s for 37 % of subjects), TFT type II/III in 50 % of subjects and type III 31% of subjects was found when compared to computer non users (TFT type I and II was present in 85,71% of subjects). Visual display terminal use, more than 8 hours daily, has been identified as a significant risk factor for dry eye. It's been advised to all persons who spend substantial time using computers to use artificial tears drops in order to minimize the symptoms of dry eyes syndrome and prevents serious complications.

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

PubMed

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Administrator Perceptions of Actual and Desired Time Spent by School Psychologists in Different Roles and Satisfaction with School Psychologists.

ERIC Educational Resources Information Center

Levinson, Edward M.; And Others

1996-01-01

Surveyed 512 elementary and secondary administrators regarding their perceptions of the time spent by school psychologists in 15 role functions and other duties. Results indicate that administrators desired school psychologists to spend less time in assessment and administrative activities than they were perceived to be spending in these areas.…

Academic Performance of College Students: Influence of Time Spent Studying and Working

ERIC Educational Resources Information Center

Nonis, Sarath A.; Hudson, Gail I.

2006-01-01

Today's college students are less prepared for college-level work than their predecessors. Once they get to college, they tend to spend fewer hours studying while spending more hours working, some even full time (D. T. Smart, C. A. Kelley, & J. S. Conant, 1999). In this study, the authors examined the effect of both time spent studying and time…

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

PubMed

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

77 FR 38035 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... government spending and 35.8 percent of state government spending. This comprehensive and ongoing, time series collection of local education agency finances maintains historical continuity in the state and...

Comparison of Objective and Subjective Life Balance Between Women With and Without a Personality Disorder.

PubMed

Larivière, Nadine; Denis, Catherine; Payeur, Amélie; Ferron, Amélie; Levesque, Stéphanie; Rivard, Guillaume

2016-12-01

Life balance is associated to health, well-being and quality of life and is a target of psychiatric rehabilitation interventions. However, little is known about this life dimension in women living with personality disorders. The purpose of this descriptive-correlational study was to compare and explore relationships between subjective life balance, objective time use, quality of life and perceived stress in women without a mental health disorder (n = 43) and women with a personality disorder (clusters B and C) (n = 30), aged between 18 and 50 years old. The variables were measured with the Life Balance Inventory (subjective life balance), the Occupational Questionnaire (objective time use), the Depression Anxiety Stress Scale (perceived stress) and the Quality of Life Index (satisfaction and importance with life domains). The analyses showed that women with a personality disorder spend significantly less time in work but more time in daily tasks and leisure. Subjective life balance, quality of life and perceived stress were significantly lower in women with a personality disorder (p < 0.05). In women with a personality disorder, subjective life balance was explained by quality of life (R 2  = 27.5 %). In women without a mental illness, subjective life balance was explained by quality of life and motherhood (R 2  = 36.1 %). To support the recovery of women with personality disorders and their quality of life, it is important to address objective and subjective time use to enable accomplishment of a variety of meaningful activities.

TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay.

PubMed

Bundgaard, Karin; Sørensen, Erik E; Delmar, Charlotte

2016-01-01

This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time. Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses' increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time. Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010. Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews. The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: 'Time - making the best of it', and the sub categories "Responsibility of time", "Information and preparation", and "Time wasters". The study underlines the possibility of combining the health care systems, patients and the nurses' perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient's needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible.

Why prevention can increase health-care spending.

PubMed

Temple, Norman J

2012-10-01

This article examines the impact of disease prevention on health-care spending. The relationship between these two variables is more complex than what, at first glance, appears to be the case. Health-care spending would be reduced if more effective means could be found to prevent health problems that are expensive to treat but are generally not fatal, such as dementia, infectious diseases and accidents. The major focus here is on interventions designed to persuade people to quit smoking. Savings on health-care spending in early years after people stop smoking are counter-balanced (often exceeded) by higher spending at a later time. In addition, when people stop smoking there is a significant negative impact on government finances from the double effect of lost tax revenues combined with increased spending on pension payments. Arguments in favour of policies designed to prevent fatal disease, such as by reducing the prevalence of smoking, should be based on improvements to population health rather than on misleading claims that this will reduce spending on health care.

Couples’ Reasons for Cohabitation: Associations with Individual Well-Being and Relationship Quality

PubMed Central

Rhoades, Galena K.; Stanley, Scott M.; Markman, Howard J.

2009-01-01

This study used a new measure to examine how different types of reasons for cohabitation were associated with individual well-being and relationship quality in a sample of 120 cohabiting heterosexual couples (N = 240). Spending more time together and convenience were the most strongly endorsed reasons. The degree to which individuals reported cohabiting to test their relationships was associated with more negative couple communication and more physical aggression as well as lower relationship adjustment, confidence, and dedication. Testing the relationship was also associated with higher levels of attachment insecurity and more symptoms of depression and anxiety. Men were more likely than women to endorse testing their relationships and less likely to endorse convenience as a reason for cohabiting. PMID:19756225

A proposed framework on hybrid feature selection techniques for handling high dimensional educational data

NASA Astrophysics Data System (ADS)

Shahiri, Amirah Mohamed; Husain, Wahidah; Rashid, Nur'Aini Abd

2017-10-01

Huge amounts of data in educational datasets may cause the problem in producing quality data. Recently, data mining approach are increasingly used by educational data mining researchers for analyzing the data patterns. However, many research studies have concentrated on selecting suitable learning algorithms instead of performing feature selection process. As a result, these data has problem with computational complexity and spend longer computational time for classification. The main objective of this research is to provide an overview of feature selection techniques that have been used to analyze the most significant features. Then, this research will propose a framework to improve the quality of students' dataset. The proposed framework uses filter and wrapper based technique to support prediction process in future study.

The demise of primary care: a diatribe from the trenches.

PubMed

Norenberg, David D

2009-05-19

Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence to a standard. Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Practice guidelines have been usurped by pay-for-performance police, on patrol for deviations--not understanding that knowing and allowing for exceptions is the heart and soul of primary care. The coercive surveillance of "Quality Improvement" has become oppressive, making single organ-system specialties increasingly attractive (or at least more tolerable). Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors. A remedy is suggested: a pilot project of volunteer salaried internists (more trusted, less audited) commissioned to our expandable national health care program, Medicare.

TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay

PubMed Central

Bundgaard, Karin; Sørensen, Erik E.; Delmar, Charlotte

2016-01-01

Aim: This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time. Background: Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses’ increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time. Design: Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010. Methods: Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews. Results/Findings: The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: ‘Time - making the best of it’, and the sub categories “Responsibility of time”, “Information and preparation”, and “Time wasters”. Conclusion: The study underlines the possibility of combining the health care systems, patients and the nurses’ perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient’s needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible. PMID:27347251

Disneyland Dads, Disneyland Moms? How Nonresident Parents Spend Time with Absent Children.

ERIC Educational Resources Information Center

Stewart, Susan D.

1999-01-01

Examines gender differences in how nonresident parents spend time with their absent children. Results suggest that nonresident mothers and fathers exhibit a similar pattern of participation in activities with their absent children. Most nonresident parents either engage in only leisure activities with their children or have no contact. (Author/MKA)

The Overdominance of Computers

ERIC Educational Resources Information Center

Monke, Lowell W.

2006-01-01

Most schools are unwilling to consider decreasing computer use at school because they fear that without screen time, students will not be prepared for the demands of a high-tech 21st century. Monke argues that having young children spend a significant amount of time on computers in school is harmful, particularly when children spend so much…

Secondary Counseling Services as Perceived by Selected Publics. RR-49.

ERIC Educational Resources Information Center

Peterson, Sarah; DeGracie, James S.

In the spring of 1983, an evaluation of the junior and senior high guidance programs in the Mesa Public Schools was conducted. Surveys were developed to solicit opinions from parents, teachers, counselors, administrators, career specialists, and students as to how counselors actually spend their time versus how they should spend their time.…

The Wage Is Right!

ERIC Educational Resources Information Center

Alden, Lori

2004-01-01

As they work to master the supply-and-demand model, high school economics students spend considerable time studying competitive markets for such goods as wheat, apples, and corn. They usually spend less time studying markets for labor. That is a shame, because high school students have a vital interest in understanding why some jobs pay more than…

Reflection after Teaching a Lesson: Experiences of Secondary School Science Teachers

ERIC Educational Resources Information Center

Halstead, Melissa A.

2017-01-01

Secondary science teachers spend most of their time planning, collaborating, and teaching, but spend little time reflecting after teaching a single lesson. The theoretical framework of the adult learning theory and the transformative learning theory was the basis of this study. This qualitative research study was conducted to understand the…

Farmers as Consumers of Agricultural Education Services: Willingness to Pay and Spend Time

ERIC Educational Resources Information Center

Charatsari, Chrysanthi; Papadaki-Klavdianou, Afroditi; Michailidis, Anastasios

2011-01-01

This study assessed farmers' willingness to pay for and spend time attending an Agricultural Educational Program (AEP). Primary data on the demographic and socio-economic variables of farmers were collected from 355 farmers selected randomly from Northern Greece. Descriptive statistics and multivariate analysis methods were used in order to meet…

Room for Adjustment

ERIC Educational Resources Information Center

Kennedy, Mike

2006-01-01

In classrooms across the U.S., students spend untold hours sitting at desks and tables working on their lessons or listening to their teachers. That lack of movement might not have been a concern years ago, when children's time away from school typically was spent outdoors playing and exercising. However, as children spend more time in front of a…

Healthcare technology: physician collaboration in reducing the surgical cost.

PubMed

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

78 FR 18318 - U.S. Healthcare Trade Mission to Turkey

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... 64. Average life expectancy is 75 years. It has a fast-growing middle class that is willing to spend more on quality goods and services, and a democratically elected government which has historically... Turkish government has made healthcare access and quality a priority. To improve healthcare access for its...

Can Student Surveys Measure Teaching Quality?

ERIC Educational Resources Information Center

Ferguson, Ronald F.

2012-01-01

Primary and secondary school students spend hundreds more hours in each classroom than any observer ever will. But, until now, school improvement efforts have seldom sought systematic student feedback at the classroom level. One impediment has been the doubt that students can provide valid and reliable responses about the quality of the teaching…

Negotiating among Opportunity and Constraint: The Participation of Young People in Out-of-School-Time Activities. Chapin Hall Working Paper

ERIC Educational Resources Information Center

Chaskin, Robert J.; Baker, Stephen

2006-01-01

In recent years, there has been increased policy interest in the way young people spend their time out of school, and in promoting the availability of opportunities for them to spend this time in productive and developmentally supportive ways. Out-of-school opportunities (such as arts and music programs, sports teams, community service, youth …

How do working-age people with disabilities spend their time? New evidence from the American Time Use Survey.

PubMed

Anand, Priyanka; Ben-Shalom, Yonatan

2014-12-01

We use the American Time Use Survey to examine the extent to which adults with disabilities-defined using both the new six-question sequence on disability and the traditional work-limitation question-spend more time on health-related activities and less time on other activities than those without disabilities. We find that men and women who both reported a work limitation and responded "yes" to any of the questions in the six-question disability sequence spend approximately 40 to 50 more minutes per week, respectively, on health-related activities. We also find that most working-age men and women who report a disability work fewer hours per day than men and women without disabilities. The largest difference is for men and women who report both types of disability; these individuals spend, on average, 5 fewer hours per day in paid work than men and women without disabilities. On average, most of the decrease in paid work time is offset by more time spent on leisure activities (defined as activities that provide direct utility, such as entertainment, social activities, attending recreational events, and general relaxation) and sleeping, which is likely due to these being default activities for individuals whose medical issues and environment constrain them from participating in other activities.

Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

PubMed

2017-05-20

An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. The Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Impact of Barcode Medication Administration Technology on How Nurses Spend Their Time On Clinical Care

PubMed Central

Poon, Eric G; Keohane, Carol; Featherstone, Erica; Hays, Brandon; Dervan, Andrew; Woolf, Seth; Hayes, Judy; Bane, Anne; Newmark, Lisa; Gandhi, Tejal K

2006-01-01

In a time-motion study conducted in a hospital that recently implemented barcode medication administration (BCMA) technology, we found that the BCMA system did not increase the amount of time nurses spend on medication administration activities, and did not compromise the amount of time nurses spent on direct care of patients. Our results should allay concerns regarding the impact of BCMA on nursing workflow. PMID:17238684

Determinants of hematology-oncology trainees' postfellowship career pathways with a focus on nonmalignant hematology

PubMed Central

Jenkins, Sarah; Mikhael, Joseph; Gitlin, Scott D.

2018-01-01

Nonmalignant hematologic conditions are extremely prevalent and contribute significantly to the global burden of disease. The US health care system may soon face a shortage of specialists in nonmalignant hematology. We sought to identify factors that lead hematology-oncology fellows to pursue (or not to pursue) careers in nonmalignant hematology. Cross-sectional, web-based survey distributed to 149 graduates of a hematology-oncology fellowship program at a large academic medical center between 1998 and 2016. Eighty-six out of 149 graduates responded (57.7%); most (59 [68.6%]) practice at an academic medical center. Respondents spend a mean of 61% of their time in clinical practice, 23.7% conducting research, 5.2% in education, and 5.2% in administration. Those in clinical practice spend a mean of 52.1% of their time in solid tumor oncology, 37.5% in hematologic malignancies, and 10% in nonmalignant hematology; only 1 spent >50% of time practicing nonmalignant hematology. Factors most significantly affecting choice of patient population included clinical experience during fellowship and intellectual stimulation of the patient population/disease type. Factors that could have most significantly influenced a decision to spend more time in nonmalignant hematology included increased exposure/access to role models and mentors and opportunities for better career growth/advancement. Fellowship graduates spend >50% of their time in clinical practice, but almost none spend a significant amount of time practicing nonmalignant hematology. Given the growing number of patients with nonmalignant hematologic conditions and a possible future provider shortage, medical trainees should be encouraged to pursue careers in nonmalignant hematology. PMID:29463548

More Freedom to Spend Less Money: What Happened when California School Districts Gained Spending Flexibility and Budgets Were Cut. Research Brief

ERIC Educational Resources Information Center

Li, Jennifer

2012-01-01

In 2009-2010, California made substantial education budget cuts at the same time that it removed its spending requirements from $4.5 billion of state money. This gave districts the flexibility to use the funds in any manner approved by the local school board. Researchers found that most of the formerly earmarked money was moved into general funds…

Taking Digital Creativity to the Art Classroom: Mystery Box Swap

ERIC Educational Resources Information Center

Shin, Ryan

2010-01-01

Today's students are the first generation to grow up with computers, cell-phones, video games, music and video players, and other digital technologies. As "digital natives", a new term coined by Prensky (2001), they spend more time reading text messaging lines than lines from books, and they spend more time on Facebook than putting their energies…

How Do Arizonans Spend their Personal Time? AZ Views, Volume 1, Issue 1

ERIC Educational Resources Information Center

Morrison Institute for Public Policy, Arizona State University, 2008

2008-01-01

When not sleeping, working, or tending to other duties, Arizonans keep busy, spending personal time on a wide array of different activities, from high culture to casual pastime. Reported data create a picture of a busy, active population sharing a lot of interests, particularly outdoor activities, while also containing discernible subgroups…

Do Traditional Fathers Always Work More? Gender Ideology, Race, and Parenthood

ERIC Educational Resources Information Center

Glauber, Rebecca; Gozjolko, Kristi L.

2011-01-01

Research has shown that men who express traditional gender ideologies spend more time in paid work when they become fathers, whereas men who express egalitarian ideologies spend less time in paid work. This study extends previous research by examining racial differences among men. We drew on data from the National Longitudinal Survey of Youth 1979…

How Newspaper Advertising Sales Managers Spend Their Time: A Pilot Study.

ERIC Educational Resources Information Center

Hudson, Jerry C.; Saathoff, Roger C.

A pilot study examined how newspaper advertising sales managers in five southwestern states spend their time during a typical work day. Of the 360 questionnaires mailed, 176 responses were received. The largest number of responses (93) came from retail sales managers of newspapers in markets with less than 50,000 population. The questionnaire…

For the Love of Reading: Engaging Students in a Lifelong Pursuit

ERIC Educational Resources Information Center

Willingham, Daniel T.

2015-01-01

This article asks American adults the question: How should teens spend their leisure time? The activity with the highest response, irrespective of race, education, and other demographic factors, was reading. Adults thought teens ought to spend about an hour and 15 minutes reading for pleasure each day. How much time do teens actually spend…

If slow rate of health care spending growth persists, projections may be off by $770 billion.

PubMed

Cutler, David M; Sahni, Nikhil R

2013-05-01

Despite earlier forecasts to the contrary, US health care spending growth has slowed in the past four years, continuing a trend that began in the early 2000s. In this article we attempt to identify why US health care spending growth has slowed, and we explore the spending implications if the trend continues for the next decade. We find that the 2007-09 recession, a one-time event, accounted for 37 percent of the slowdown between 2003 and 2012. A decline in private insurance coverage and cuts to some Medicare payment rates accounted for another 8 percent of the slowdown, leaving 55 percent of the spending slowdown unexplained. We conclude that a host of fundamental changes--including less rapid development of imaging technology and new pharmaceuticals, increased patient cost sharing, and greater provider efficiency--were responsible for the majority of the slowdown in spending growth. If these trends continue during 2013-22, public-sector health care spending will be as much as $770 billion less than predicted. Such lower levels of spending would have an enormous impact on the US economy and on government and household finances.

Investing in children: changes in parental spending on children, 1972-2007.

PubMed

Kornrich, Sabino; Furstenberg, Frank

2013-02-01

Parental spending on children is often presumed to be one of the main ways that parents invest in children and a main reason why children from wealthier households are advantaged. Yet, although research has tracked changes in the other main form of parental investment-namely, time-there is little research on spending. We use data from the Consumer Expenditure Survey to examine how spending changed from the early 1970s to the late 2000s, focusing particularly on inequality in parental investment in children. Parental spending increased, as did inequality of investment. We also investigate shifts in the composition of spending and linkages to children's characteristics. Investment in male and female children changed substantially: households with only female children spent significantly less than parents in households with only male children in the early 1970s; but by the 1990s, spending had equalized; and by the late 2000s, girls appeared to enjoy an advantage. Finally, the shape of parental investment over the course of children's lives changed. Prior to the 1990s, parents spent most on children in their teen years. After the 1990s, however, spending was greatest when children were under the age of 6 and in their mid-20s.

"I Wish We Had More Time to Spend Together...": The Distribution and Predictors of Perceived Family Time Pressures among Married Men and Women in the Paid Labor Force

ERIC Educational Resources Information Center

Roxburgh, Susan

2006-01-01

In this article, I examine the distribution of time pressure associated with the roles of marital partner and parent using data from a telephone survey. Results of an analysis of open-ended responses indicate that less than a quarter of respondents are satisfied with the time they spend with their children and spouses. Women are more likely to…

Time use patterns among women with rheumatoid arthritis: association with functional limitations and psychological status.

PubMed

Katz, P; Morris, A

2007-03-01

This study assessed time use patterns among 375 women with rheumatoid arthritis (RA). We hypothesized that (i) as functional limitations increased, time use imbalances would occur (i.e. time needed for obligatory activities would conflict with time needed for productive and free-time activities) and (ii) time use imbalances would be associated with psychological distress. Time use estimates were obtained from written questionnaires; other study data were collected from annual telephone interviews. Activities were categorized as obligatory, committed or discretionary, as defined by Verbrugge. Time use estimates were aggregated to define number of obligatory (e.g. self-care) activities requiring >2 h/day and a number of committed and discretionary activities in which no time was spent each day. After adjusting for age, education, marital status and pain severity, women with more functional limitations were significantly more likely to spend >2 h/day in obligatory activities. As functional limitations increased, the proportion spending no time in each committed activity and many discretionary activities increased. Spending >2 h/day in obligatory activities was not significantly associated with poor psychological status, but spending no time in a greater number of committed and discretionary activities was associated with lower life satisfaction and higher levels of depressive symptoms. Having more severe functional limitations appears to shift time use patterns towards more time spent in obligatory activities and less time spent in committed and discretionary activities. These imbalances in time use were associated with psychological distress, highlighting the need for women with RA to maintain important productive, social and discretionary activities.

The economic downturn and its lingering effects reduced medicare spending growth by $4 billion in 2009-12.

PubMed

Dranove, David; Garthwaite, Craig; Ody, Christopher

2015-08-01

Previous work has found a strong connection between the most recent economic recession and reductions in private health spending. However, the effect of economic downturns on Medicare spending is less clear. In contrast to studies involving earlier time periods, our study found that when the macroeconomy slowed during the Great Recession of 2007-09, so did Medicare spending growth. A small (14 percent) but significant share of the decline in Medicare spending growth from 2009 to 2012 relative to growth from 2004 to 2009 can be attributed to lingering effects of the recession. Absent the economic downturn, Medicare spending would have been $4 billion higher in 2009-12. A major reason for the relatively small impact of the macroeconomy is the relative lack of labor-force participation among people ages sixty-five and older. We estimate that if they had been working at the same rate as the nonelderly before the recession, the effect of the downturn on Medicare spending growth would have been twice as large. Project HOPE—The People-to-People Health Foundation, Inc.

Vertical integration: hospital ownership of physician practices is associated with higher prices and spending.

PubMed

Baker, Laurence C; Bundorf, M Kate; Kessler, Daniel P

2014-05-01

We examined the consequences of contractual or ownership relationships between hospitals and physician practices, often described as vertical integration. Such integration can reduce health spending and increase the quality of care by improving communication across care settings, but it can also increase providers' market power and facilitate the payment of what are effectively kickbacks for inappropriate referrals. We investigated the impact of vertical integration on hospital prices, volumes (admissions), and spending for privately insured patients. Using hospital claims from Truven Analytics MarketScan for the nonelderly privately insured in the period 2001-07, we constructed county-level indices of prices, volumes, and spending and adjusted them for enrollees' age and sex. We measured hospital-physician integration using information from the American Hospital Association on the types of relationships hospitals have with physicians. We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians--ownership of physician practices--was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured.

Ways of spending leisure time by the third year-students of the Faculty of Pharmacy, Medical University of Lublin.

PubMed

Czabak-Garbacz, Róza; Skibniewska, Agnieszka; Mazurkiewicz, Piotr; Gdula, Agnieszka

2002-01-01

The aim of the study was the assessment of leisure time among third-year students from the Faculty of Pharmacy of the Medical University of Lublin. It analysed quantity of time devoted to school activity and ways of spending free time. The study involved 114 students (82 women and 32 men). The study revealed that women had less free time than men, who, most probably did not attend some lectures. The most popular activities among the questioned students were: sleeping (average 6.8 hours a day), studying (average 3.6 hours a day), listening to the radio (average 2.9 hours a day), talking with friends (average 1.9 hours a day), personal hygiene (average 1.1 hours a day), watching TV (average 1.1 hours a day), housework. Students devoted the least of their free time on active rest, for example walking (women did it more often than men) or practising sport (more popular among men). Cultural life of the students consisted only of meetings with friends and going to the cinema (women did it more often). The least popular way of spending free time was going to the theatre, opera, concerts and exhibitions. Few students spent their time working. Their number increased significantly during holidays. The way of spending free time by third-year students from the Faculty of Pharmacy (both men and women) during the day was similar, differences related only to the amount of time devoted to each activity.

Good News and Bad News on Parenting

ERIC Educational Resources Information Center

Caplan, Bryan

2009-01-01

Sociologists focus on the theory that parents spend less time with their kids than they used to. But fact-checking popular perceptions about the evolution of parenting indicates that fathers spend much more time with their children than they used to (from a weekly average of 3 hours of primary child care in 1965, to seven hours in 2000.). A more…

Spending Time: The Impact of Hours Worked on Work-Family Conflict

ERIC Educational Resources Information Center

Adkins, Cheryl L.; Premeaux, Sonya F.

2012-01-01

Scholars have long assumed that as workers spend more time at work fewer hours are available for their non-work lives leading to negative effects in both domains, and most studies examining the impact of work hours on work and life domains have supported this viewpoint. However, the majority of these studies have used one-dimensional measures of…

How Children Can Benefit from the Transition to Digital TV: Putting the Remote Control Back into the Hands of Parents. Policy Brief

ERIC Educational Resources Information Center

Benton Foundation, 2004

2004-01-01

Today, parents are struggling to ensure that their children have the education and skills they need to compete and win in the 21st century economy. But children spend more time watching television than any other activity except sleeping--and for many parents that is cause for concern. In fact, children spend 4 times as much time each week…

Decomposition of the drivers of the U.S. hospital spending growth, 2001–2009

PubMed Central

2014-01-01

Background United States health care spending rose rapidly in the 2000s, after a period of temporary slowdown in the 1990s. However, the description of the overall trend and the understanding of the underlying drivers of this trend are very limited. This study investigates how well historical hospital cost/revenue drivers explain the recent hospital spending trend in the 2000s, and how important each of these drivers is. Methods We used aggregated time series data to describe the trend in total hospital spending, price, and quantity between 2001 and 2009. We used the Oaxaca-Blinder method to investigate the relative importance of major hospital cost/spending drivers (derived from the literature) in explaining the change in hospital spending patterns between 2001 and 2007. We assembled data from Medicare Cost Reports, American Hospital Association annual surveys, Prospective Payment System (PPS) Impact Files, Medicare Provider Analysis and Review (MedPAR) Medicare claims data, InterStudy reports, National Health Expenditure data, and Area Resource Files. Results Aggregated time series trends show that high hospital spending between 2001 and 2009 appears to be driven by higher payment per unit of hospital output, not by increased utilization. Results using the Oaxaca-Blinder regression decomposition method indicate that changes in historically important spending drivers explain a limited 30% of unit-payment growth, but a higher 60% of utilization growth. Hospital staffing and labor-related costs, casemix, and demographics are the most important drivers of higher hospital revenue, utilization, and unit-payment. Technology is associated with lower utilization, higher unit payment, and limited increases in total revenue. Market competition, primarily because of increased managed care concentration, moderates total revenue growth by driving lower unit payment. Conclusions Much of the rapidly rising hospital spending growth in the 2000s in the United States is driven by factors not commonly known or well measured. Future studies need to explore new factors and dynamics that drive longer-term hospital spending growth in recent years, particularly through the channel of higher prices. PMID:24886580

Roles for specialty societies and vascular surgeons in accountable care organizations

PubMed Central

Goodney, Philip P.; Fisher, Elliott S.; Cambria, Richard P.

2012-01-01

With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a “seat at the table” will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. PMID:22370029

[Local groups as a tool for quality assurance of community health services].

PubMed

Mjell, J; Hjortdahl, P

2001-05-30

The aim of this study was to assess the use of local interprofessional or audit groups as a tool of quality enhancement. Fifty-six doctors, physiotherapists and nurses attended nine local interprofessional groups. The aim was to improve the quality of each professional's practice and to improve communication between the professions. The groups had a total of 62 meetings with each professional attending on average 5.7 meetings. All groups initiated quality enhancement projects. Initially the groups were very active and showed great initiative, but there were few final results. However, many groups reported improved communication and cooperation between the participating professionals. The experience from this project may be summarised as follows: The professionals within one and the same group should have more or less the same background and specialty. We recommend caution with organising interprofessional groups unless their participants work in the same practice. Interprofessional groups should spend adequate time for the members to get to know each other, and they should be guided by an experienced leader.

The impact of financial incentives on physician empathy: a study from the perspective of patients with private and statutory health insurance.

PubMed

Neumann, Melanie; Bensing, Jozien; Wirtz, Markus; Wübker, Ansgar; Scheffer, Christian; Tauschel, Diethard; Edelhäuser, Friedrich; Ernstmann, Nicole; Pfaff, Holger

2011-08-01

We hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI). A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects. PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE. Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE. Health policy should discuss these findings in terms of equality in receiving high-quality care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Helpers benefit offspring in both the short and long-term in the cooperatively breeding banded mongoose.

PubMed

Hodge, Sarah J

2005-12-07

Helpers in cooperative and communal breeding species are thought to accrue fitness benefits through improving the condition and survival of the offspring that they care for, yet few studies have shown conclusively that helpers benefit the offspring they rear. Using a novel approach to control for potentially confounding group-specific variables, I compare banded mongoose (Mungos mungo) offspring within the same litter that differ in the amount of time they spend with a helper, and hence the amount of care they receive. I show that pups that spend more time in close proximity to a helper are fed more, grow faster and have a higher probability of survival to independence than their littermates. Moreover, high growth rates during development reduce the age at which females breed for the first time, suggesting that helpers can improve the future fecundity of the offspring for which they care. These results provide strong evidence that it is the amount of investment per se that benefits offspring, rather than some correlate such as territory quality, and validate the assumption that helpers improve the reproductive success of breeders, and hence may gain fitness benefits from their actions. Furthermore, the finding that helpers may benefit offspring in the long-term suggests that current studies underestimate the fitness benefits that helpers gain from rearing the offspring of others.

A guide for digitising manuscript climate data

NASA Astrophysics Data System (ADS)

Brönnimann, S.; Annis, J.; Dann, W.; Ewen, T.; Grant, A. N.; Griesser, T.; Krähenmann, S.; Mohr, C.; Scherer, M.; Vogler, C.

2006-10-01

Hand-written or printed manuscript data are an important source for paleo-climatological studies, but bringing them into a suitable format can be a time consuming adventure with uncertain success. Before digitising such data (e.g., in the context a specific research project), it is worthwhile spending a few thoughts on the characteristics of the data, the scientific requirements with respect to quality and coverage, the metadata, and technical aspects such as reproduction techniques, digitising techniques, and quality control strategies. Here we briefly discuss the most important considerations according to our own experience and describe different methods for digitising numeric or text data (optical character recognition, speech recognition, and key entry). We present a tentative guide that is intended to help others compiling the necessary information and making the right decisions.

A guide for digitising manuscript climate data

NASA Astrophysics Data System (ADS)

Brönnimann, S.; Annis, J.; Dann, W.; Ewen, T.; Grant, A. N.; Griesser, T.; Krähenmann, S.; Mohr, C.; Scherer, M.; Vogler, C.

2006-05-01

Hand-written or printed manuscript data are an important source for paleo-climatological studies, but bringing them into a suitable format can be a time consuming adventure with uncertain success. Before starting the digitising work, it is worthwhile spending a few thoughts on the characteristics of the data, the scientific requirements with respect to quality and coverage, and on the different digitising techniques. Here we briefly discuss the most important considerations and report our own experience. We describe different methods for digitising numeric or text data, i.e., optical character recognition (OCR), speech recognition, and key entry. Each technique has its advantages and disadvantages that may become important for certain applications. It is therefore crucial to thoroughly investigate beforehand the characteristics of the manuscript data, define the quality targets and develop validation strategies.

Probe-And-Socket Fasteners For Robotic Assembly

NASA Technical Reports Server (NTRS)

Nyberg, Karen

1995-01-01

Self-alignment and simplicity of actuation make mechanism amenable to robotic assembly. Includes socket, mounted on structure at worksite, and probe, mounted on piece of equipment to be attached to structure at socket. Probe-and-socket mechanism used in conjunction with fixed target aiding in placement of end effector of robot during grasping, and with handle or handles on structure. Intended to enable robot to set up workstation in hostile environment. Workstation then used by astronaut, aquanaut, or other human, spending minimum time in environment. Human concentrates on performing quality work rather than on setting up equipment, with consequent reduction of risk.

Designing intuitive dialog boxes in Windows environments

NASA Astrophysics Data System (ADS)

Souetova, Natalia

2000-01-01

There were analyzed some approaches to user interface design. Most existing interfaces seem to be difficult for understanding and studying for newcomers. There were defined some ways for designing interfaces based on psychology of computer image perception and experience got while working with artists and designers without special technique education. Some applications with standard Windows interfaces, based on these results, were developed. Windows environment was chosen because they are very popular now. This increased quality and speed of users' job and reduced quantity of troubles and mistakes. Now high-qualified employers do not spend their working time for explanation and help.

Lean Six Sigma applied to a process innovation in a mexican health institute's imaging department.

PubMed

Garcia-Porres, J; Ortiz-Posadas, M R; Pimentel-Aguilar, A B

2008-01-01

Delivery of services to a patient has to be given with an acceptable measure of quality that can be monitored through the patient's satisfaction. The objective of this work was to innovate processes eliminating waste and non value-added work in processes done at the Imaging Department in the National Institute of Respiratory Diseases (INER for its Spanish acronym) in Mexico City, to decrease the time a patient spends in a study and increase satisfaction. This innovation will be done using Lean Six Sigma tools and applied in a pilot program.

'The right direction'. Primary-care docs see promise in CMS' proposed pay for non face-to-face work.

PubMed

Robeznieks, Andis

2013-07-15

The CMS has proposed paying physicians for managing patients apart from face-to-face office visits. Among the details under consideration are requiring practices to use an electronic health-record system that supports access to care, care coordination, care management and communications. "It's a step in the right direction. The devil will be in the details and, if the burden of documentation is so high, people may choose not to spend their time doing it," says Dr. Matt Handley, physician and medical director for quality at the Group Health Cooperative.

Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation.

PubMed

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2018-01-01

We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis.

PubMed

Lexchin, Joel

2018-01-01

Competing claims are made about the amount of money that pharmaceutical companies spend on research and development (R&D) versus promotion. This study investigates this question in the Canadian context. Two methods for determining industry-wide figures for spending on promotion were employed. First, total industry spending on detailing and journal advertising for 2013-2016 was abstracted from reports from QuintilesIMS. Second, the mean total promotion spending for the years 2002-2005 was used to estimate total spending for 2013-2016. Total industry spending on R&D came from the Patented Medicine Prices Review Board (PMPRB). R&D to promotion spending using each method of determining the amount spent on promotion was compared for 2013-2016 inclusive. Data on the 50 top promoted drugs, the amounts spent, the companies marketing these products and their overall sales were abstracted from the QuintilesIMS reports. Spending on R&D and promotion as a percent of sales was compared for these companies. Industry wide, the ratio of R&D to promotion spending went from 1.43 to 2.18 when promotion was defined as the amount spent on detailing and journal advertising for the 50 most promoted drugs. Calculating total promotion spending from the mean of the 2002-2005 figures the ratio was 0.88 to 1.32 for the 50 most promoted drugs. For individual companies marketing one or more of the 50 most promoted drugs, mean R&D spending ranged from 3.7% of sales to 4.1% compared to mean promotion spending that went from 1.7 to 1.9%. The ratio of spending on R&D to promotion varied from 2.11 to 2.32. Eight to 10 companies per year spent more on promotion than on R&D. Depending on the method used to determine promotion spending, industry-wide the ratio of R&D spending to promotion ranges from 1.45 to 2.18 (sales representatives and journal advertising only) or from 0.88 to 1.32 (total promotion spending estimated based 2003-2005 data.) For the individual companies promoting one or more of the 50 most promoted drugs, 2.11 to 2.32 times more is spent on R&D compared to promotion. However these results should be interpreted cautiously because of data limitations.

Waiting can be an optimal conservation strategy, even in a crisis discipline

PubMed Central

Possingham, Hugh P.; Bode, Michael

2017-01-01

Biodiversity conservation projects confront immediate and escalating threats with limited funding. Conservation theory suggests that the best response to the species extinction crisis is to spend money as soon as it becomes available, and this is often an explicit constraint placed on funding. We use a general dynamic model of a conservation landscape to show that this decision to “front-load” project spending can be suboptimal if a delay allows managers to use resources more strategically. Our model demonstrates the existence of temporal efficiencies in conservation management, which parallel the spatial efficiencies identified by systematic conservation planning. The optimal timing of decisions balances the rate of biodiversity decline (e.g., the relaxation of extinction debts, or the progress of climate change) against the rate at which spending appreciates in value (e.g., through interest, learning, or capacity building). We contrast the benefits of acting and waiting in two ecosystems where restoration can mitigate forest bird extinction debts: South Australia’s Mount Lofty Ranges and Paraguay’s Atlantic Forest. In both cases, conservation outcomes cannot be maximized by front-loading spending, and the optimal solution recommends substantial delays before managers undertake conservation actions. Surprisingly, these delays allow superior conservation benefits to be achieved, in less time than front-loading. Our analyses provide an intuitive and mechanistic rationale for strategic delay, which contrasts with the orthodoxy of front-loaded spending for conservation actions. Our results illustrate the conservation efficiencies that could be achieved if decision makers choose when to spend their limited resources, as opposed to just where to spend them. PMID:28894004

Waiting can be an optimal conservation strategy, even in a crisis discipline.

PubMed

Iacona, Gwenllian D; Possingham, Hugh P; Bode, Michael

2017-09-26

Biodiversity conservation projects confront immediate and escalating threats with limited funding. Conservation theory suggests that the best response to the species extinction crisis is to spend money as soon as it becomes available, and this is often an explicit constraint placed on funding. We use a general dynamic model of a conservation landscape to show that this decision to "front-load" project spending can be suboptimal if a delay allows managers to use resources more strategically. Our model demonstrates the existence of temporal efficiencies in conservation management, which parallel the spatial efficiencies identified by systematic conservation planning. The optimal timing of decisions balances the rate of biodiversity decline (e.g., the relaxation of extinction debts, or the progress of climate change) against the rate at which spending appreciates in value (e.g., through interest, learning, or capacity building). We contrast the benefits of acting and waiting in two ecosystems where restoration can mitigate forest bird extinction debts: South Australia's Mount Lofty Ranges and Paraguay's Atlantic Forest. In both cases, conservation outcomes cannot be maximized by front-loading spending, and the optimal solution recommends substantial delays before managers undertake conservation actions. Surprisingly, these delays allow superior conservation benefits to be achieved, in less time than front-loading. Our analyses provide an intuitive and mechanistic rationale for strategic delay, which contrasts with the orthodoxy of front-loaded spending for conservation actions. Our results illustrate the conservation efficiencies that could be achieved if decision makers choose when to spend their limited resources, as opposed to just where to spend them.

The impact on the workload of the Ward Manager with the introduction of administrative assistants.

PubMed

Locke, Rachel; Leach, Camilla; Kitsell, Fleur; Griffith, Jacki

2011-03-01

To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative support. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Boom Time.

ERIC Educational Resources Information Center

Agron, Joe

1998-01-01

Examines building-cost trend data for educational facilities from the American School & University's 24th annual Official Education Construction Report for 1997. Data tables list education construction by projects completed; by projected spending; institution type; type of spending; projects projected for completion; and how construction costs…

Effects of Accountable Care and Payment Reform on Substance Use Disorder Treatment: Evidence from the Initial Three Years of the Alternative Quality Contract

PubMed Central

Stuart, Elizabeth A.; Barry, Colleen L.; Donohue, Julie M.; Greenfield, Shelly F.; Duckworth, Kenneth; Song, Zirui; Kouri, Elena M.; Ebnesajjad, Cyrus; Mechanic, Robert; Chernew, Michael E.; Huskamp, Haiden A.

2016-01-01

Background and Aims Global payment and accountable care reform efforts in the US may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an ‘Alternative Quality Contract’ (AQC) model within the Blue Cross Blue Shield of Massachusetts’ (BCBSMA) insurer increased care for individuals with SUD. Design Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC. Setting Massachusetts, USA. Participants BCBSMA enrollees aged 13–64 from 2006–2011 (three years prior to and after implementation) representing 1,333,534 enrollees and 42,801 SUD service users. Measurements Outcomes were SUD service use and spending and SUD performance metrics. Primary exposures were enrollment in an AQC provider organization and whether the AQC organization did or did not face risk for behavioral health costs. Findings Enrollees in AQC organizations facing behavioral health risk experienced no change in the probability of using SUD services (1.64% vs. 1.66%; p=0.63), SUD spending ($2,807 vs. $2,700; p=0.34) or total spending ($12,631 vs. $12,849; p=0.53), or SUD performance metrics (identification: 1.73% vs. 1.76%, p=0.57; initiation: 27.86% vs. 27.02%, p=0.50; engagement: 11.19% vs. 10.97%, p=0.79). Enrollees in AQC organizations not at risk for behavioral health spending experienced a small increase in the probability of using SUD services (1.83% vs. 1.66%; p=0.003) and the identification performance metric (1.92% vs. 1.76%; p=0.007), and a reduction in SUD medication use (11.84% vs. 14.03%; p=0.03) and the initiation performance metric (23.76% vs. 27.02%; p=0.005). Conclusions A global payment and accountable care model introduced in Massachusetts USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients’ care during a specified time period, incentivizing providers to keep their patients’ healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first three years following its implementation. PMID:27517740

Effects of accountable care and payment reform on substance use disorder treatment: evidence from the initial 3 years of the alternative quality contract.

PubMed

Stuart, Elizabeth A; Barry, Colleen L; Donohue, Julie M; Greenfield, Shelly F; Duckworth, Kenneth; Song, Zirui; Mechanic, Robert; Kouri, Elena M; Ebnesajjad, Cyrus; Chernew, Michael E; Huskamp, Haiden A

2017-01-01

Global payment and accountable care reform efforts in the United States may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an Alternative Quality Contract (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC. Massachusetts, USA. BCBSMA enrollees aged 13-64 years from 2006 to 2011 (3 years prior to and after implementation) representing 1 333 534 enrollees and 42 801 SUD service users. Outcomes were SUD service use and spending and SUD performance metrics. Primary exposures were enrollment into an AQC provider organization and whether the AQC organization did or did not face risk for behavioral health costs. Enrollees in AQC organizations facing behavioral health risk experienced no change in the probability of using SUD services (1.64 versus 1.66%; P = 0.63), SUD spending ($2807 versus $2700; P = 0.34) or total spending ($12 631 versus $12 849; P = 0.53), or SUD performance metrics (identification: 1.73 versus 1.76%, P = 0.57; initiation: 27.86 versus 27.02%, P = 0.50; engagement: 11.19 versus 10.97%, P = 0.79). Enrollees in AQC organizations not at risk for behavioral health spending experienced a small increase in the probability of using SUD services (1.83 versus 1.66%; P = 0.003) and the identification performance metric (1.92 versus 1.76%; P = 0.007) and a reduction in SUD medication use (11.84 versus 14.03%; P = 0.03) and the initiation performance metric (23.76 versus 27.02%; P = 0.005). A global payment and accountable care model introduced in Massachusetts, USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients' care during a specified time-period, incentivizing providers to keep their patients healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first 3 years following its implementation. © 2016 Society for the Study of Addiction.

Monitoring Indoor Air Quality for Enhanced Occupational Health.

PubMed

Pitarma, Rui; Marques, Gonçalo; Ferreira, Bárbara Roque

2017-02-01

Indoor environments are characterized by several pollutant sources. Because people spend more than 90% of their time in indoor environments, several studies have pointed out the impact of indoor air quality on the etiopathogenesis of a wide number of non-specific symptoms which characterizes the "Sick Building Syndrome", involving the skin, the upper and lower respiratory tract, the eyes and the nervous system, as well as many building related diseases. Thus, indoor air quality (IAQ) is recognized as an important factor to be controlled for the occupants' health and comfort. The majority of the monitoring systems presently available is very expensive and only allow to collect random samples. This work describes the system (iAQ), a low-cost indoor air quality monitoring wireless sensor network system, developed using Arduino, XBee modules and micro sensors, for storage and availability of monitoring data on a web portal in real time. Five micro sensors of environmental parameters (air temperature, humidity, carbon monoxide, carbon dioxide and luminosity) were used. Other sensors can be added for monitoring specific pollutants. The results reveal that the system can provide an effective indoor air quality assessment to prevent exposure risk. In fact, the indoor air quality may be extremely different compared to what is expected for a quality living environment. Systems like this would have benefit as public health interventions to reduce the burden of symptoms and diseases related to "sick buildings".

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

PubMed Central

Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2015-01-01

Objectives Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. PMID:26683885

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries.

PubMed

Burnett, Susan; Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2016-04-01

Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. © The Author(s) 2015.

Maternal employment, acculturation, and time spent in food-related behaviors among Hispanic mothers in the United States. Evidence from the American Time Use Survey.

PubMed

Sliwa, Sarah A; Must, Aviva; Peréa, Flavia; Economos, Christina D

2015-04-01

Employment is a major factor underlying im/migration patterns. Unfortunately, lower diet quality and higher rates of obesity appear to be unintended consequences of moving to the US. Changes in food preparation practices may be a factor underlying dietary acculturation. The relationships between employment, acculturation, and food-related time use in Hispanic families have received relatively little attention. We used cross-sectional data collected from Hispanic mothers (ages 18-65) with at least one child <13 years old participating in the 2003-2011 American Time Use Survey (n = 3622) to estimate the relationship between employment, acculturation (US-born vs. im/migrant), and time spent in food preparation and family dinner. Regression models were estimated separately for the employed and the non-working and were adjusted for Hispanic origin group, socio-demographic and household characteristics. Working an eight-hour day was associated with spending 38 fewer minutes in food preparation (-38.0 ± SE 4.8, p < 001). Although being US-born was associated with spending fewer minutes in food preparation, this relationship varied by origin group. Acculturation did not appear to modify the relationship between hours worked and time spent in food preparation or family dinner. Mothers who worked late hours spent less time eating the evening meal with their families (-9.8 ± SE 1.3). Although an eight-hour workday was associated with a significant reduction in food preparation time, an unexpected result is that, for working mothers, additional time spent in paid work is not associated with the duration of family dinner later that day. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of Mental Workload among ICU Ward's Nurses

PubMed Central

Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

2015-01-01

Background: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor­mance obstacles in ICUs. Methods: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Results: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs. PMID:26933647

The benefits of bad economies: Business cycles and time-based work-life conflict.

PubMed

Barnes, Christopher M; Lefter, Alexandru M; Bhave, Devasheesh P; Wagner, David T

2016-04-01

Recent management research has indicated the importance of family, sleep, and recreation as nonwork activities of employees. Drawing from entrainment theory, we develop an expanded model of work-life conflict to contend that macrolevel business cycles influence the amount of time employees spend on both work and nonwork activities. Focusing solely on working adults, we test this model in a large nationally representative dataset from the Bureau of Labor Statistics that spans an 8-year period, which includes the "Great Recession" from 2007 through 2009. We find that during economic booms, employees work more and therefore spend less time with family, sleeping, and recreating. In contrast, in recessionary economies, employees spend less time working and therefore more time with family, sleeping, and recreating. Thus, we extend the theory on time-based work-to-family conflict, showing that there are potential personal and relational benefits for employees in recessionary economies. (c) 2016 APA, all rights reserved).

Child Care Assistance Spending and Participation in 2012: A Record Low

ERIC Educational Resources Information Center

Matthews, Hannah; Schmit, Stephanie

2014-01-01

Child care subsidies help make quality child care affordable for low-income parents, allowing them to attend work or school to support their families while ensuring their children's healthy development. Access to quality child care is also proven to strengthen families' economic security. The Child Care and Development Block Grant (CCDBG) is the…

Improving the Nutritional Quality of the Lunches of Elementary School Children

ERIC Educational Resources Information Center

Farris, Alisha R.

2015-01-01

Over 50 million children attend public elementary and secondary schools in the United States each day. Children spend a substantial portion of their waking hours in school and consume one-third to one-half of their daily calories there, making schools a promising site to influence dietary quality and potentially the risk of childhood obesity.…

Health effects of air quality regulations in Delhi, India

NASA Astrophysics Data System (ADS)

Foster, Andrew; Kumar, Naresh

2011-03-01

This, the first systematic study, quantifies the health effects of air quality regulations in Delhi, which adopted radical measures to improve air quality, including, for example, the conversion of all commercial vehicles to compressed natural gas (CNG), and the closure of polluting industries in residential areas from 2000 to 2002. Air pollution data, collected at 113 sites (spread across Delhi and its neighboring areas) from July-December 2003, were used to compute exposure at the place of residence of 3989 subjects. A socio-economic and respiratory health survey was administered in 1576 households. This survey collected time-use, residence histories, demographic information, and direct measurements of lung function with subjects. The optimal interpolation methods were used to link air pollution and respiratory health data at the place of their residence. Resident histories, in combination with secondary data, were used to impute cumulative exposure prior to the air-quality interventions, and the effects of recent air quality measures on lung function were then evaluated. Three important findings emerge from the analysis. First, the interventions were associated with a significant improvement in respiratory health. Second, the effect of these interventions varied significantly by gender and income. Third, consistent with a causal interpretation of these results, effects were the strongest among those individuals who spend a disproportionate share of their time out-of-doors.

The use of modern technologies in carbon dioxide monitoring

NASA Astrophysics Data System (ADS)

Komínek, Petr; Weyr, Jan; Hirš, Jiří

2017-12-01

Indoor environment has huge influence on person's health and overall comfort. It is of great importance that we realize how essential indoor air quality is, considering we spend on average as much as 90% of our time indoors. There are many factors that affect indoor air quality: specifically, inside air temperature, relative humidity, and odors to name the most important factors. One of the key factors indicating indoor air quality is carbon dioxide (CO2) level. The CO2 levels, measured in prefab apartment buildings, indicates substantial indoor air quality issues. Therefore, a proper education of the occupants is of utmost importance. Also, great care should be directed towards technical and technological solutions that would ensure meeting the normative indoor environment criteria, especially indoor air CO2 levels. Thanks to the implementation of new emerging autonomous technologies, such as Internet of Things (IoT), monitoring in real-time is enhanced. An area where IoT plays a major role is in the monitoring of indoor environment. IoT technology (e.g. smart meters and sensors) provide awareness of information about the quality of indoor environment. There is a huge potential for influencing behaviour of the users. Through the web application, it is possible to educate people and ensure fresh air supply.

Variability in individual assessment behaviour and its implications for collective decision-making.

PubMed

O'Shea-Wheller, Thomas A; Masuda, Naoki; Sendova-Franks, Ana B; Franks, Nigel R

2017-02-08

Self-organized systems of collective behaviour have been demonstrated in a number of group-living organisms. There is, however, less research relating to how variation in individual assessments may facilitate group decision-making. Here, we investigate this using the decentralized system of collective nest choice behaviour employed by the ant Temnothorax albipennis, combining experimental results with computational modelling. In experiments, isolated workers of this species were allowed to investigate new nest sites of differing quality, and it was found that for any given nest quality, there was wide variation among individuals in the durations that they spent within each nest site. Additionally, individual workers were consistent in spending more time in nest sites of higher quality, and less time in those of lower quality. Hence, the time spent in a new nest site must have included an assessment of nest quality. As nest site visit durations (henceforth termed assessment durations) are linked to recruitment, it is possible that the variability we observed may influence the collective decision-making process of colonies. Thus, we explored this further using a computational model of nest site selection, and found that heterogeneous nest assessments conferred a number of potential benefits. Furthermore, our experiments showed that nest quality assessments were flexible, being influenced by experience of prior options. Our findings help to elucidate the potential mechanisms underlying group behaviour, and highlight the importance of heterogeneity among individuals, rather than precise calibration, in shaping collective decision-making. © 2017 The Author(s).

Making the Case: A Fact Sheet on Children and Youth in Out-of-School Time

ERIC Educational Resources Information Center

National Institute on Out of School Time, 2005

2005-01-01

This fact sheet resource is packed with the latest research and information on how children and youth spend their non-school hours, how they benefit from afterschool activities and much more. Sections include: (1) Children and youth today; (2) Health and well-being; (3) Children and youth spend time after school in a variety of ways; (4) Children…

Deciding when It's Time to Buy a New PC

ERIC Educational Resources Information Center

Goldsborough, Reid

2004-01-01

How to best decide when it's time to replace your PC, whether at home or at work, is always tricky. Spending on computers can make you more productive, but it's money you otherwise cannot spend, invest or save, and faster systems always await you in the future. What is clear is that the computer industry really wants you to buy, and the computer…

US Spending on Personal Health Care and Public Health, 1996-2013.

PubMed

Dieleman, Joseph L; Baral, Ranju; Birger, Maxwell; Bui, Anthony L; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I; Vos, Theo; Murray, Christopher J L

2016-12-27

US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]). Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

State variation in HIV/AIDS health outcomes: the effect of spending on social services and public health.

PubMed

Talbert-Slagle, Kristina M; Canavan, Maureen E; Rogan, Erika M; Curry, Leslie A; Bradley, Elizabeth H

2016-02-20

Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States. We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty. We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors. States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05). Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.

An analysis of restructuring orientation to enhance nurse retention.

PubMed

Kiel, Joan M

2012-01-01

The nursing shortage has received much media attention; however, something that contributes to it-nurse turnover-has not received the same attention. Facilities spend time and money to train new employees only to have them leave within a few months. Staff morale, money, time, and quality of care are all affected by nurse turnover. The fact that it often occurs so soon after one takes a position makes it pertinent to look at the process of transition into the new position, namely, the orientation program. This article examines the turnover statistics, costs, rationale, and orientation programs that have proven positive results. It is hoped that the findings can assist health care facilities to replicate successful orientation programs and reduce nurse turnover.

Traffic and meteorological impacts on near-road air quality: summary of methods and trends from the Raleigh Near-Road Study.

PubMed

Baldauf, Richard; Thoma, Eben; Hays, Michael; Shores, Richard; Kinsey, John; Gullett, Brian; Kimbrough, Sue; Isakov, Vlad; Long, Thomas; Snow, Richard; Khlystov, Andrey; Weinstein, Jason; Chen, Fu-Lin; Seila, Robert; Olson, David; Gilmour, Ian; Cho, Seung-Hyun; Watkins, Nealson; Rowley, Patricia; Bang, John

2008-07-01

A growing number of epidemiological studies conducted worldwide suggest an increase in the occurrence of adverse health effects in populations living, working, or going to school near major roadways. A study was designed to assess traffic emissions impacts on air quality and particle toxicity near a heavily traveled highway. In an attempt to describe the complex mixture of pollutants and atmospheric transport mechanisms affecting pollutant dispersion in this near-highway environment, several real-time and time-integrated sampling devices measured air quality concentrations at multiple distances and heights from the road. Pollutants analyzed included U.S. Environmental Protection Agency (EPA)-regulated gases, particulate matter (coarse, fine, and ultrafine), and air toxics. Pollutant measurements were synchronized with real-time traffic and meteorological monitoring devices to provide continuous and integrated assessments of the variation of near-road air pollutant concentrations and particle toxicity with changing traffic and environmental conditions, as well as distance from the road. Measurement results demonstrated the temporal and spatial impact of traffic emissions on near-road air quality. The distribution of mobile source emitted gas and particulate pollutants under all wind and traffic conditions indicated a higher proportion of elevated concentrations near the road, suggesting elevated exposures for populations spending significant amounts of time in this microenvironment. Diurnal variations in pollutant concentrations also demonstrated the impact of traffic activity and meteorology on near-road air quality. Time-resolved measurements of multiple pollutants demonstrated that traffic emissions produced a complex mixture of criteria and air toxic pollutants in this microenvironment. These results provide a foundation for future assessments of these data to identify the relationship of traffic activity and meteorology on air quality concentrations and population exposures.

Time well spent? Assessing nursing-supply chain activities.

PubMed

Ferenc, Jeff

2010-02-01

The amount of time nurses spend providing direct patient care seems to be continually eroding. So it's little wonder a survey conducted last year of critical care, OR nurses and nurse executives found that half of the 1600 respondents feel they spend too much time on supply chain duties. Most also said their supply chain duties impact patient safe ty and their ability to provide bedside care. Experts interviewed for this report believe it's time for supply chain leaders and nurses to develop a closer working partnership. Included are their recommendations to improve performance.

Problems associated with pooling mark-recapture data prior to estimating stopover length for migratory passerines

Treesearch

Sara R. Morris; Erica M. Turner; David A. Liebner; Amanda M. Larracuente; H. David Sheets

2005-01-01

One measure of the importance of a stopover site is the length of time that migrants spend at an area, however measuring the time birds spend at a stopover site has proven difficult. Most banding studies have presented only minimum length of stopover, based on the difference between initial capture and final recapture of birds that are captured more than once. Cormack-...

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

PubMed

Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L

2017-02-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

Work hard, play hard?: A comparison of male and female lawyers' time in paid and unpaid work and participation in leisure activities.

PubMed

Wallace, Jean E; Young, Marisa C

2010-02-01

There has been a considerable amount of research that documents how women and men spend their time in different work and home tasks. We examine how much time professional women and men spend in paid and unpaid work and how this relates to their participation in different leisure activities. We also explore whether time in paid and unpaid work has gender-specific effects on leisure participation. In examining these issues, we rely on data from lawyers working in different legal settings. Our results show that, as hypothesized, men report more time in paid work and leisure whereas women devote more time to housework and childcare. An unexpected finding is that the time men spend in housework or childcare is either unrelated or positively related to their leisure participation. These results suggest that men's greater overall opportunities for leisure compared with women's appear to stem from the unanticipated relationships between men's involvement in housework and childcare and their leisure activities. We raise several possible explanations for these findings.

Patients Provide Recommendations for Improving Patient Satisfaction.

PubMed

Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

2016-04-01

National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five.

PubMed

Wallace, Jacob; Song, Zirui

2016-05-01

To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers-including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter-or 32.4 percent-upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does. Project HOPE—The People-to-People Health Foundation, Inc.

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five

PubMed Central

Wallace, Jacob; Song, Zirui

2016-01-01

To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter—or 32.4 percent—upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does. PMID:27140993

Individual, social and physical environmental correlates of sedentary behaviours in adults: a systematic review protocol.

PubMed

Prince, Stephanie A; Gresty, Katelin M; Reed, Jennifer L; Wright, Erica; Tremblay, Mark S; Reid, Robert D

2014-10-21

Adults spend the majority of their time being sedentary, and evidence suggests that those who spend more of their day engaged in sedentary activities (TV viewing, sitting, screen-based activities) are at increased risk for morbidity and mortality, regardless of whether they exercise regularly. In order to develop effective interventions to reduce sedentary time, it is necessary to identify and understand the strongest modifiable factors of these behaviours. Therefore, the objective of this systematic review is to examine the available evidence in order to identify individual, social, environmental and policy correlates and determinants of sedentary behaviours (TV time, sitting time, screen time) and total sedentary time among adults. Six electronic databases will be searched to identify all studies that report on individual, social and/or environmental correlates and determinants of sedentary behaviours and total sedentary time in adults. Grey literature sources including theses, published conference abstracts and websites from relevant organizations will also be included. Articles that report on modifiable individual (e.g. health behaviours and status, self-efficacy, socio-economic status), social (e.g. crime, safety, social support, climate and capital), environmental (e.g. weather, workplace, home, neighbourhood, recreation environment, transportation environment) and policy correlates and determinants (based on study design) of sedentary behaviours in an adult population (mean age ≥18 years) will be included. Study quality and risk of bias will be assessed within and across all included studies. Harvest plots will be used to synthesize results across all correlates, and meta-analyses will be conducted where possible among studies with sufficient homogeneity. This review will provide a comprehensive examination of evidence in the field and will serve to highlight gaps for future research on the determinants of sedentary behaviours and inform intervention design. PROSPERO CRD42014009814.

US Spending on Personal Health Care and Public Health, 1996–2013

PubMed Central

Dieleman, Joseph L.; Baral, Ranju; Birger, Maxwell; Bui, Anthony L.; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K.; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D.; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I.; Vos, Theo; Murray, Christopher J. L.

2017-01-01

IMPORTANCE US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. OBJECTIVE To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. DESIGN AND SETTING Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. EXPOSURES Encounter with US health care system. MAIN OUTCOMES AND MEASURES National spending estimates stratified by condition, age and sex group, and type of care. RESULTS From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion–$106.5 billion) in spending, including 57.6% (UI, 53.8%–62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%–25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion–$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion–$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion–$64.4 billion) and $64.4 billion (UI, $57.8 billion–$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%–6.4%] and 5.6% [UI, 5.6%–5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%–2.5%]). CONCLUSIONS AND RELEVANCE Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending. PMID:28027366

Patterns, Trends and Policy Implications of Private Spending on Skills Development in Mexico and the United States

ERIC Educational Resources Information Center

Székely, Miguel; Mendoza, Pamela

2017-01-01

This paper explores families' investment in skills development through education in a high-inequality, low-education quality country such as Mexico, comparing it to a lower-inequality, higher-quality education country such as the United States. The paper uses a series of Household Income and Expenditure Surveys for both countries spanning around…

Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

PubMed

Keene, Lyndon; Bagshaw, Philip; Nicholls, M Gary; Rosenberg, Bill; Frampton, Christopher M; Powell, Ian

2016-05-27

Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency

PubMed Central

Roberts, Eric T.; Mehrotra, Ateev; McWilliams, J. Michael

2017-01-01

Provider consolidation has intensified concerns that providers with market power may be able to charge higher prices without having to deliver better care. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and the quality and efficiency of care provided to their patients. Using commercial claims, we classified practices as high-priced or low-priced. We compared care quality, utilization, and spending between high-priced and low-priced practices in the same areas using data from the Consumer Assessment of Health Care Providers and Systems survey and linked claims for Medicare beneficiaries. Compared with low-priced practices, high-priced practices were much larger and received 36% higher prices. Patients of high-priced practices reported significantly higher scores on some measures of care coordination and management, but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of mammography, vaccinations, or diabetes services, acute care use, or total Medicare spending. These findings suggest an overall weak relationship between practices’ prices and the quality and efficiency of care they provide, calling into question claims that high-priced providers deliver substantially higher-value care. PMID:28461352

Contaminant Control

ERIC Educational Resources Information Center

Bloech, Henning

2006-01-01

Five days a week, more than 55 million children, teachers and employees spend the majority of their waking hours in the U.S. school buildings. Besides being exposed to science, history and math, children and teachers are exposed to hundreds if not thousands of potentially hazardous chemicals and pollutants. Because children spend so much time in…

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2013 CFR

2013-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2012 CFR

2012-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2011 CFR

2011-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2014 CFR

2014-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

School Library Journal's Spending Survey

ERIC Educational Resources Information Center

Farmer, Lesley; Shontz, Marilyn

2009-01-01

This year's "School Library Journal's" spending survey showed that, despite the recession, the vast majority of media centers around the country have retained their credentialed media specialists. For example, almost 85% of elementary schools and more than 95% of middle and high schools have a full-time certified librarian. In addition, salaries…

Fleet of Foot: Adolescent Foot and Ankle Mobility

ERIC Educational Resources Information Center

Legacy, Kelly Bromley

2018-01-01

In today's world of advanced technologies, accessible transportation, and fingertip talking, adolescents are spending too many hours each day sedentary. The purpose of this article is to underscore the importance of foot and ankle mobility in an adolescent population that spends very little time on their feet. Physical educators and athletic…

The state of domestic affairs: Housework, gender and state-level institutional logics.

PubMed

Ruppanner, Leah; Maume, David J

2016-11-01

Multi-level cross-national research consistently shows individual housework arrangements are structured by broader contexts of equality. Across this body of research, the United States is treated as a single entity. Yet, individual-level housework time may vary by state-to-state differences in institutional market, family and legislative logics. To test these relationships, we pair individual-level data from the American Time Use Survey (2003-2012; aged 18 to 64 n = 106,190) with three state-level indices - female labor force empowerment, family traditionalism and state government liberalism. For market institutional logics, we find wives and husbands spend more but mothers less time in housework in states where women have more labor market power. For family logics, we find mothers spend more and husbands less time in housework in more traditional states. For legislative logics, we find women and husbands spend more time in housework in more liberal states. Our results highlight the importance of state-to-state institutional logics on individuals' housework time. Copyright © 2016 Elsevier Inc. All rights reserved.

Caring for the health of the public: cross sectional study of the activities of UK public health departments.

PubMed

Lawlor, D A; Morgan, K; Frankel, S

2002-03-01

The relative time spent in different areas of work in public health departments in the UK was assessed by means of a postal questionnaire. Departments spend one third of their time on population health work, this being similar to the amount of time spent on planning health services. Having a planning department in the health authority did not affect the amount of time spent in any area of work. Having a greater number of consultants in the department was associated with a tendency to spend more time on population health and being involved in training was associated with spending less time on planning. Public health departments in the UK are the only part of the health service with responsibility for the broader aspects of public health. Whilst the tensions between medical care and the wider influences upon population health may represent a false dichotomy, public health professionals must maintain a central focus of their work on the wider influences upon population health if balance is to be maintained within the National Health Service.

Induction for Radiology Patients

NASA Astrophysics Data System (ADS)

Yıldırım, Pınar; Tolun, Mehmet R.

This paper represents the implementation of an inductive learning algorithm for patients of Radiology Department in Hacettepe University hospitals to discover the relationship between patient demographics information and time that patients spend during a specific radiology exam. ILA has been used for the implementation which generates rules and the results are evaluated by evaluation metrics. According to generated rules, some patients in different age groups or birthplaces may spend more time for the same radiology exam than the others.

Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

PubMed

Cunningham, Peter J

2011-06-01

This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

Internet use, social networks, loneliness, and quality of life among adults aged 50 and older: mediating and moderating effects.

PubMed

Khalaila, Rabia; Vitman-Schorr, Adi

2018-02-01

The increase in longevity of people on one hand, and on the other hand the fact that the social networks in later life become increasingly narrower, highlights the importance of Internet use to enhance quality of life (QoL). However, whether Internet use increases or decreases social networks, loneliness, and quality of life is not clear-cut. To explore the direct and/or indirect effects of Internet use on QoL, and to examine whether ethnicity and time the elderly spent with family moderate the mediation effect of Internet use on quality of life throughout loneliness. This descriptive-correlational study was carried out in 2016 by structured interviews with a convenience sample of 502 respondents aged 50 and older, living in northern Israel. Bootstrapping with resampling strategies was used for testing mediation a model. Use of the Internet was found to be positively associated with QoL. However, this relationship was mediated by loneliness, and moderated by the time the elderly spent with family members. In addition, respondents' ethnicity significantly moderated the mediation effect between Internet use and loneliness. Internet use can enhance QoL of older adults directly or indirectly by reducing loneliness. However, these effects are conditional on other variables. The indirect effect moderated by ethnicity, and the direct effect moderated by the time the elderly spend with their families. Researchers and practitioners should be aware of these interactions which can impact loneliness and quality of life of older persons differently.

Trends in Health Care Spending by the Private Sector

DTIC Science & Technology

1997-04-01

private - sector spending for health insurance increases each year has raised many questions about the meaning of the trend and its implications for the future. According to the federal government’s national health accounts (NHA), the annual growth rate of private health insurance expenditures tumbled from around 14 percent in 1990 to less than 3 percent in 1994 and 1995. Understanding the factors that contribute to that reduction is of particular concern to policymakers who are seeking ways to slow the growth of Medicare spending. At the same time that fundamental

An examination of flexible spending accounts.

PubMed

Cardon, J H; Showalter, M H

2001-11-01

This paper develops a framework for analyzing flexible spending account (FSA) participation and usage. We explore patterns of FSA usage using data from a benefits firm for 1996 including an examination of types of FSA expenditures and their timing. We estimate some simple econometric models of the participation decision and also the decision of how much to put into an FSA. Several pieces of evidence suggest that much of an FSA election amount is based on foreknowledge of expenditures. We also find that participants tend to spend their election amount early, thus obtaining an interest-free loan.

Showing that you care: the evolution of health altruism.

PubMed

Hanson, Robin

2008-01-01

Human behavior regarding medicine seems strange; assumptions and models that seem workable in other areas seem less so in medicine. Perhaps, we need to rethink the basics. Toward this end, I have collected many puzzling stylized facts about behavior regarding medicine, and have sought a small number of simple assumptions which might together account for as many puzzles as possible. The puzzles I consider include a willingness to provide more medical than other assistance to associates, a desire to be seen as so providing, support for nation, firm, or family provided medical care, placebo benefits of medicine, a small average health value of additional medical spending relative to other health influences, more interest in public that private signals of medical quality, medical spending as an individual necessity but national luxury, a strong stress-mediated health status correlation, and support for regulating health behaviors of the low status. These phenomena seem widespread across time and cultures. I can explain these puzzles moderately well by assuming that humans evolved deep medical habits long ago in an environment where people gained higher status by having more allies, honestly cared about those who remained allies, were unsure who would remain allies, wanted to seem reliable allies, inferred such reliability in part based on who helped who with health crises, tended to suffer more crises requiring non-health investments when having fewer allies, and invested more in cementing allies in good times in order to rely more on them in hard times. These ancient habits would induce modern humans to treat medical care as a way to show that you care. Medical care provided by our allies would reassure us of their concern, and allies would want you and other allies to see that they had pay enough to distinguish themselves from posers who didn't care as much as they. Private information about medical quality is mostly irrelevant to this signaling process. If people with fewer allies are less likely to remain our allies, and if we care about them mainly assuming they remain our allies, then we want them to invest more in health than they would choose for themselves. This tempts us to regulate their health behaviors. This analysis suggests that the future will continue to see robust desires for health behavior regulation and for communal medical care and spending increases as a fraction of income, all regardless of the health effects of these choices.

Roles for specialty societies and vascular surgeons in accountable care organizations.

PubMed

Goodney, Philip P; Fisher, Elliott S; Cambria, Richard P

2012-03-01

With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a "seat at the table" will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

The Health Quality and Safety Commission: making good health care better.

PubMed

Shuker, Carl; Bohm, Gillian; Bramley, Dale; Frost, Shelley; Galler, David; Hamblin, Richard; Henderson, Robert; Jansen, Peter; Martin, Geraint; Orsborn, Karen; Penny, Anthea; Wilson, Janice; Merry, Alan F

2015-01-30

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better.

Practical aspects of integrating allergy and pulmonology management into a rhinology practice: the Vanderbilt ASAP experience.

PubMed

Duncavage, James; Hagaman, David D

2013-02-01

In the aftermath of reforms in healthcare laws, there is a focused conversation concerning healthcare delivery with an increasing emphasis on quality, cost containment, improved outcomes and access. Concurrently, providers are experiencing pressure as patient volume escalates yet while funding levels fail to keep pace. Addressing these issues is imperative to the medical practices. In this review, the integration of an allergy and rhinology practice into a center focused on managing chronic airway disease is detailed in the examination of an existing practice. In 2010, healthcare spending in the Unites States was nearly US$ 2.6 trillion, 17.9% of the nation's gross domestic product and 10 times 1980 levels. Insurance premiums have increased 113% since 2001 and continue to outpace income gains. Seventy-five percent of spending is attributed to chronic diseases such as stroke, cancer, heart disease, diabetes, Parkinson's disease and Alzheimer's. Airway disease (rhinitis, sinusitis, asthma, chronic obstructive pulmonary disease) is one of the largest chronic disease states. In fact, more patients suffer from airway disease than the aforementioned diseases in total. Any effort to affect costs must include a chronic disease strategy. This review will focus on the nature of the integrated program and its relation to the nature of airway diseases; a detailed description of how it works and why it is different from traditional models. This integrated model of healthcare will improve the quality of care provided to airway disease patients as well as help contain overall healthcare cost.

Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity.

PubMed

Sarma, Sisira; Devlin, Rose Anne; Belhadji, Bachir; Thind, Amardeep

2010-12-01

To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care. Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously. To this end, we estimate a system of work activity equations and allow for correlated errors. Our results show that the mode of remuneration has little effect on the total hours worked after accounting for the endogeneity of remuneration schemes; however it does affect the allocation of time to different activities. We find that physicians working in non-fee-for-service remuneration schemes spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings, and more hours on indirect patient care. Canadian family physicians working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and devote more hours to indirect patient care. The allocation of time in non-fee-for-service practices may have some implications for quality improvement. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[Invested time in private care: estimated by people in need of help and care and their private caregivers].

PubMed

Heinemann-Knoch, M; Knoch, T; Korte, E

2006-12-01

The amount of time that ought to be invested for private care is regulated by the German Care Assurance (SGB XI). Whether this reflects the actual amount of help given to the people cornered is not certain. In our qualitative study, which was part of the project "Potentials and Limits of Independent Living in Private Households in Germany" [1] funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, we had the chance to document the amount of time people themselves think they spend or vice versa receive for help and care with a timetable. Even if the amount of time alone does not yet lead to a conclusion about the quality of the given effort, it is one indicator for an adequate care that allows living at home as long as possible.

The lost art of the covenant: trust as a commodity in health care.

PubMed

Bruhn, John G

2005-01-01

Physicians argue that the advent of managed care has turned medicine into a business and that they spend more time learning the art of doing business than practicing medicine, while losing their professional spirit, patient loyalty, autonomy, and income. Medicine was a business before it was a science. Holding on to Hippocratic ideals in a world of on-demand consumers has made the covenantal physician-patient relationship ineffective and devoid of mutual trust. Physicians have argued that trust is time-dependent and a casualty of time-bound managed care guidelines. The author suggests that the principle of trust is not outdated, not exclusively time-dependent, and is still relevant to a modern Hippocrates loyalist. A relationship of trust is built on the style and quality of verbal and nonverbal communication. Trust is not an acquired trait; it is an expectation resulting from an interactive process of human concern and caring.

Best practices for world-class call centers.

PubMed

1998-11-01

Quality, not quantity, counts more in performance measures for best-practice call centers. Spend money on effective upfront training to save later through increased employee and customer loyalty. Give structured feedback and strong internal support to call-center representatives.

Buying time promotes happiness.

PubMed

Whillans, Ashley V; Dunn, Elizabeth W; Smeets, Paul; Bekkers, Rene; Norton, Michael I

2017-08-08

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands ( n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction.

Buying time promotes happiness

PubMed Central

Whillans, Ashley V.; Dunn, Elizabeth W.; Smeets, Paul; Bekkers, Rene; Norton, Michael I.

2017-01-01

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands (n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction. PMID:28739889

Indoor Environment in Residential Prefabricated Buildings

NASA Astrophysics Data System (ADS)

Kraus, Michal; Juhásová Šenitková, Ingrid

2017-10-01

The contribution presents results of the experimental measurement of indoor air quality in residential prefabricated buildings. People spend about 90% of their life in the indoor environment of buildings. Hygrothermal parameters and indoor air quality are the essential component that define the quality of the indoor environment. The results of case study characterize the quality of the indoor environment of the ordinary occupants in housing unit of residential prefabricated building. A current problem of revitalized prefabricated buildings is inadequate air exchange and related thereto to poor indoor air quality. The experimental measurements were carried out just before and at the beginning of the heating season (from 1st October to 30th November 2016). Heating season was launched in the middle of experimental measurement. The wireless indoor sensor Elgato Eve Room was used for measurements. The obtained values of indoor air temperature [°C], relative humidity [%] and indoor air quality [ppm] are describe and analysis in this study. The results of the study indicate that the values of temperature and indoor air quality meet optimal levels during the experiment with nuances. The mean air temperature in the indoor environment is 22.43 °C. The temperature of the indoor environment is held at the optimum level (18-24 °C) for 94.50% time of the experimental measurements. In addition, the indoor air quality in the context of the content of harmful volatile organic compounds (VOCs) has been excellent for almost 91% time of the total experiment. However, the values of relative humidity were less than the optimum value nearly 40% of the total observed time. The mean 10-minutes values of relative humidity during the heating season is about 10% lower than the mean 10-minutes relative humidity before the heating season.

Outpatient Office Wait Times And Quality Of Care For Medicaid Patients.

PubMed

Oostrom, Tamar; Einav, Liran; Finkelstein, Amy

2017-05-01

The time patients spend in a doctor's waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care. Project HOPE—The People-to-People Health Foundation, Inc.

Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?

PubMed

Snyder, Angela; Marton, James; McLaren, Susan; Feng, Bo; Zhou, Mei

2017-12-01

Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework. (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation. The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts. In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending. Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes. Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation. Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.

Leisure time activities in teenagers in urban and rural areas.

PubMed

Borzecki, Andrzej; Nieradko, Barbara; Gnasś, Bogumiła; Sieklucka-Dziuba, Maria

2002-01-01

The work aimed to determine the leisure time activities in teenagers on weekdays, weekends, during winter and summer holidays. Vast majority of teenagers spend their leisure time resting in a passive way, i.e. watching TV or playing computer games irrespectively of the season. As a result of this, the number of kids with posture defects increase. On weekdays the country teenagers spend much more time doing outdoor sports and games than town children. They also more often help their parents and less frequently travel away from their homes than children living in towns.

Cultural Differences in Support Provision: The Importance of Relationship Quality.

PubMed

Chen, Jacqueline M; Kim, Heejung S; Sherman, David K; Hashimoto, Takeshi

2015-11-01

Emotional expression is highly valued in individualistic cultures, whereas emotional restraint is prioritized in collectivistic cultures. We hypothesized that high-quality relationships in these cultures would exhibit the forms of support provision congruent with their respective expectations. Study 1 examined support transactions among friends in response to a laboratory stressor and found that objectively judged relationship quality (RQ) more strongly positively predicted emotion-focused support provision behaviors by European Americans than by Asian Americans. Study 2, a questionnaire study, found that self-reported RQ predicted emotion-focused support provision more strongly among European Americans than among Japanese. Study 3 investigated more indirect forms of support and found that RQ more strongly predicted worrying about and monitoring close others enduring stressors and spending time with them without talking about the stressor among Asian Americans compared with European Americans. These findings suggest that RQ is expressed in terms of support provision in culturally normative ways. © 2015 by the Society for Personality and Social Psychology, Inc.

[Hygiene during leisure time among third year students from the Department of Nursing and Health Sciences].

PubMed

Czabak-Garbacz, Róza; Skibniewska, Agnieszka; Mazurkiewicz, Piotr; Wisowska, Anna

2002-01-01

The aim of the study was the assessment of hygiene of leisure time among third year students from Faculty of Nursing and Health Science of Lublin Medical Academy. It analysed passive and active ways of spending free time. The study involved 106 students (55 stationary and 51 extramural) and it was conducted by means of questionnaire. The study revealed that students prefer passive types of spending their leisure time. The most popular activity was listening to the radio, to which they devoted average 2.9 hours a day (listening to music mainly). Extramural students listened to the radio shorter than stationary ones (the difference was statistically significant). Students spent also a lot of their time watching television (average 1.5 hours a day), reading books and newspapers (average 1.85 hours a day) and doing housework, which is an active way of rest (average 2.7 hours a day), mainly preparing meals and shopping. Students devoted the least of their free time to sleep during the day in spite of the fact it is an excellent way of rest. The study found also that physical activity was not a favourite type of spending free time. Every third student did not do any sport. Stationary students did sport 4 times longer than extramural (the difference was statistically significant). Only 31% practiced taking a daily walk and only 44% of students made tourist trips. 81.9% of them went away during summer holidays, but only 31% of them during the winter break. Undoubtedly, the way of spending free time by the students under examination was not hygienic as it did not give them a sense of relaxation and rest; also the students themselves were not satisfied with it.

The Education Challenge in Mexico: Delivering Good Quality Education to All. OECD Economics Department Working Papers, No. 447

ERIC Educational Resources Information Center

Guichard, Stephanie

2005-01-01

The growth of potential GDP in Mexico is not fast enough to narrow the income gap with other OECD countries at a sufficient pace. The persistent weakness in human capital development contributes to this situation. In particular, Mexicans spend comparatively few years in formal education, and the quality of the education they receive is lower than…

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

PubMed

Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

2013-02-01

During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

LISTENing to healthcare students: the impact of new library facilities on the quality of services.

PubMed

Haldane, Graham C

2003-06-01

Following a low assessment of 'Learning resources' provision by the Quality Assurance Agency, the librarian of Homerton College, School of Health Studies commenced the LISTEN Project, a long-term study to monitor the effects of planned interventions on the quality of library provision. Surveys of entry-to-register student nurses & midwives were conducted in 1999 and 2001 by extensive questionnaires, inviting Likert-scaled and free text responses. Following a college relocation, students made greater than expected use of a new health studies library in Cambridge, and significantly less use of the local teaching hospital library. Using both a satisfaction index and a non-parametric test of mean scores, student evaluation of library services in Cambridge significantly improved following relocation. The physical accommodation and location of library services remain important to healthcare students. Identifiable improvements to the quality of services, however, will overcome initial resistance to change. Education providers must ensure the best mix of physical and electronic services for students who spend much of their time on clinical placement.

Direct-to-consumer drug advertising: you get what you pay for.

PubMed

Jeffords, James M

2004-01-01

Between 1997 and 2001 spending on direct-to-consumer (DTC) drug advertising more than doubled. Opinions differ as to whether and to what extent DTC advertising benefits the doctor-patient relationship. Some analysts argue that the current regulatory regime is sufficient, others advocate a stricter enforcement, and still others promote an outright ban. An alternative may be to use the purchasing power of the federal government to require the inclusion of comparative quality data, thus creating a basis for more informed consumer choice. This approach could create incentives for the pharmaceutical industry to adjust spending on DTC advertising while avoiding "big government" interference with commercial free speech.

Medicaid's Role in the Many Markets for Health Care

PubMed Central

Quinn, Kevin; Kitchener, Martin

2007-01-01

To illuminate Medicaid's growing role as a health care purchaser, we estimated Medicaid spending and market shares for 30 markets defined by provider category of service. For approximately 15 markets, our estimates are more detailed than the data available from standard sources. Two-thirds of Medicaid spending occurs in markets where the program has a modest market share. The other one-third occurs in markets that Medicaid dominates, especially in the areas of long-term care (LTC), mental retardation, and mental health. We explore the implications of the different roles for payment policy, industry organization, data availability, and quality of care. PMID:17722752

"We want the world and we want it now": Materialism, time perspectives and problem spending tendency of Chinese.

PubMed

Ku, Lisbeth; Wu, Anise M S; Lao, Angie K P; Lam, Kerwin I N

2016-10-06

Chinese consumers' spending has been expanding rapidly in the past decade, and along with it household and credit card debt. The present research collected evidence to triangulate the contention that materialism is positively related with Chinese's problem spending tendency (PST), and that present-time-perspective (PTP) and future-time perspectives (FTP) interact systematically with materialism to affect PST. A survey of the general population in Macao, China (Study 1; N = 239) confirmed that materialism was positively correlated with PST. An interaction between materialism and PTP intensified the relationship, whereas an interaction with FTP weakened the relationship. Another survey with a sample of university students (Study 2; N = 223) again found positive relationships among PST, materialism, and PTP, as measured by temporal discount rate. But further exploration showed that PST was only related with temporal discounting among high materialists, but not among low materialists. Study 3 experimentally examined the causal effects of materialism and FTP on PST. When being primed of an orientation towards materialism (n = 33), the participants' planned consumption doubled that of the control group (n = 31). A FTP prime interacted with materialism prime and put a "damper" on participants' planned spending (n = 29), compared to their counterparts who were not primed of such a time perspective. © 2016 International Union of Psychological Science.

Rising Educational Expectations: Trends and Limits in Times of Economic Downturn

ERIC Educational Resources Information Center

Hart, Doug; Livingstone, D. W.

2009-01-01

Advocates for education have seized upon the current economic downturn as an opportunity to advance their cause. If governments are poised for an attempt to spend their way out of a deep recession, what better target than underfunded educational institutions, from daycare to universities? Public support for increased spending on education is…

40 CFR 35.4070 - How can my group spend TAG money?

Code of Federal Regulations, 2012 CFR

2012-07-01

... grant; and/or (3) Provide one-time health and safety training for your technical advisor to gain site... 40 Protection of Environment 1 2012-07-01 2012-07-01 false How can my group spend TAG money? 35.4070 Section 35.4070 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL...

Tough Choices in Tough Times: Debt and Medication Nonadherence

ERIC Educational Resources Information Center

Kalousova, Lucie; Burgard, Sarah A.

2014-01-01

Debt is a ubiquitous component of households' financial portfolios. Yet we have scant understanding of how household debt constrains spending on needed health care. Diverse types of debt have different financial properties and recent work has shown that they may have varying implications for spending on needed health care. In this article, we…

Current Issues in Early Childhood Education.

ERIC Educational Resources Information Center

Katz, Lilian G.

If present trends in family life and education continue into the next decade, most children under five will spend substantial proportions of their early years in various types of early childhood programs, most five- to six-year-olds will attend all-day kindergarten, and during their elementary school years they will spend much of their time before…

Problematic Internet Use and Body Mass Index in University Students

ERIC Educational Resources Information Center

Sari, Serkan Volkan; Aydin, Betül

2014-01-01

Problem Statement: Today, immobility and resulting weight gain constitutes one of the greatest problems among young people. The greatest problem for individuals spending a lot of time on the Internet is immobility. The result of this status is spending less energy than the amount required daily. Immobility is considered a cause of being…

Media and Risky Behaviors

ERIC Educational Resources Information Center

Escobar-Chaves, Soledad Liliana; Anderson, Craig A.

2008-01-01

Liliana Escobar-Chaves and Craig Anderson investigate two important trends among American youth and examine the extent to which the two trends might be related. First, the authors note that U.S. youth are spending increasing amounts of time using electronic media, with the average American youngster now spending one-third of each day with some…

38th Annual Maintenance & Operations Cost Study for Schools

ERIC Educational Resources Information Center

Agron, Joe

2009-01-01

Despite the worst economic environment in generations, spending by K-12 institutions on maintenance and operations (M&O) held its own--defying historical trends that have shown M&O spending among the most affected in times of budget tightening. This article presents data from the 38th annual Maintenance & Operations Cost Study for…

Physician pattern of patient notification of test results.

PubMed

Thiedke, Carolyn C; Hoeft, Katherine A; Pearson, William S

2005-01-01

To discover how community-based family physicians notify patients of test results and whether there are differences based on sex, length of time in practice, reimbursement status, employment status,or percentage of practice in managed care. We mailed a survey to 500 randomly selected members of the South Carolina chapter of the American Academy of Family Physicians. All analyses were preformed using SASTM version 8.2. Both descriptive and inferential statistics were used to analyze the collected data. A total of 367 physicians responded (73% response rate). The main outcome variable was the time each physician spent notifying patients of test results: a mean of 20.86 +/- 18.3 minutes per day(range 0-120 minutes/day). Women physicians and those with more than 75% managed care were significantly more likely to spend more than the median time notifying patients of test results. Physicians vary in the amount of time they spend notifying patients of their test results, with female physicians and those with more than 75% of their practice in managed care spending more time than do male physicians and physicians with less managed care.

[Central purchasing bodies and spending review in health sector].

PubMed

Spampinato, Luigi

2017-01-01

The aim of this paper is to analyze the new model of centralization of purchases in Italy after the approval of the 2016 Stability Law, with particular reference to the health sector. In fact, the spending review process in Italy in the health sector has had a strong evolution with the 2016 Stability Law, which has introduced the obligation for the institutions of the National Health Service to obtain supplies, exclusively, from aggregators subjects, for certain product categories of the health sector. The legislature, over the years, was mainly characterized by measures to reduce the spending limits for purchases of goods and services or by resetting the fees, including the provision of an obligation for the renegotiation of health goods and services contracts, in order to ensure the effective implementation of the expenditure rationalization by aggregation of goods and services. From 2016, the legislature has provided an innovative model of centralization of purchases based on a new network governance model on several levels, national and regional, which should ensure an efficiency of procurement processes. The proper functioning of the governance model adopted can be an important driver of economic policy in order to understand that it is important not only to spend less, but to spend better. This can be realized in the public administration with a strong innovation process in this administration and also with a strong investment in skills, in order to ensure the same service quality throughout the national territory to the health sector.

World Population Crisis.

ERIC Educational Resources Information Center

Ehrlich, Paul R.; Ehrlich, Anne H.

1986-01-01

Rapid population growth, rising competition for resources, and increasing environmental deterioration are intertwined factors in the human predicament that feed political tensions and conflicts of the late twentieth century. Outlines dimensions of this predicament (including data on population, growth, military spending, quality of life, and…

Militarism and mortality. An international analysis of arms spending and infant death rates.

PubMed

Woolhandler, S; Himmelstein, D U

1985-06-15

Examination of data from 141 countries showed that infant mortality rates for 1979 were positively correlated with the proportion of gross national product devoted to military spending (r = 0.23, p less than 0.01) and negatively correlated with indicators of economic development, health resources, and social spending. In a multivariate analysis controlling for per caput gross national product, arms spending remained a significant positive predictor of infant mortality rate (p less than 0.0001), while the proportion of the population with access to clean water, the number of teachers per head, and caloric consumption per head were negative predictors. The multivariate model accounted for much of the observed variance in infant mortality rate (R2 = 0.78, p less than 0.0001), and showed good fit to similar data for the year 1972 (R2 = 0.80, p less than 0.0001). The model was also predictive of infant mortality rates in subgroup analysis of underdeveloped, middle developed, and developed nations. Analysis of time trends confirmed that an increase in military spending presages a poor record of improvement in infant mortality rate. These findings support the hypothesis that arms spending is causally related to infant mortality.

Dementia and Out-of-Pocket Spending on Health Care Services

PubMed Central

Delavande, Adeline; Hurd, Michael D.; Martorell, Francisco; Langa, Kenneth M.

2014-01-01

Background High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications, as well as hamper their ability to pay for other essential goods. Dementia, because it leads to disability and the loss of independence may put patients and their families at risk for high OOP spending, especially for long-term care services. Methods We used data from the Aging, Demographics, and Memory Study, a nationally representative sub-sample (n=743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared to those with cognitive impairment without dementia (CIND) and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications, two types of health care that are frequently paid for out-of-pocket. Multivariate and logistic regression models were used to adjust for the influence of potential confounders. Results After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared to those with normal cognition ($8,216 for those with dementia vs. $2,570 for those with normal cognition, p<.01) Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (p<.01). Dementia was not associated with the likelihood of visiting the dentist (p=0.76) or foregoing prescription medications due to cost (p=.34). Conclusions Dementia is associated with high levels of OOP spending, but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not “crowd out” spending on these other health care services. PMID:23154049

Public health and the economy could be served by reallocating medical expenditures to social programs.

PubMed

Tran, Linda Diem; Zimmerman, Frederick J; Fielding, Jonathan E

2017-12-01

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Factors Associated With Increases in US Health Care Spending, 1996-2013

PubMed Central

Squires, Ellen; Bui, Anthony L.; Campbell, Madeline; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Li, Zhiyin; Matyasz, Taylor; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Murray, Christopher J. L.

2017-01-01

Importance Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. Objective To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. Design and Setting Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. Exposures Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. Main Outcomes and Measures Change in health care spending from 1996 through 2013. Results After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. Conclusions and Relevance Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending. PMID:29114831

Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine. Results of a survey.

PubMed

Buckley, L M; Sanders, K; Shih, M; Hampton, C L

2000-09-25

To assess attitudes about career progress, resources for career development, and commitment to academic medicine in physician faculty at an academic medical center who spend more than 50% of their time in clinical care. Faculty survey. Academic medical center and associated Veterans Affairs medical center. A total of 310 physician faculty responded to the survey. Half of the faculty reported spending 50% or less of their time in clinical care (mean, 31% of time) (group 1) and half reported spending more than 50% of their time in clinical care (mean, 72% of time) (group 2). Group 2 faculty had one third of the time for scholarly activities, reported slower career progress, and were less likely to be at the rank of professor (40% and 16% for groups 1 and 2, respectively; P<.001) or to be tenured (52% and 26%, respectively; P<.001) despite similar age and years on faculty. Group 2 faculty were 50% more likely to report that tenure and promotion criteria were not reviewed at their annual progress report (P =.003) and that they did not understand the criteria (P<.001). Group 2 faculty valued excellence in patient care over scholarship and national visibility. Group 2 faculty reported greater dissatisfaction with academic medicine and less commitment to a career in academic medicine. Physician faculty who spend more than 50% of their time in clinical care have less time, mentoring, and resources needed for development of an academic career. These obstacles plus differences in their attitudes about career success and recognition contribute to significant differences in promotion. These factors are associated with greater dissatisfaction with academic medicine and lower commitment to academic careers.

Introducing a checking technician allows pharmacists to spend more time on patient-focused activities.

PubMed

Napier, Patti; Norris, Pauline; Braund, Rhiannon

2018-04-01

Internationally there is an increasing focus on the clinical and cognitive services that pharmacists can provide. Lack of time has been identified as a barrier to pharmacists increasing their clinical activities. Within the pharmacy workplace there are many tasks that can only be performed by a pharmacist. The final accuracy check of a dispensed prescription is currently the sole responsibility of pharmacists in New Zealand. This takes up a significant amount of time during a pharmacist's work day. The introduction of a checking technician role has been suggested to allow pharmacists more time to do more patient focused work. To investigate the amount of time pharmacy staff spend on specific activities and to establish whether the introduction of a checking technician into twelve pilot sites increased the amount of time that the pharmacists could spend on patient focused activities. This study utilised a self-reported work sampling technique in twelve pilot sites, selected from both the hospital and community settings. Work sampling using an electronic device was conducted at two time-points (before the implementation of a Pharmacy Accuracy Checking Technician (PACT) role and when the PACT was in place). Data was collected at 10 min intervals for the period of five days, a working week. Tasks were grouped into patient focused, dispensing and personal activities. The introduction of the PACT into the pilot sites saw a mean increase of 19% in pharmacists' patient focused activities and a mean 20% decrease in dispensing activities. The introduction of a checking technician role into New Zealand pharmacies demonstrated the potential to provide pharmacists with more time to spend on patient focused activities. Copyright © 2017 Elsevier Inc. All rights reserved.

Reducing children's television-viewing time: a qualitative study of parents and their children.

PubMed

Jordan, Amy B; Hersey, James C; McDivitt, Judith A; Heitzler, Carrie D

2006-11-01

The American Academy of Pediatrics recommends that children over age 2 years spend < or = 2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children. The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old. Most of the children reported spending approximately 3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

Young people's time use and maternal employment in the UK.

PubMed

Mullan, Killian

2009-12-01

This paper analyses the relationship between young people's time use and maternal employment in the United Kingdom (UK). Two dimensions of young people's time use are important for understanding the impact of maternal employment. The first of these is family context. This concerns the time young people are near their parents or not. The second relates to young people's activity patterns. Combining information from both dimensions is necessary to provide a comprehensive overview of the impact of maternal employment on young people's time use. The paper demonstrates that young people's time use is associated with maternal employment both in terms of activity patterns and family context. Young people with employed mothers spend more time alone with a father, and more time with neither parent. More specifically, young people with mothers employed full time (FT) spend significantly more time watching TV than those whose mothers are not employed, especially when they are not near any parents. There is a negative association between FT maternal employment and the time young people spend in achievement-related activities, concentrated in time when alone with a mother. Unlike time in leisure activities or time watching TV, time in achievement-related activities when in the presence of a father does not increase to compensate for the loss in time spent in achievement-related activities when alone with a mother.

[Colombian Health spending 1993-2003: its composition and trends].

PubMed

Barón-Leguizamón, Gilberto

2007-01-01

Analysing the magnitude, composition, evolution and trends in Colombian national spending on health, forming a proposal and making an important contribution towards knowledge re the reality of social health security. The results obtained respond to an ongoing effort to systematise and standardise the adopted methodology and update calculations and estimates for the eleven-year period during which Law 100/1993 was being reformed. Analysing the above led to identifying changes in the flow of resources and establishing objective comparisons according to current/available international standards. The project began in the Colombian Planning Department (lasting 5 years) and was then passed to the Ministry of Social Protection's Health Reform Support Programme where new institutional scope has been applied during the last four years. Perhaps the work's most important contribution consists of producing annual estimates of total public and private spending on health as a time-series, for a relatively significant period. The results confirm fulfilment of the reform's suppositions in terms of the significant amount of resources channelled to the sector, the important substitution of financing private spending for spending on health insurance, greater dynamism and the importance of public funds in financing total spending and the managing of an important segment of such resources by some of the new agents created by the reform. This contrasts with the little importance paid to spending on promotion and prevention and on public health and basic attention programmes.

The economic impact of NASA R and D spending Appendices

NASA Technical Reports Server (NTRS)

Evans, M. K.

1976-01-01

Seven appendices related to a previous report on the economic impact of NASA R and D spending were presented. They dealt with: (1) theoretical and empirical development of aggregate production functions, (2) the calculation of the time series for the rate of technological progress, (3) the calculation of the industry mix variable, (4) the estimation of distributed lags, (5) the estimation of the equations for gamma, (6) a ten-year forecast of the U.S. economy, (7) simulations of the macroeconomic model for increases in NASA R and D spending of $1.0, $.0.5, and 0.1 billions.

Inventory information approval system certification and flexible spending account purchases.

PubMed

Shuey, Brandon; Williams, La Vonn A

2010-01-01

There is no question that 2009 was a year of change within the pharmacy industry. Several new requirements were implemented, including the need for an Inventory Information Approval System for accepting flexible spending or health reimbursement account cords. Some pharmacies relied on the 90% exemption rule, which is discussed within this article, or an alternative method to avoid the expense of a point of sale. However, with flexible spending or health reimbursement account card participation expected to reach 85% in 2010, now bay be the time for compounding pharmacists to weigh the pros and cons of Inventory Information Approval System certification.

DataView: Business, Households, and Government: Health Spending, 1994

PubMed Central

Cowan, Cathy A.; Braden, Bradley R.; McDonnell, Patricia A.; Sivarajan, Lekha

1996-01-01

During the 1990s, growth in health care costs slowed considerably, helping to lessen the spending strain on business, government, and households. Although cost growth has slowed, the Federal Government continues to pay an ever-increasing share of the total health care bill. This article reviews important health care spending trends, and for the first time, provides separate estimates of the employer and employee share of the premium costs for employer-sponsored private health insurance. This article also highlights some of the emerging trends in the employer-sponsored insurance market, including managed care, cost-sharing, and employment shifts. PMID:10165707

[Activities without patient contact : Estimate of time costs based on telephone interviews in eight psychiatric hospitals].

PubMed

Blume, A; Brückner-Bozetti, P; Steinert, T

2018-04-20

The aim of this pilot study was to estimate the share of working time that staff in psychiatric hospitals theoretically spend on obligatory activities, such as training and further education, organizational and documentation tasks as well as statutory lecturing duties without patient contact. A total of 47 physicians, 39 nurses, 34 psychologists and 35 social workers from eight psychiatric hospitals were interviewed. The results reveal that the theoretically remaining time for direct patient contact is low. The ratio of time spent with versus time spent without patient contact was even worse for senior physicians and leading nurses as well as part-time employees; however, all activities without direct contact to patients seemed to be indispensable in terms of quality of treatment and care. Hence, employees in German psychiatric hospitals regularly have to make decisions on which of their duties they prefer to neglect, to which they are actually obligated.

Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review.

PubMed

Yoon, Seungwon; Mooney, Michael A; Bohl, Michael A; Sheehy, John P; Nakaji, Peter; Little, Andrew S; Lawton, Michael T

2018-05-01

OBJECTIVE With drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth. METHODS For 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors' institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time. RESULTS In the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016). CONCLUSIONS Even after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency.

PubMed

Roberts, Eric T; Mehrotra, Ateev; McWilliams, J Michael

2017-05-01

Consolidation of physician practices has intensified concerns that providers with greater market power may be able to charge higher prices without having to deliver better care, compared to providers with less market power. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Using commercial claims data, we classified practices as being high- or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36 percent higher prices. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of preventive services, acute care use, or total Medicare spending. This suggests an overall weak relationship between practice prices and the quality and efficiency of care and calls into question claims that high-price providers deliver substantially higher-value care. Project HOPE—The People-to-People Health Foundation, Inc.

Smart Health Caring Home: A Systematic Review of Smart Home Care for Elders and Chronic Disease Patients.

PubMed

Moraitou, Marina; Pateli, Adamantia; Fotiou, Sotiris

2017-01-01

As access to health care is important to people's health especially for vulnerable groups that need nursing for a long period of time, new studies in the human sciences argue that the health of the population depend less on the quality of the health care, or on the amount of spending that goes into health care, and more heavily on the quality of everyday life. Smart home applications are designed to "sense" and monitor the health conditions of its residents through the use of a wide range of technological components (motion sensors, video cameras, wearable devices etc.), and web-based services that support their wish to stay at home. In this work, we provide a review of the main technological, psychosocial/ethical and economic challenges that the implementation of a Smart Health Caring Home raises.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Healthcare Utilization and Spending Among Carve-In Enrollees

PubMed Central

Harwood, Jessica M.; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K.; Tseng, Chi-Hong; Wells, Kenneth B.; Friedman, Sarah; Ettner, Susan L.

2016-01-01

Objective The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA’s impact on BH expenditures and utilization among “carve-in” enrollees. Method We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008–2009), during (2010), and after (2011–2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual and family psychotherapy); intermediate care utilization (structured outpatient; day treatment; residential); and inpatient utilization. Results MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits (respective immediate increases of: $1.05 [p=0.02]; $0.88 [p=0.04]; 0.00045 visits [p=0.00]), and individual psychotherapy visits (immediate increase of 0.00578 visits [p=0.00] and additional increases of 0.00017 visits/month [p=0.03]). Conclusions MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; e.g., in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets. PMID:27632769

3 CFR - Ensuring Responsible Spending of Recovery Act Funds

Code of Federal Regulations, 2010 CFR

2010-01-01

... long-term public benefits by, for example, investing in technological advances in science and health to increase economic efficiency and improve quality of life; investing in transportation, environmental... example, investing in technological advances in science and health to increase economic efficiency and...

Relations of parenting quality, interparental conflict, and overnights with mental health problems of children in divorcing families with high legal conflict.

PubMed

Sandler, Irwin N; Wheeler, Lorey A; Braver, Sanford L

2013-12-01

The current study examined the associations between child mental health problems and the quality of maternal and paternal parenting, and how these associations were moderated by three contextual factors: quality of parenting by the other parent, interparental conflict, and the number of overnights parents had with the child. Data for the current study came from a sample of divorcing families who are in high legal conflict over developing or maintaining a parenting plan following divorce. Analyses revealed that the associations between child mental health problems and positive maternal and paternal parenting were moderated by the quality of parenting provided by the other parent and by the number of overnights children spent with parents, but not by the level of interparental conflict. When parenting by the other parent and number of overnights were considered together in the same model, only number of overnights moderated the relations between parenting and child-behavior problems. The results support the proposition that the well-being of children in high-conflict divorcing families is better when they spend adequate time with at least one parent who provides high-quality parenting.

Relations of Parenting Quality, Interparental Conflict, and Overnights with Mental Health Problems of Children in Divorcing Families with High Legal Conflict

PubMed Central

Sandler, Irwin N.; Wheeler, Lorey A.; Braver, Sanford L.

2013-01-01

The current study examined the associations between child mental health problems and the quality of maternal and paternal parenting, and how these associations were moderated by three contextual factors, quality of parenting by the other parent, interparental conflict, and the number of overnights parents had with the child. Data for the current study come from a sample of divorcing families who are in high legal conflict over developing or maintaining a parenting plan following divorce. Analyses revealed that the associations between child mental health problems and positive maternal and paternal parenting were moderated by the quality of parenting provided by the other parent and by the number of overnights children spent with parents, but not by the level of interparental conflict. When both parenting by the other parent and number of overnights were considered in the same model, only number of overnights moderated the relations between parenting and child behavior problems. The results support the proposition that the well-being of children in high conflict divorcing families is better when they spend adequate time with at least one parent who provides high quality parenting. PMID:24098960

The interplay of couple's shared time, women's intimacy, and intradyadic stress.

PubMed

Milek, Anne; Butler, Emily A; Bodenmann, Guy

2015-12-01

Theoretically, spending time together should be central for couples to build intimacy and should be associated with less relationship stress; however, few empirical studies have examined these links. The present study used 14 days of diary data from 92 women to investigate the interplay between the amount of time they spent with their partner (shared time), intimacy, and daily stress originating inside the relationship (intradyadic stress) on a within- and between-personal level. Multilevel analyses revealed moderation patterns: For example, when women spent more time with their partners than usual on a weekday with low levels of intradyadic stress, they reported higher intimacy. These associations varied substantially between women and were weaker on the weekend or on days with high levels of intradyadic stress. At the between-person level, higher average shared time appeared to buffer the negative association between intradyadic stress and intimacy. Our results suggest that daily fluctuations in intradyadic stress, intimacy, and shared time may have different implications compared with aggregated amounts of those variables. Spending more time together on a weekday with low intimacy might be linked to more intradyadic stress, but aggregated over the long run, spending more time together may provide opportunities for stress resolution and help couples to maintain their intimacy. (c) 2015 APA, all rights reserved).

Do Expenditures Other than Instructional Expenditures Affect Graduation and Persistence Rates in American Higher Education?

ERIC Educational Resources Information Center

Webber, Douglas A.; Ehrenberg, Ronald G.

2010-01-01

During the last two decades, median instructional spending per full-time equivalent (FTE) student at American 4-year colleges and universities has grown at a slower rate than median spending per FTE student in a number of other expenditure categories, including academic support, student services and research. Our paper uses institutional level…

Florida's Past and Future Roles in Education Finance Reform Litigation

ERIC Educational Resources Information Center

Bauries, Scott R.

2006-01-01

The state of Florida has since the time of "San Antonio v. Rodriguez" an education finance system called the Florida Education Finance Plan (FEFP), which makes substantial effort to equalize per-pupil spending in all of the state's school districts, while recognizing the local factors that may necessitate changes in that spending. Still,…

Divorced Parents' Qualitative and Quantitative Reports of Children's Living Arrangements

ERIC Educational Resources Information Center

Lin, I-fen; Schaeffer, Nora Cate; Seltzer, Judith A.; Tuschen, Kay L.

2004-01-01

We use data from a sample of divorced parents in Wisconsin (N=1,392) to examine how parents describe their children's living arrangements. When the children spend substantial time in both parents homes, both parents are less likely to use the phrase live with to describe living arrangements. When children spend most nights with their mother,…

Teaching about the Holocaust--A Resource Guide

ERIC Educational Resources Information Center

Russell, William Benedict, III

2005-01-01

Teaching about the Holocaust is an emotional process that can be extremely difficult, especially without the proper resources. Most teachers spend one or two class periods on the Holocaust and usually cram the lesson into a unit on World War II. As a teacher, the author understands that time is short and that it is impossible to spend the…

Tax Expert Offers Ideas for Monitoring Big Spending on College Sports

ERIC Educational Resources Information Center

Sander, Libby

2009-01-01

The federal government could take a cue from its regulation of charitable organizations in monitoring the freewheeling fiscal habits of big-time college athletics, a leading tax lawyer says. The author reports on the ideas offered by John D. Colombo, a professor at the University of Illinois College of Law, for monitoring big spending on college…

Estimating financial resources for universal access to sexual reproductive health care: Evidence from two states in India.

PubMed

Rout, Sarit Kumar; Pradhan, Jalandhar; Choudhury, Sarmistha

2016-10-01

India has made insignificant progress towards achieving universal access to sexual and reproductive health (SRH). One of the key inputs for achieving universal access to SRH is financial resources. Given this, many international agencies including the UN are emphasising on monitoring the financial progress towards achieving SRH. To generate evidence on spending on SRH from various sources - (government, household, international donors and NGOs) to improve the accountability of the government towards SRH goal. Adapting a sub account framework of the NHA, this paper investigated the SRH expenditure of the two divergent states of India. The data were collected from government, households (NSSO), and foreign donors and were classified as per the International Classification of Health Accounts (ICHA). Total SRH expenditure is less than one percent of SGDP from all sources in each state. Among the sources, government's spending on SRH is more than household. A large part of household spending is on curative care which has implications for accessing services by the poor. In spite of data constraints, this paper presents a comprehensive analysis on SRH spending, which is critical for monitoring the commitment towards universal access to SRH. This evidence can be used for further improving data quality for RCH account in LMICs. Copyright © 2016 Elsevier B.V. All rights reserved.

Assessing the level of public health partner spending using the funding formula analysis tool.

PubMed

Bernet, Patrick M

2012-01-01

Public health services are delivered through a variety of organizations. Traditional accounting of public health expenditures typically captures only spending by government agencies. New Hampshire collected information from public health partners, such as community centers that host smoking cessation classes or health education done by Girls, Inc. This study compares the new data to spending by government agencies, focusing on breakdowns by fund source and service categories. Expanded funds secured by these partners account for a 42% of all local public health spending, and they spent 4 times more than government agencies on promoting healthy behavior. The funding formula analysis tool revealed that these partners spent in ways that would be politically difficult to achieve. In an era of declining budgets, an understanding of public health's partners is increasingly vital.

HOW DO IMMIGRANTS SPEND THEIR TIME?

PubMed Central

Hamermesh, Daniel S.

2012-01-01

Sharp differences in time use by nativity emerge when activities are distinguished by incidence and intensity in recent U.S. data. A model with daily fixed costs for assimilating activities predicts immigrants are less likely than natives to undertake such activities on a given day; but those who do will spend relatively more time on them. Activities such as purchasing, education, and market work conform to the model. Other results suggest that fixed costs for assimilating activities are higher for immigrants with poor English proficiency or who originate in less developed countries. An analysis of comparable Australian data yields similar results. PMID:24443631

Improving data management practices in the Portuguese HIV/AIDS surveillance system during a time of public sector austerity.

PubMed

Shivaji, Tara; Cortes Martins, Helena

2015-01-01

In a climate of public sector austerity, the demand for accurate information about disease epidemiology rises as health program managers try to align spending to health needs. A policy of case re-notification to improve HIV information quality resulted in a nine-fold increase in the number of case reports received in 2013 by the Portuguese HIV surveillance office. We used value stream mapping to introduce improvements to data processing practices, identify and reduce waste. Two cycles of improvement were trialled. Before intervention, processing time was nine minutes and 28 seconds (95%CI 8:53-10:58) per report. Two months post intervention, it was six minutes and 34 seconds (95% CI 6:25-6:43). One year after the start of the project, processing time was five minutes and 20 seconds (95% CI 1:46-8:52).

Improving data management practices in the Portuguese HIV/AIDS surveillance system during a time of public sector austerity

PubMed Central

Shivaji, Tara; Cortes Martins, Helena

2015-01-01

In a climate of public sector austerity, the demand for accurate information about disease epidemiology rises as health program managers try to align spending to health needs. A policy of case re-notification to improve HIV information quality resulted in a nine-fold increase in the number of case reports received in 2013 by the Portuguese HIV surveillance office. We used value stream mapping to introduce improvements to data processing practices, identify and reduce waste. Two cycles of improvement were trialled. Before intervention, processing time was nine minutes and 28 seconds (95%CI 8:53–10:58) per report. Two months post intervention, it was six minutes and 34 seconds (95% CI 6:25–6:43). One year after the start of the project, processing time was five minutes and 20 seconds (95% CI 1:46–8:52). PMID:26734448

The German Environmental Survey for Children (GerES IV): reference values and distributions for time-location patterns of German children.

PubMed

Conrad, André; Seiwert, Margarete; Hünken, Andreas; Quarcoo, David; Schlaud, Martin; Groneberg, David

2013-01-01

Children's time-location patterns are important determinants of environmental exposure and other health-relevant factors. Building on data of the German Environmental Survey for Children (GerES IV), our study aimed at deriving reference values and distributions for time-location patterns of 3-14-year-old German children. We also investigated if GerES IV data are appropriate for evaluating associations with children's health determinants by linking them to data of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). Parents reported on the time their children usually spend at home, in other indoor environments, and outdoors. This information was characterized by statistical parameters, which were also calculated for different strata concerning socio-demography and the residential environment. Consequently, group differences were evaluated by t-tests and univariate ANOVA. Reference distributions were fitted to the time-location data by a Maximum Likelihood approach to make them also useable in probabilistic exposure modeling. Finally, associations between data on the children's physical activity as well as body weight and their outdoor time were investigated by bivariate correlation analysis and cross tabulation. On daily average, German children spend 15 h and 31 min at home, 4 h and 46 min in other indoor environments, and 3 h and 43 min outdoors. Time spent at home and outdoors decreases with age while time spent in other indoor environments increases. Differences in time-location patterns were also observed for the socio-economic status (SES) and immigration status. E.g., children with a high SES spend 24 min less outdoors than low SES children. Immigrants spend on daily average 20 min more at home and 15 min less outdoors than non-immigrant children. Outdoor time was associated with parameters of the residential environment like the building development. Children living in 1- or 2-family houses spend more time outdoors than children living in building blocks (3 h 48 min vs. 3 h 29 min). Physical activity correlates with outdoor time. For children with diminished age-specific outdoor time, a higher prevalence of obesity was observed (odds ratio: 3.2, 95% CI: 1.5-7.1). GerES IV provides a compilation of current time-location reference values and distributions on German children. This data hint to substantial differences in time-location patterns within the population to be considered in environmental health risk assessment. Copyright © 2012 Elsevier GmbH. All rights reserved.

Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

PubMed

Mintzes, Barbara; Morgan, Steve; Wright, James M

2009-05-27

Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning.

Twelve Years' Experience with Direct-to-Consumer Advertising of Prescription Drugs in Canada: A Cautionary Tale

PubMed Central

Mintzes, Barbara; Morgan, Steve; Wright, James M.

2009-01-01

Background Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow ‘reminder’ advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. ‘Reminder’ advertising is prohibited in the US for drugs that have ‘black box’ warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Methodology/Principal Findings Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Conclusions/Significance Branded ‘reminder’ advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning. PMID:19479084

Characteristics of the Unexpected Message Queue of MPI applications

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

Keller, Rainer; Graham, Richard L

2010-01-01

High Performance Computing systems are used on a regular basis to run a myriad of application codes, yet a surprising dearth of information exists with respect to communications characteristics. Even less information is available on the low-level communication libraries, such as the length of MPI Unexpected Message Queues (UMQs) and the length of time such messages spend in these queues. Such information is vital to developing appropriate strategies for handling such data at the library and system level. In this paper we present data on the communication characteristics of three applications GTC, LSMS, and S3D. We present data on themore » size of their UMQ, the time spend searching the UMQ and the length of time such messages spend in these queues. We find that for the particular inputs used, these applications have widely varying characteristics with regard to UMQ length and show patterns for specific applications which persist over various scales.« less

Screen-based sedentary behaviours among a nationally representative sample of youth: are Canadian kids couch potatoes?

PubMed

Leatherdale, S T; Ahmed, R

2011-09-01

To determine the percentage of Canadian youth meeting screen-time guidelines and to identify characteristics associated with different screen-time behaviours. Using nationally representative data collected from the 2008/2009 Youth Smoking Survey (YSS), we analyzed three screen-time behaviours, cigarette smoking, weekly spending money, self esteem, region and grade by sex, and conducted four logistic regression models to examine factors associated with more than 2 hours a day of sedentary screen time. Of 51 922 Canadian youth in grades 6 to 12, 50.9% spent more than 2 hours per day in screen-based behaviours. The average daily screen time was 7.8 (± 2.3) hours. Males and current smokers were more likely to report over 2 hours per day watching TV and videos or playing video games, whereas students in higher grades and those with weekly spending money were more likely to report playing or surfing on a computer. Youth with higher self-esteem were less likely to report spending over 2 hours per day in each of the three screen-time behaviours examined. Developing a better understanding of the factors associated with more hours of screen time is required to develop and target interventions that reduce screen-time behaviours.

Social class, gender, and time use: implications for the social determinants of body weight?

PubMed

McLaren, Lindsay; Godley, Jenny; MacNairn, Ian A S

2009-12-01

The social gradient in body weight (for example, obesity) departs from the social gradient in other health outcomes. Innovative approaches are needed to understand the observed patterns. This study examines time-use patterns by indicators of socio-economic position, and considers the implications of variations in time use for the social gradient in weight reported in other studies. The data are from respondents aged 25 to 64 to Canada's 1986 and 2005 General Social Surveys, which focused on time use. Participation in various activities was examined by sex, and by personal income and education, stratified by sex, in both years. Higher-income men and women were more likely than those of lower income to spend time in paid work, commuting and eating out, and less likely to spend time sleeping. Men and women with higher education were more likely than those with lower education to spend time in physical activity (2005 only) and reading. These time-use patterns plausibly contribute to the social gradient in obesity reported in other Canadian studies. The findings suggest that there is value in looking beyond a narrow range of health behaviours toward broader measures of daily routines to gain insight into the social determinants of weight and health.

[Anthropometric indexes of the state of nutrition and eating habits, and recreational physical activity of working physically men aged 20-60 of urban population].

PubMed

Gacek, Maria; Chrzanowska, Maria

2011-01-01

The aim of this studies was the comparison of somatic indexes and eating habits of working physically men who prefer different ways (active vs. passive) of spending their free time. The studies has been carried out on a group of 1271 people who work in HTS (steelworks) in Nowa Huta (one of Cracow's districts), including 523 men aged 20-40 (181 active and 342 non-active) and 748 men aged 40-60 (194 active and 554 non-active). Men referred to as active declared active spending of their free time and taking up recreational physical activity at lest twice a week. The presented research has not revealed statistically important differentiation of somatic parameters depending on preferred way of spending free time, or a connection between the physical activity level during free time and some eating habits indicating more rational choices, connected with the control of energy value of the diet, larger consumption of vegetables and fruit and smaller consumption of sweet products, and less frequently appearance of 'canine appetite' in the case of active men.

A Modular IoT Platform for Real-Time Indoor Air Quality Monitoring.

PubMed

Benammar, Mohieddine; Abdaoui, Abderrazak; Ahmad, Sabbir H M; Touati, Farid; Kadri, Abdullah

2018-02-14

The impact of air quality on health and on life comfort is well established. In many societies, vulnerable elderly and young populations spend most of their time indoors. Therefore, indoor air quality monitoring (IAQM) is of great importance to human health. Engineers and researchers are increasingly focusing their efforts on the design of real-time IAQM systems using wireless sensor networks. This paper presents an end-to-end IAQM system enabling measurement of CO₂, CO, SO₂, NO₂, O₃, Cl₂, ambient temperature, and relative humidity. In IAQM systems, remote users usually use a local gateway to connect wireless sensor nodes in a given monitoring site to the external world for ubiquitous access of data. In this work, the role of the gateway in processing collected air quality data and its reliable dissemination to end-users through a web-server is emphasized. A mechanism for the backup and the restoration of the collected data in the case of Internet outage is presented. The system is adapted to an open-source Internet-of-Things (IoT) web-server platform, called Emoncms, for live monitoring and long-term storage of the collected IAQM data. A modular IAQM architecture is adopted, which results in a smart scalable system that allows seamless integration of various sensing technologies, wireless sensor networks (WSNs) and smart mobile standards. The paper gives full hardware and software details of the proposed solution. Sample IAQM results collected in various locations are also presented to demonstrate the abilities of the system.

In-store marketing of inexpensive foods with good nutritional quality in disadvantaged neighborhoods: increased awareness, understanding, and purchasing.

PubMed

Gamburzew, Axel; Darcel, Nicolas; Gazan, Rozenn; Dubois, Christophe; Maillot, Matthieu; Tomé, Daniel; Raffin, Sandrine; Darmon, Nicole

2016-09-27

Consumers often do not understand nutrition labels or do not perceive their usefulness. In addition, price can be a barrier to healthy food choices, especially for socio-economically disadvantaged individuals. A 6-month intervention combined shelf labeling and marketing strategies (signage, prime placement, taste testing) to draw attention to inexpensive foods with good nutritional quality in two stores located in a disadvantaged neighborhood in Marseille (France). The inexpensive foods with good nutritional quality were identified based on their nutrient profile and their price. Their contribution to customers' spending on food was assessed in the two intervention stores and in two control stores during the intervention, as well as in the year preceding the intervention (n = 6625). Exit survey (n = 259) and in-depth survey (n = 116) were used to assess customers' awareness of and perceived usefulness of the program, knowledge of nutrition, understanding of the labeling system, as well as placement-, taste- and preparation-related attractiveness of promoted products. Matched purchasing data were used to assess the contribution of promoted products to total food spending for each customer who participated in the in-depth survey. The contribution of inexpensive foods with good nutritional quality to customers' total food spending increased between 2013 and 2014 for both the control stores and the intervention stores. This increase was significantly higher in the intervention stores than in the control stores for fruits and vegetables (p = 0.001) and for starches (p = 0.011). The exit survey revealed that 31 % of customers had seen the intervention materials; this percentage increased significantly at the end of the intervention (p < 0.001). The in-depth survey showed that customers who had seen the intervention materials scored significantly higher on quizzes assessing nutrition knowledge (p < 0.001) and understanding of the labeling system (p = 0.024). A social marketing intervention aimed at increasing the visibility and attractiveness of inexpensive foods with good nutritional quality may improve food purchasing behaviors in disadvantaged neighborhoods.

Feasibility of a 6-Month Yoga Program to Improve the Physical and Psychosocial Status of Persons with Multiple Sclerosis and their Family Members.

PubMed

Kahraman, Turhan; Ozdogar, Asiye Tuba; Yigit, Pinar; Hosgel, Ilknur; Mehdiyev, Zaur; Ertekin, Ozge; Ozakbas, Serkan

To the best of our knowledge, there has been no study on yoga that includes both persons with multiple sclerosis (MS) and their family members. Because yoga has therapeutic effects in both persons with MS and healthy persons, we hypothesized that it would be an effective method to improve not only the physical and psychosocial status but also the time persons with MS and their family members spend together. To examine the feasibility of a 6-month (long-term) yoga program to improve the physical and psychosocial status of persons with MS and their family members. Uncontrolled clinical trial. The protocol was developed at the Department of Neurology, Faculty of Medicine, and School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey. Persons with MS and healthy family members. Walking, balance, fatigue, health-related quality of life, depression, pain, and kinesiophobia. Yoga training was given once a week (at least 1h) for 6 months. The same assessors who assessed at baseline also performed the same assessments immediately after the end of the training (i.e., after 6 months). In total, 44 participants (27 persons with MS and 17 healthy family members) participated in the study. Twelve persons with MS and three healthy family members completed the 6-month yoga intervention. The completion rate for persons with MS and healthy subjects was 44.4% and 17.6%, respectively. In persons with MS, the mental dimension of health-related quality of life, walking speed, fatigue, and depression levels significantly improved after the yoga program (p < .05). However, there was no significant change in the self-reported walking impact, balance, pain, physical dimension of health-related quality of life, and kinesiophobia levels in the persons with MS (p > .05). This study suggests that a 6-month yoga program can improve the mental dimension of health-related quality of life, walking speed, fatigue, and depression in the persons with MS. However, the 6-month yoga program does not appear to be a feasible method to increase the time that persons with MS spend together with their family members. Copyright © 2018 Elsevier Inc. All rights reserved.

State tobacco control expenditures and tax paid cigarette sales

PubMed Central

Tauras, John A.; Xu, Xin; Huang, Jidong; King, Brian; Lavinghouze, S. Rene; Sneegas, Karla S.; Chaloupka, Frank J.

2018-01-01

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC’s Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008–2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs. PMID:29652890

General guidelines for biomedical software development

PubMed Central

Silva, Luis Bastiao; Jimenez, Rafael C.; Blomberg, Niklas; Luis Oliveira, José

2017-01-01

Most bioinformatics tools available today were not written by professional software developers, but by people that wanted to solve their own problems, using computational solutions and spending the minimum time and effort possible, since these were just the means to an end. Consequently, a vast number of software applications are currently available, hindering the task of identifying the utility and quality of each. At the same time, this situation has hindered regular adoption of these tools in clinical practice. Typically, they are not sufficiently developed to be used by most clinical researchers and practitioners. To address these issues, it is necessary to re-think how biomedical applications are built and adopt new strategies that ensure quality, efficiency, robustness, correctness and reusability of software components. We also need to engage end-users during the development process to ensure that applications fit their needs. In this review, we present a set of guidelines to support biomedical software development, with an explanation of how they can be implemented and what kind of open-source tools can be used for each specific topic. PMID:28443186

The relationship between computer games and quality of life in adolescents.

PubMed

Dolatabadi, Nayereh Kasiri; Eslami, Ahmad Ali; Mostafavi, Firooze; Hassanzade, Akbar; Moradi, Azam

2013-01-01

Term of doing computer games among teenagers is growing rapidly. This popular phenomenon can cause physical and psychosocial issues in them. Therefore, this study examined the relationship between computer games and quality of life domains in adolescents aging 12-15 years. In a cross-sectional study using the 2-stage stratified cluster sampling method, 444 male and female students in Borkhar were selected. The data collection tool consisted of 1) World Health Organization Quality Of Life - BREF questionnaire and 2) personal information questionnaire. The data were analyzed by Pearson correlation, Spearman correlation, chi-square, independent t-tests and analysis of covariance. The total mean score of quality of life in students was 67.11±13.34. The results showed a significant relationship between the age of starting to play games and the overall quality of life score and its fourdomains (range r=-0.13 to -0.18). The mean of overall quality of life score in computer game users was 68.27±13.03 while it was 64.81±13.69 among those who did not play computer games and the difference was significant (P=0.01). There were significant differences in environmental and mental health domains between the two groups (P<0.05). However, there was no significant relationship between BMI with the time spent and the type of computer games. Playing computer games for a short time under parental supervision can have positive effects on quality of life in adolescents. However, spending long hours for playing computer games may have negative long-term effects.

Specialty Payment Model Opportunities and Assessment

PubMed Central

Huckfeldt, Peter J.; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L.; Mulcahy, Andrew W.; Popescu, Ioana; Stevens, Clare; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer. PMID:28083364

Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report.

PubMed

Huckfeldt, Peter J; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L; Mulcahy, Andrew W; Popescu, Ioana; Stevens, Clare; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.

Changing the Way We Work

ERIC Educational Resources Information Center

Coote, Anna

2010-01-01

A 21-hour working week is a long way from today's standard of 40 hours or more, but not so far-fetched when people consider the infinitely varied ways in which they actually spend their time. On average, people of working age spend 19.6 hours a week in paid employment and 20.4 hours in unpaid housework and childcare. These averages mask huge…

Does Increasing Hours of Schooling Lead to Improvements in Student Learning? Policy Brief No. 1

ERIC Educational Resources Information Center

Sandoval-Hernandez, Andres; Aghakasiri, Parisa; Wild, Justin; Rutkowski, David

2013-01-01

Increasing the number of hours students spend in school each year, on the assumption that this will improve student achievement, has become a widespread trend. However, the analysis reported here suggests that this trend can be misguided: the time students spend in the classroom is not always positively related to their academic achievement.…

Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

PubMed

Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

2011-04-01

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

Takeaway food consumption and its associations with diet quality and abdominal obesity: a cross-sectional study of young adults

PubMed Central

Smith, Kylie J; McNaughton, Sarah A; Gall, Seana L; Blizzard, Leigh; Dwyer, Terence; Venn, Alison J

2009-01-01

Background Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults. Methods A national sample of 1,277 men and 1,585 women aged 26–36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as ≥ 94 cm for men and ≥ 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group. Results Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P < 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P < 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P < 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50). Conclusion Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women. PMID:19473547

Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer

PubMed Central

Gomes, Edimar Pedrosa; Reboredo, Maycon Moura; Carvalho, Erich Vidal; Teixeira, Daniel Rodrigues; Carvalho, Laís Fernanda Caldi d'Ornellas; Filho, Gilberto Francisco Ferreira; de Oliveira, Julio César Abreu; Sanders-Pinheiro, Helady; Chebli, Júlio Maria Fonseca; de Paula, Rogério Baumgratz; Pinheiro, Bruno do Valle

2015-01-01

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity. PMID:26090432

Risk alignment in health care quality and financing: optimizing value.

PubMed

Granata, A V

1998-01-01

How should health care best consolidate rational cost control while preserving and enhancing quality? That is, how can a system best optimize value? A limitation of many current health management modalities may be that the power to control health spending has been expropriated from physician providers, while they are still fully responsible for quality. Assigning responsibility without authority is a significant predicament. There are growing indications that well-organized, well-managed groups of high quality physicians may be able to directly manage both types of risk-quality and financial. The best way to optimize responsibility and authority, and to control financial and quality risks, is to place such responsibility and authority within the same entity.

Physical activity patterns in American high school students. Results from the 1990 Youth Risk Behavior Survey.

PubMed

Heath, G W; Pratt, M; Warren, C W; Kann, L

1994-11-01

To assess by self-reported participation in vigorous physical activity, the quantity and quality of school physical education, team sports, and television watching among 11,631 American high school students. Of all students in grades 9 through 12, 37% reported engaging in 20 minutes of vigorous physical activity three or more times per week. Participation in vigorous physical activity was higher among boys than girls (P < .01) and higher among white students than among those of other races and ethnic groups (P < .01). Overall, 43.7% of boys and 52% of girls reported that they were not enrolled in physical education classes. Of the students who reported attending physical education class during the past 2 weeks, 33.2% reported exercising 20 minutes or more in physical education class three to five times per week. In contrast, rates of participation in varsity and junior varsity sports remained constant across grade levels, but participation in recreational physical activity programs showed a lesser magnitude and also decreased with advancing grade. More than 70% of students reported spending at least 1 hour watching television each school day, and more than 35% reported watching television 3 hours or more each school day. Participation in vigorous physical activity and physical education class time devoted to physical activity are substantially below the goals set in Healthy People 2000. As students move toward graduation, we observed disturbing declines in participation in community recreation programs and overall vigorous activity. Students appear to spend considerably more time watching television than participating in physical activity. Public health efforts should focus on increasing the physical activity levels of our youth to enhance their current well-being and to reduce the risks of future chronic disease.

An approach to forecasting health expenditures, with application to the U.S. Medicare system.

PubMed

Lee, Ronald; Miller, Timoth

2002-10-01

To quantify uncertainty in forecasts of health expenditures. Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.

Mapping nurses' activities in surgical hospital wards: A time study.

PubMed

van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

2018-01-01

Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences in the patient mix, nurse staffing (proportion of nursing students), type of surgery and region of the body where the surgery was performed. However, we could not explain all differences. We made a first attempt in identifying and explaining differences in nurses' activities between wards, however this domain needs more research in order to better explain the differences.

Rescue US energy innovation

NASA Astrophysics Data System (ADS)

Anadon, Laura Diaz; Gallagher, Kelly Sims; Holdren, John P.

2017-10-01

President Trump has proposed severe cuts to US government spending on energy research, development and demonstration, but Congress has the `power of the purse' and can rescue US energy innovation. If serious cuts are enacted, the pace of innovation will slow, harming the economy, energy security and global environmental quality.

Provider communication quality: influence of patients' weight and race.

PubMed

Wong, Michelle S; Gudzune, Kimberly A; Bleich, Sara N

2015-04-01

To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Assessment of Indoor Air Pollution in Homes with Infants

PubMed Central

Pickett, Anna Ruth; Bell, Michelle L.

2011-01-01

Infants spend most of their indoor time at home; however, residential air quality is poorly understood. We investigated the air quality of infants’ homes in the New England area of the U.S. Participants (N = 53) were parents of infants (0–6 months) who completed telephone surveys to identify potential pollutant sources in their residence. Carbon monoxide (CO), carbon dioxide (CO2), particulate matter with aerodynamic diameter ≤0.5 µm (PM0.5), and total volatile organic compounds (TVOCs) were measured in 10 homes over 4–7 days, and levels were compared with health-based guidelines. Pollutant levels varied substantially across homes and within homes with overall levels for some homes up to 20 times higher than for other homes. Average levels were 0.85 ppm, 663.2 ppm, 18.7 µg/m3, and 1626 µg/m3 for CO, CO2, PM0.5, and TVOCs, respectively. CO2, TVOCs, and PM0.5 levels exceeded health-based indoor air quality guidelines. Survey results suggest that nursery renovations and related potential pollutant sources may be associated with differences in urbanicity, income, and presence of older children with respiratory ailments, which could potentially confound health studies. While there are no standards for indoor residential air quality, our findings suggest that additional research is needed to assess indoor pollution exposure for infants, which may be a vulnerable population. PMID:22408586

Assessing Complex Learning Objectives through Analytics

NASA Astrophysics Data System (ADS)

Horodyskyj, L.; Mead, C.; Buxner, S.; Semken, S. C.; Anbar, A. D.

2016-12-01

A significant obstacle to improving the quality of education is the lack of easy-to-use assessments of higher-order thinking. Most existing assessments focus on recall and understanding questions, which demonstrate lower-order thinking. Traditionally, higher-order thinking is assessed with practical tests and written responses, which are time-consuming to analyze and are not easily scalable. Computer-based learning environments offer the possibility of assessing such learning outcomes based on analysis of students' actions within an adaptive learning environment. Our fully online introductory science course, Habitable Worlds, uses an intelligent tutoring system that collects and responds to a range of behavioral data, including actions within the keystone project. This central project is a summative, game-like experience in which students synthesize and apply what they have learned throughout the course to identify and characterize a habitable planet from among hundreds of stars. Student performance is graded based on completion and accuracy, but two additional properties can be utilized to gauge higher-order thinking: (1) how efficient a student is with the virtual currency within the project and (2) how many of the optional milestones a student reached. In the project, students can use the currency to check their work and "unlock" convenience features. High-achieving students spend close to the minimum amount required to reach these goals, indicating a high-level of concept mastery and efficient methodology. Average students spend more, indicating effort, but lower mastery. Low-achieving students were more likely to spend very little, which indicates low effort. Differences on these metrics were statistically significant between all three of these populations. We interpret this as evidence that high-achieving students develop and apply efficient problem-solving skills as compared to lower-achieving student who use more brute-force approaches.

Inequity in costs of seeking sexual and reproductive health services in India and Kenya.

PubMed

Haghparast-Bidgoli, Hassan; Pulkki-Brännström, Anni-Maria; Lafort, Yves; Beksinska, Mags; Rambally, Letitia; Roy, Anuradha; Reza-Paul, Sushena; Ombidi, Wilkister; Gichangi, Peter; Skordis-Worrall, Jolene

2015-09-15

This study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending. Data for this study were collected as a part of the situational analysis for the "Diagonal Interventions to Fast Forward Enhanced Reproductive Health" (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10% of total household income. The results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2% and 0.03-7.5% in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were "receiving [money] from partner or household members" (69%) and "using own savings or regular income" (44%), respectively. Highly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.

Influence of positive distractions on children in two clinic waiting areas.

PubMed

Pati, Debajyoti; Nanda, Upali

2011-01-01

To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas. People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment? Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009. Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.

Nocturnal Polyuria in Older Women with Urge Urinary Incontinence: Role of Sleep Quality, Time in Bed, and Medications Used

PubMed Central

Tyagi, Shachi; Perera, Subashan; Clarkson, Becky D.; Tadic, Stasa D; Resnick, Neil M

2016-01-01

Purpose Nocturia is common and bothersome in older adults especially those who are also incontinent. Since nocturnal polyuria (NP) is a major contributor, we examined factors associated with NP in this population to identify those possibly amenable to intervention. Method We analyzed baseline data from two previously-completed studies of urge urinary incontinence (UUI). The studies involved 284 women (mean 72.9 ±7.9 years) who also completed 3-day voiding diaries. Participants with nocturnal polyuria index (NPi) of > 33% were categorized as having NP (NPi= nocturnal urinary volume/24-hour urine volume). Associations between NP and various demographic, clinical, and sleep-related parameters were determined. Results Fifty-five percent of the participants had NP. Multivariable regression analysis revealed that age, body mass index (BMI), use of angiotensin-converting-enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB), time spent in bed, and duration of first uninterrupted sleep (DUS) were independent correlates of NP. Participants with larger nocturnal excretion reported shorter DUS and worse sleep quality despite spending similar time in bed. Conclusion BMI, use of ACE-I/ARB, time in bed and DUS are independently associated with NP in older women with UUI, and are potentially modifiable. These findings also confirm the association between sleep and NP. Further studies should explore whether interventions to reduce NP and/or increase DUS help to improve sleep quality in this population and thereby reduce or eliminate the need for sedative hypnotics. PMID:27678299

Do Expenditures Other Than Instructional Expenditures Affect Graduation and Persistence Rates in American Higher Education. NBER Working Paper No. 15216

ERIC Educational Resources Information Center

Webber, Douglas A.; Ehrenberg, Ronald G.

2009-01-01

During the last two decades, median instructional spending per full-time equivalent (FTE) student at American 4-year colleges and universities has grown at a slower rate than median spending per FTE student in a number of other expenditure categories including academic support, student services and research. Our paper uses institutional level…

Brief Report: Disposable Income, and Spending on Fast Food, Alcohol, Cigarettes, and Gambling by New Zealand Secondary School Students

ERIC Educational Resources Information Center

Darling, Helen; Reeder, Anthony I.; McGee, Rob; Williams, Sheila

2006-01-01

We describe self-reported sources of income and expenditure, and the association between part-time employment and spending on fast food, alcohol, cigarettes, and gambling for a sample of 3434 New Zealand (NZ) secondary school students (mean age 15.0 years). Disposable income was usually received from parents and guardians, but nearly 40% of…

Child Care Costs as a Barrier to Women's Employment. Final Report.

ERIC Educational Resources Information Center

Brayfield, April

A study focused on how child care costs may restrict women's employment prospects, in terms of their current employment status and the amount of time they spend in paid work. It compared the effects of four dimensions of child care costs on women's labor supply: market price of care within a local area, amount of money parents spend on child care,…

How Can School Funding Increase If Operating Budgets Are Declining? Get the Facts... #2

ERIC Educational Resources Information Center

Kansas Association of School Boards (NJ1), 2012

2012-01-01

State and local funding for general operating budgets for Kansas public schools will be at a five-year low this school year, yet total Kansas school district spending will reach an all-time high of $5.67 billion according to estimates released by the Kansas State Department of Education. Total per pupil spending is projected to reach $12,454 per…

Localized real-time information on outdoor air quality at kindergartens in Oslo, Norway using low-cost sensor nodes.

PubMed

Castell, Nuria; Schneider, Philipp; Grossberndt, Sonja; Fredriksen, Mirjam F; Sousa-Santos, Gabriela; Vogt, Mathias; Bartonova, Alena

2018-08-01

In Norway, children in kindergartens spend significant time outdoors under all weather conditions, and there is thus a natural concern about the quality of outdoor air. It is well known that air pollution is associated with a wide variety of adverse health impacts for children, with greater impact on children with asthma. Especially during winter and spring, kindergartens in Oslo that are situated close to streets with busy traffic, or in areas where wood burning is used for house heating, can experience many days with bad air quality. During these periods, updated information on air quality levels can help the kindergarten teachers to plan appropriate outdoor activities and thus protect children's health. We have installed 17 low-cost air quality nodes in kindergartens in Oslo. These nodes are smaller, cheaper and less complex to use than traditional equipment. Performance evaluation shows that while they are less accurate and suffer from higher uncertainty than reference equipment, they still can provide reliable coarse information about local pollution. The main challenge when using this technology is that calibration parameters might change with time depending on the atmospheric conditions. Thus, even if the sensors are calibrated a priori, once deployed, and especially if they are deployed for a long time, it is not possible to determine if a node is over- or under-estimating the concentration levels. To enhance the data from the sensors, we employed a data fusion technique that allows generating a detailed air quality map merging the data from the sensors and the data from an urban model, thus being able to offer air quality information to any location within Oslo. We arranged a focus group with the participation of local administration, kindergarten staff and parents to understand their opinion and needs related to the air quality information that was provided to the participant kindergartens. They expressed concern about the data quality but agree that having updated information on the air quality in the surroundings of kindergartens can help them to reduce children's exposure to air pollution. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries.

PubMed

Chen, Candice; Petterson, Stephen; Phillips, Robert; Bazemore, Andrew; Mullan, Fitzhugh

2014-12-10

Graduate medical education training may imprint young physicians with skills and experiences, but few studies have evaluated imprinting on physician spending patterns. To examine the relationship between spending patterns in the region of a physician's graduate medical education training and subsequent mean Medicare spending per beneficiary. Secondary multilevel multivariable analysis of 2011 Medicare claims data (Part A hospital and Part B physician) for a random, nationally representative sample of family medicine and internal medicine physicians completing residency between 1992 and 2010 with Medicare patient panels of 40 or more patients (2851 physicians providing care to 491,948 Medicare beneficiaries). Locations of practice and residency training were matched with Dartmouth Atlas Hospital Referral Region (HRR) files. Training and practice HRRs were categorized into low-, average-, and high-spending groups, with approximately equal distribution of beneficiary numbers. There were 674 physicians in low-spending training and low-spending practice HRRs, 180 in average-spending training/low-spending practice, 178 in high-spending training/low-spending practice, 253 in low-spending training/average-spending practice, 417 in average-spending training/average-spending practice, 210 in high-spending training/average-spending practice, 97 in low-spending training/high-spending practice, 275 in average-spending training/high-spending practice, and 567 in high-spending training/high-spending practice. Mean physician spending per Medicare beneficiary. For physicians practicing in high-spending regions, those trained in high-spending regions had a mean spending per beneficiary per year $1926 higher (95% CI, $889-$2963) than those trained in low-spending regions. For practice in average-spending HRRs, mean spending was $897 higher (95% CI, $71-$1723) for physicians trained in high- vs low-spending regions. For practice in low-spending HRRs, the difference across training HRR levels was not significant ($533; 95% CI, -$46 to $1112). After controlling for patient, community, and physician characteristics, there was a 7% difference (95% CI, 2%-12%) in patient expenditures between low- and high-spending training HRRs. Across all practice HRRs, this corresponded to an estimated $522 difference (95% CI, $146-$919) between low- and high-spending training regions. For physicians 1 to 7 years in practice, there was a 29% difference ($2434; 95% CI, $1004-$4111) in spending between those trained in low- and high-spending regions; however, after 16 to 19 years, there was no significant difference. Among general internists and family physicians who completed residency training between 1992 and 2010, the spending patterns in the HRR in which their residency program was located were associated with expenditures for subsequent care they provided as practicing physicians for Medicare beneficiaries. Interventions during residency training may have the potential to help control future health care spending.

Tuition May Outpace the Rate of Inflation for 10th Year in a Row.

ERIC Educational Resources Information Center

Evangelauf, Jean

1990-01-01

Early announcements show many colleges are raising tuition 5 to 11 percent, squeezed by pressures to keep costs down and spend more to improve educational quality. A federal investigation of possible tuition price-fixing at 56 institutions has also increased anxiety among administrators. (MSE)

Small Change, Big Difference

ERIC Educational Resources Information Center

McKinnell, Catherine

2011-01-01

Government spending is declining, yet the need for jobs and training is higher than ever. The current supply of quality apprenticeships is clearly not sufficient to meet demand and that was highlighted this year when British Telecom received 24,000 applications for only 221 places on its apprenticeship programme. The main obstacle to increasing…

Implementing a Quality Needs Assessment

ERIC Educational Resources Information Center

Cuiccio, Cary

2012-01-01

Districts nationwide are facing budget cuts that, to some, feel more like funding cliffs. Accordingly, school teams are re-examining their personnel, programs, and schedules so that they can make difficult decisions about where to spend resources to realize the greatest improvement. The principals who are able to make decisions with data from…

Music Education under Threat

ERIC Educational Resources Information Center

Stevenson, Kate

2011-01-01

Leicester-Shire Arts in Education has long had both a national and international reputation for providing high-quality music education to young people. Last year, its future seemed in jeopardy as a result of County Council spending cuts. This article provides a historical background to the service, and describes how a campaign developed to defend…

A targeted conservation approach for improving environmental quality

Treesearch

Lisa Schulte; Heidi Asbjornsen; Ryan Atwell; Chad Hart; Matt Helmers; Tom Isenhart; Randy Kolka; Matt Liebman; Jeri Neal; Matt O’Neal; Silvia Secchi; Richard Schultz; Jan Thompson; Mark Tomer; John. Tyndall

2008-01-01

Among our most basic needs are clean air and water to breathe and drink. The cleaner these resources are in the natural environment, the less we have to spend on purifying them in our homes and municipalities. Clean environments are also safer, more attractive places for people to live and recreate.

Predicting indoor pollutant concentrations, and applications to air quality management

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

Lorenzetti, David M.

Because most people spend more than 90% of their time indoors, predicting exposure to airborne pollutants requires models that incorporate the effect of buildings. Buildings affect the exposure of their occupants in a number of ways, both by design (for example, filters in ventilation systems remove particles) and incidentally (for example, sorption on walls can reduce peak concentrations, but prolong exposure to semivolatile organic compounds). Furthermore, building materials and occupant activities can generate pollutants. Indoor air quality depends not only on outdoor air quality, but also on the design, maintenance, and use of the building. For example, ''sick building'' symptomsmore » such as respiratory problems and headaches have been related to the presence of air-conditioning systems, to carpeting, to low ventilation rates, and to high occupant density (1). The physical processes of interest apply even in simple structures such as homes. Indoor air quality models simulate the processes, such as ventilation and filtration, that control pollutant concentrations in a building. Section 2 describes the modeling approach, and the important transport processes in buildings. Because advection usually dominates among the transport processes, Sections 3 and 4 describe methods for predicting airflows. The concluding section summarizes the application of these models.« less

The home electronic media environment and parental safety concerns: relationships with outdoor time after school and over the weekend among 9-11 year old children.

PubMed

Wilkie, Hannah J; Standage, Martyn; Gillison, Fiona B; Cumming, Sean P; Katzmarzyk, Peter T

2018-04-05

Time spent outdoors is associated with higher physical activity levels among children, yet it may be threatened by parental safety concerns and the attraction of indoor sedentary pursuits. The purpose of this study was to explore the relationships between these factors and outdoor time during children's discretionary periods (i.e., after school and over the weekend). Data from 462 children aged 9-11 years old were analysed using generalised linear mixed models. The odds of spending > 1 h outdoors after school, and > 2 h outdoors on a weekend were computed, according to demographic variables, screen-based behaviours, media access, and parental safety concerns. Interactions with sex and socioeconomic status (SES) were explored. Boys, low SES participants, and children who played on their computer for < 2 h on a school day had higher odds of spending > 1 h outside after school than girls, high SES children and those playing on a computer for ≥2 h, respectively. Counterintuitive results were found for access to media devices and crime-related safety concerns as both of these were positively associated with time spent outdoors after school. A significant interaction for traffic-related concerns*sex was found; higher road safety concerns were associated with lower odds of outdoor time after school in boys only. Age was associated with weekend outdoor time, which interacted with sex and SES; older children were more likely to spend > 2 h outside on weekends but this was only significant among girls and high SES participants. Our results suggest that specific groups of children are less likely to spend their free time outside, and it would seem that only prolonged recreational computer use has a negative association with children's outdoor time after school. Further research is needed to explore potential underlying mechanisms, and parental safety concerns in more detail.

The Economics of NASA Mission Cost Reserves

NASA Technical Reports Server (NTRS)

Whitley, Sally; Shinn, Stephen

2012-01-01

Increases in NASA mission costs are well-noted but not well-understood, and there is little evidence that they are decreasing in frequency or amount over time. The need to control spending has led to analysis of the causes and magnitude of historical mission overruns, and many program control efforts are being implemented to attempt to prevent or mitigate the problem (NPR 7120). However, cost overruns have not abated, and while some direct causes of increased spending may be obvious (requirements creep, launch delays, directed changes, etc.), the underlying impetus to spend past the original budget may be more subtle. Gaining better insight into the causes of cost overruns will help NASA and its contracting organizations to avoid .them. This paper hypothesizes that one cause of NASA mission cost overruns is that the availability of reserves gives project team members an incentive to make decisions and behave in ways that increase costs. We theorize that the presence of reserves is a contributing factor to cost overruns because it causes organizations to use their funds less efficiently or to control spending less effectively. We draw a comparison to the insurance industry concept of moral hazard, the phenomenon that the presence of insurance causes insureds to have more frequent and higher insurance losses, and we attempt to apply actuarial techniques to quantifY the increase in the expected cost of a mission due to the availability of reserves. We create a theoretical model of reserve spending motivation by defining a variable ReserveSpending as a function of total reserves. This function has a positive slope; for every dollar of reserves available, there is a positive probability of spending it. Finally, the function should be concave down; the probability of spending each incremental dollar of reserves decreases progressively. We test the model against available NASA CADRe data by examining missions with reserve dollars initially available and testing whether they are more likely to spend those dollars, and whether larger levels of reserves lead to higher cost overruns. Finally, we address the question of how to prevent reserves from increasing mission spending without increasing cost risk to projects budgeted without any reserves. Is there a "sweet spot"? How can we derive the maximum benefit associated with risk reduction from reserves while minimizing the effects of reserve spending motivation?

Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria

PubMed Central

Duintjer Tebbens, Radboud J.; Pallansch, Mark A.; Wassilak, Steven G. F.; Cochi, Stephen L.; Thompson, Kimberly M.

2015-01-01

Background Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Materials and Methods Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. Results More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. Conclusions National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency. PMID:26068928

Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria.

PubMed

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Wassilak, Steven G F; Cochi, Stephen L; Thompson, Kimberly M

2015-01-01

Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency.

Early Child Care and Education: HHS and Education Are Taking Steps to Improve Workforce Data and Enhance Worker Quality. Report to the Chairman, Committee on Finance, U.S. Senate. GAO-12-248

ERIC Educational Resources Information Center

Brown, Kay E.

2012-01-01

Research shows that well trained and educated early child care and education (ECCE) workers are key to helping children in care reach their full developmental potential. Federal and state governments spend billions of dollars each year to improve ECCE programs, including the quality of its caregivers and teachers. Because of the importance of this…

Air Quality and Indoor Environmental Exposures: Clinical ...

EPA Pesticide Factsheets

Indoor air quality (IAQ) is a term which refers to the air quality within and around buildings and homes as it relates to the health and comfort of the occupants. Many ambient (outdoor) air pollutants readily permeate indoor spaces. Because indoor air can be considerably more polluted than ambient air, the USEPA lists poor IAQ as a major environmental concern. In the sections that follow, health effects associated with commonly encountered ambient air pollutants and indoor contaminants will be broken down by agent class. In some cases, exposure may be acute, with one or more pets (and owners) experiencing signs within a relatively short period. However, most exposures are episodic or chronic, making it difficult to definitively link poor IAQ to respiratory or other adverse health outcomes. Age or underlying immunologic, cardiac, or respiratory disease may further complicate the clinical picture, as those patients may be more sensitive to (and affected by) lower concentrations than prove problematic for healthy housemates. Because pets, like their owners, spend most of their lives indoors, we will discuss how certain home conditions can worsen indoor air quality and will briefly discuss measures to improve IAQ for owners and their pets. In this overview presentation, health effects associated with commonly encountered ambient air pollutants and indoor contaminants will be broken down by agent class. Because pets, like their owners, spend most of their lives indoo

U-shaped associations between time in bed and the physical and mental functioning of Japanese civil servants: the roles of work, family, behavioral and sleep quality characteristics.

PubMed

Sekine, M; Tatsuse, T; Cable, N; Chandola, T; Marmot, M

2014-09-01

This study aimed to evaluate (i) whether work, family, behavioral and sleep quality characteristics differ among individuals with different time in bed (TIB), and (ii) whether and how much the U-shaped associations between TIB and health can be explained by these characteristics. Participants were 3510 employees (2371 males and 1139 females) aged 20-65 years working in local government in Japan. They completed a questionnaire regarding work, family, and behavioral characteristics. Sleep quality and physical and mental functioning were evaluated using the Pittsburgh Sleep Quality Index and the Short Form 36. High job demands, long work hours, and high work-family conflict were more prevalent among those with short TIB. Those with long TIB had daily drinking habits. Whereas those with short TIB had poor sleep, mainly due to poor subjective sleep quality and daytime dysfunction, those with long TIB had poor sleep, mainly due to long sleep latency, poor sleep efficiency and sleep disturbances. The U-shaped associations between TIB and poor physical and mental health, with the best health observed in those spending ~8 h in bed, weakened considerably after adjustment for sleep quality, followed by work and family characteristics. After adjusting for behavioral characteristics and long-standing illnesses, the associations hardly changed. The U-shaped associations between TIB and health may be explained by U-shaped associations between TIB and poor sleep and psychosocial stress in work and family life. Copyright © 2014 Elsevier B.V. All rights reserved.

Mass imprisonment and the life course revisited: Cumulative years spent imprisoned and marked for working-age black and white men.

PubMed

Patterson, Evelyn J; Wildeman, Christopher

2015-09-01

Over the last 40 years, imprisonment has become a common stage in the life-course for low-skilled and minority men, with implications not only for inequality among adult men but also for inequality more broadly. Unfortunately, all research documenting how increases in imprisonment have transformed the life-course of poor, minority men has neglected to estimate how much time black and white men on average spend imprisoned or marked as an ex-prisoner. In this article, we fill this gap by using multistate life tables to estimate what share of their working lives (18-64) black and white men will spend imprisoned and marked as ex-prisoners. Our estimates imply that white men spend on average 0.33 years of their working lives imprisoned and 2.31 years marked, while black men spend on average 1.79 years of their working lives imprisoned and 11.14 years marked. This implies that black men spend on average one-third of their working lives either imprisoned or having been freed but marked by the penal system. For the 32.2% of black men who ever experience imprisonment (Bonczar, 2003), moreover, these estimates imply that they spend on average 5.56 years imprisoned, corresponding to 13.4% of their working lives. Taken together, these findings imply a dramatic reorientation of the life course for black men, as one-third of the black male population will spend one-seventh of their working life in prison. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of age, season, gender and urban-rural status on time-activity: CanadianHuman Activity Pattern Survey 2 (CHAPS 2).

PubMed

Matz, Carlyn J; Stieb, David M; Davis, Karelyn; Egyed, Marika; Rose, Andreas; Chou, Benedito; Brion, Orly

2014-02-19

Estimation of population exposure is a main component of human health risk assessment for environmental contaminants. Population-level exposure assessments require time-activity pattern distributions in relation to microenvironments where people spend their time. Societal trends may have influenced time-activity patterns since previous Canadian data were collected 15 years ago. The Canadian Human Activity Pattern Survey 2 (CHAPS 2) was a national survey conducted in 2010-2011 to collect time-activity information from Canadians of all ages. Five urban and two rural locations were sampled using telephone surveys. Infants and children, key groups in risk assessment activities, were over-sampled. Survey participants (n = 5,011) provided time-activity information in 24-hour recall diaries and responded to supplemental questionnaires concerning potential exposures to specific pollutants, dwelling characteristics, and socio-economic factors. Results indicated that a majority of the time was spent indoors (88.9%), most of which was indoors at home, with limited time spent outdoors (5.8%) or in a vehicle (5.3%). Season, age, gender and rurality were significant predictors of time activity patterns. Compared to earlier data, adults reported spending more time indoors at home and adolescents reported spending less time outdoors, which could be indicative of broader societal trends. These findings have potentially important implications for assessment of exposure and risk. The CHAPS 2 data also provide much larger sample sizes to allow for improved precision and are more representative of infants, children and rural residents.

Savings opportunities through Medicaid disease management.

PubMed

Lewis, Alfred

2004-01-01

In their attempts to control spending in Medicaid, a few states have looked beyond the obvious reductions in reimbursement, tightened eligibility requirements, and institution of copays to disease management outsourcing. While the traditional panoply of cutbacks will save money the year they are instituted, they tend to have trade-offs. Reducing reimbursement, for example, may encourage providers to leave the program. As a result, several states are implementing outsourced medical management programs, which together at maturity will, as shown below, noticeably reduce Medicaid spending by improving the way health care is delivered. These purely voluntary, quality-enhancing outsourced medical management programs are also fully guaranteed by a wide variety of vendors to save money starting in the first year they are implemented.

Reference Pricing Changes The 'Choice Architecture' Of Health Care For Consumers.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher

2017-03-01

Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are selected. The short-term impact of reference pricing has been to shift patient volumes from hospital-based to freestanding surgical, diagnostic, imaging, and laboratory facilities. This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. We conclude with a discussion of the incentives created for providers to redesign their clinical processes and for efficient providers to expand into price-sensitive markets. Over time, reference pricing may increase pressures for price competition and lead to further cost-reducing innovations in health care products and processes. Project HOPE—The People-to-People Health Foundation, Inc.

Limited Influence of Excipients in Extemporaneous Compounded Suspensions

PubMed Central

Dijkers, Eli; Nanhekhan, Valerie; Thorissen, Astrid; Marro, Diego; Uriel, Marta

2017-01-01

Objective: The objective of this study was to identify whether compounding oral suspensions with SyrSpend SF based on tablets or capsules is a suitable alternative for using raw pharmaceutical materials. Methods: Suspensions based on 5 different tablets and capsules were studied in SyrSpend SF. The summary of product characteristics of these different tablets and capsules were obtained from the manufacturer. Our hypothesis was that, if the maximum beyond-use date of the study was reached, the excipient did not seem to have an influence on the stability of the active pharmaceutical ingredient (API) within the studied time frame. Results: All excipients used in flecainide acetate, labetalol HCl, and tiagabine HCl tablets as well as in celecoxib and oseltamivir capsules did not seem to influence the beyond-use date of the overall suspension based on SyrSpend SF. Conclusion: Although using raw materials as API sources is preferred, oral suspensions with SyrSpend SF prepared from crushed tablets or opened capsules could be a possible alternative. Based on this study, a wide range of different excipients does not seem to impact the beyond-use date of different APIs compounded in SyrSpend SF. PMID:29276267

Limited Influence of Excipients in Extemporaneous Compounded Suspensions.

PubMed

Dijkers, Eli; Nanhekhan, Valerie; Thorissen, Astrid; Marro, Diego; Uriel, Marta

2017-06-01

Objective: The objective of this study was to identify whether compounding oral suspensions with SyrSpend SF based on tablets or capsules is a suitable alternative for using raw pharmaceutical materials. Methods: Suspensions based on 5 different tablets and capsules were studied in SyrSpend SF. The summary of product characteristics of these different tablets and capsules were obtained from the manufacturer. Our hypothesis was that, if the maximum beyond-use date of the study was reached, the excipient did not seem to have an influence on the stability of the active pharmaceutical ingredient (API) within the studied time frame. Results: All excipients used in flecainide acetate, labetalol HCl, and tiagabine HCl tablets as well as in celecoxib and oseltamivir capsules did not seem to influence the beyond-use date of the overall suspension based on SyrSpend SF. Conclusion: Although using raw materials as API sources is preferred, oral suspensions with SyrSpend SF prepared from crushed tablets or opened capsules could be a possible alternative. Based on this study, a wide range of different excipients does not seem to impact the beyond-use date of different APIs compounded in SyrSpend SF.

Tell it like it is.

PubMed

Lee, S L

2000-05-01

Nurses, therapists and case managers were spending too much time each week on the phone waiting to read patient reports to live transcriptionists who would then type the reports for storage in VNSNY's clinical management mainframe database. A speech recognition system helped solve the problem by providing the staff 24-hour access to an automated transcription service any day of the week. Nurses and case managers no longer wait in long queues to transmit patient reports or to retrieve information from the database. Everything is done automatically within minutes. VNSNY saved both time and money by updating its transcription strategy. Now nurses can spend more time with patients and less time on the phone transcribing notes. It also means fewer staff members are needed on weekends to do manual transcribing.

LiFi based automated shopping assistance application in IoT

NASA Astrophysics Data System (ADS)

Akter, Sharmin; Funke Olanrewaju, Rashidah, Dr; Islam, Thouhedul; Salma

2018-05-01

Urban people minimize shopping time in daily life due to time constrain. From that point of view, the concept of supermarket is being popular while consumers can buy different items from same place. However, customer spends hours and hours to find desired items in a large supermarket. In addition, it’s also required to be queued during payment at counter that is also time consuming. As a result, a customer has to spend 2-3 hours for shopping in a large superstore. This paper proposes an Internet of Things and Li-Fi based automated application for smart phone and web to find items easily during shopping that can save consumer’s time as well as reduce man power in supermarket.

Bowel function and quality of life after colostomy in individuals with spinal cord injury.

PubMed

Bølling Hansen, Rikke; Staun, Michael; Kalhauge, Anna; Langholz, Ebbe; Biering-Sørensen, Fin

2016-05-01

To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). Cross-sectional descriptive study. Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet. Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. Questionnaires and measurement of gastrointestinal transit time (GITT). Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. Seventy-two percent significantly reduced their use of time on bowel emptying after the colostomy. All but one reported being content with the colostomy. Thirty-nine percent reported one or more problems related to the colostomy. Seventy-five percent had a GITT within normal range for able-bodied populations. When disregarding the physical component, QoL was not significantly lower in the total study group compared to a Danish norm group, but significantly lower when compared the subgroup of persons with tetraplegia. A colostomy reduces the time necessary for bowel management. The majority of individuals with SCI and a colostomy did not perceive bowel management as being a problem. The results indicate that colostomy is a favourable option for individuals with SCI, who spend long hours on bowel management and for whom non-invasive procedures did not improve the situation enough.

Laser-based rework in electronics production

NASA Astrophysics Data System (ADS)

Albert, Florian; Mys, Ihor; Schmidt, Michael

2007-02-01

Despite the electronic manufacturing is well-established mass production process for a long time, the problem of reworking, i.a. reject and replace of defect components, still exists. The rework operations (soldering, replacement and desoldering) are performed in most cases manually. However, this practice is characterized by an inconsistent quality of the reworked solder joints and a high degree of physiological stress for the employees. In this paper, we propose a novel full-automated laser based soldering and rework process. Our developed soldering system is a pick-and-place unit with an integrated galvanometer scanner, a fiber coupled diode laser for quasi-simultaneous soldering and a pyrometer-based process control. The developed system provides soldering and reworking processes taking into account a kind of defect, a type of electronic component and quality requirements from the IPC- 610 norm. The paper spends a great deal of efforts to analyze quality of laser reworked solder joints. The quality depends mainly on the type and thickness of intermetallic phases between solder, pads and leads; the wetting angles between pad, solder and lead; and finally, the joint microstructure with its mechanical properties. The influence of the rework soldering on these three factors is discussed and compared to conventional laser soldering results. In order to optimize the quality of reworked joints, the different strategies of energy input are applied.

Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital

PubMed Central

2010-01-01

Background In the modern hospital environment, increasing possibilities in medical examination techniques and increasing documentation tasks claim the physicians' energy and encroach on their time spent with patients. This study aimed to investigate how much time physicians at hospital wards spend on communication with patients and their families and how much time they spend on other specific work tasks. Methods A non-participatory, observational study was conducted in thirty-six wards at the University Medical Center Freiburg, a 1700-bed academic hospital in Germany. All wards belonging to the clinics of internal medicine, surgery, radiology, neurology, and to the clinic for gynaecology took part in the study. Thirty-four ward doctors from fifteen different medical departments were observed during a randomly chosen complete work day. The Physicians' time for communication with patients and relatives and time spent on different working tasks during one day of work were assessed. Results 374 working hours were analysed. On average, a physician's workday on a university hospital ward added up to 658.91 minutes (10 hrs 58 min; range 490 - 848 min). Looking at single items of time consumption on the evaluation sheet, discussions with colleagues ranked first with 150 minutes on average. Documentation and administrative requirements took an average time of 148 minutes per day and ranked second. Total time for communication with patients and their relatives was 85 minutes per physician and day. Consequently, the available time for communication was 4 minutes and 17 seconds for each patient on the ward and 20 seconds for his or her relatives. Physicians assessed themselves to communicate twice as long with patients and sevenfold with relatives than they did according to this study. Conclusions Workload and time pressure for physicians working on hospital wards are high. To offer excellent medical treatment combined with patient centred care and to meet the needs of patients and relatives on hospital wards, physicians should be given more time to focus on core clinical tasks. Time and health care management solutions to minimize time pressure are required. Further research is needed to assess quality of communication in hospital settings. PMID:20380725

Federal Spending for Means Tested Programs, 2007 to 2027

DTIC Science & Technology

2017-02-01

child tax credits (which are refundable), the Supplemental Nutrition Assistance Program (SNAP), and Supplemental Security Income. The largest non...child tax credits, and SNAP—have been or will be significantly affected by program changes that unfold over time: B Medicaid spending rose by 35...total outlays in the Part D program). Increases in the number of beneficiaries account for about one- third of that growth; the introduction of new

Educate the Women and You Change the World: Investing in the Education of Women Is the Best Investment in a Country's Growth and Development

ERIC Educational Resources Information Center

Jackson, Leah Witcher

2009-01-01

An extensive body of research indicates a significant correlation between gender equality and the level of economic and social development of a country. Gender inequities have been found to influence the way members of the family spend their time and resources. Evidence suggests that women with more control over resources will spend more money on…

The impact of pharmaceutical policy measures: an endogenous structural-break approach.

PubMed

Barros, Pedro Pita; Nunes, Luis C

2010-08-01

Pharmaceutical spending in many countries has seen a steep increase in recent years. Governments have adopted several measures to reduce pharmaceutical expenditure growth, ranging from increased co-payments to price decreases determined administratively. Promotion of generic consumption has also ranked high in political priorities. We adopt a novel time series approach to the detection of which policy measures have a noticeable impact. The number and timing of the structural breaks are endogenously determined. As an illustration, we assess the overall impact of the several policy measures on total pharmaceutical spending, using monthly data from January 1995 to August 2008 for the Portuguese market. Our findings suggest that, in general, policy measures aimed at controlling pharmaceutical expenditure have been unsuccessful. Two breaks that were identified coincide with administratively determined price decreases. Measures aimed at increasing competition in the market had no visible effect on the dynamics of Government spending in pharmaceutical products. In particular, the introduction of reference pricing had only a transitory effect of less than one year, with historical growth resuming quickly. The consequence of this policy ineffectiveness is a transfer of financial burden from the Government to the patients, with no apparent effect on the dynamics of total pharmaceutical spending. Copyright 2010 Elsevier Ltd. All rights reserved.

Revisiting the Time Trade-Off Hypothesis: Work, Organized Activities, and Academics During College.

PubMed

Greene, Kaylin M; Maggs, Jennifer L

2015-08-01

How adolescents spend their time has long-term implications for their educational, health, and labor market outcomes, yet surprisingly little research has explored the time use of students across days and semesters. The current study used longitudinal daily diary data from a sample of college students attending a large public university in the Northeastern US (n = 726, M age = 18.4) that was followed for 14 days within each of seven semesters (for up to 98 diary days per student). The study had two primary aims. The first aim was to explore demographic correlates of employment time, organized activity time, and academic time. The second aim was to provide a rigorous test of the time trade-off hypothesis, which suggests that students will spend less time on academics when they spend more time on employment and extracurricular activities. The results demonstrated that time use varied by gender, parental education, and race/ethnicity. Furthermore, the results from multi-level models provided some support for the time trade-off hypothesis, although associations varied by the activity type and whether the day was a weekend. More time spent on employment was linked to less time spent on academics across days and semesters whereas organized activities were associated with less time on academics at the daily level only. The negative associations between employment and academics were most pronounced on weekdays. These results suggest that students may balance certain activities across days, whereas other activities may be in competition over longer time frames (i.e., semesters).

Revisiting the Time Trade-off Hypothesis: Work, Organized Activities, and Academics during College

PubMed Central

Maggs, Jennifer L.

2014-01-01

How adolescents spend their time has long-term implications for their educational, health, and labor market outcomes, yet surprisingly little research has explored the time use of students across days and semesters. The current study used longitudinal daily diary data from a sample of college students attending a large public university in the Northeastern US (n = 726, Mage = 18.4) that was followed for 14 days within each of 7 semesters (for up to 98 diary days per student). The study had two primary aims. The first aim was to explore demographic correlates of employment time, organized activity time, and academic time. The second aim was to provide a rigorous test of the time trade-off hypothesis, which suggests that students will spend less time on academics when they spend more time on employment and extracurricular activities. The results demonstrated that time use varied by gender, parental education, and race/ethnicity. Furthermore, the results from multi-level models provided some support for the time trade-off hypothesis, although associations varied by the activity type and whether the day was a weekend. More time spent on employment was linked to less time spent on academics across days and semesters whereas organized activities were associated with less time on academics at the daily level only. The negative associations between employment and academics were most pronounced on weekdays. These results suggest that students may balance certain activities across days, whereas other activities may be in competition over longer time frames (i.e., semesters). PMID:25381597

A self-determination theory perspective on the role of autonomy in solitary behavior.

PubMed

Chua, Sook Ning; Koestner, Richard

2008-10-01

People are often seen as social creatures and, consequently, solitary behaviors are often cast in a negative light. However, the authors hypothesized that the act of spending time alone is not necessarily related to negative outcomes; rather, individuals' motivation for doing so plays a key role. On the basis of self-determination theory (E. L Deci & R. M. Ryan, 2000; R. M. Ryan & E. L. Deci, 2000), the authors predicted and found that when individuals spend time alone in a volitional and autonomous manner, they counterintuitively report lower levels of loneliness and higher levels of well-being.

Public financing of health in developing countries: a cross-national systematic analysis.

PubMed

Lu, Chunling; Schneider, Matthew T; Gubbins, Paul; Leach-Kemon, Katherine; Jamison, Dean; Murray, Christopher J L

2010-04-17

Government spending on health from domestic sources is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in developing countries; describe trends in public financing of health; and test the extent to which they were related to changes in gross domestic product (GDP), government size, HIV prevalence, debt relief, and development assistance for health (DAH) to governmental and non-governmental sectors. We did a systematic analysis of all data sources available for government expenditures on health as agent (GHE-A) in developing countries, including government reports and databases from WHO and the International Monetary Fund (IMF). GHE-A consists of domestically and externally financed public health expenditures. We assessed the quality of these sources and used multiple imputation to generate a complete sequence of GHE-A. With these data and those for DAH to governments, we estimated government spending on health from domestic sources. We used panel-regression methods to estimate the association between government domestic spending on health and GDP, government size, HIV prevalence, debt relief, and DAH disbursed to governmental and non-governmental sectors. We tested the robustness of our conclusions using various models and subsets of countries. In all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% (IMF 120%; WHO 88%) from 1995 to 2006. Overall, this increase was the product of rising GDP, slight decreases in the share of GDP spent by government, and increases in the share of government spending on health. At the country level, while shares of government expenditures to health increased in many regions, they decreased in many sub-Saharan African countries. The statistical analysis showed that DAH to government had a negative and significant effect on domestic government spending on health such that for every US$1 of DAH to government, government health expenditures from domestic resources were reduced by $0.43 (p=0) to $1.14 (p=0). However, DAH to the non-governmental sector had a positive and significant effect on domestic government health spending. Both results were robust to multiple specifications and subset analyses. Other factors, such as debt relief, had no detectable effect on domestic government health spending. To address the negative effect of DAH on domestic government health spending, we recommend strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH. Bill & Melinda Gates Foundation. Copyright 2010 Elsevier Ltd. All rights reserved.

A Modular IoT Platform for Real-Time Indoor Air Quality Monitoring

PubMed Central

Abdaoui, Abderrazak; Ahmad, Sabbir H.M.; Touati, Farid; Kadri, Abdullah

2018-01-01

The impact of air quality on health and on life comfort is well established. In many societies, vulnerable elderly and young populations spend most of their time indoors. Therefore, indoor air quality monitoring (IAQM) is of great importance to human health. Engineers and researchers are increasingly focusing their efforts on the design of real-time IAQM systems using wireless sensor networks. This paper presents an end-to-end IAQM system enabling measurement of CO2, CO, SO2, NO2, O3, Cl2, ambient temperature, and relative humidity. In IAQM systems, remote users usually use a local gateway to connect wireless sensor nodes in a given monitoring site to the external world for ubiquitous access of data. In this work, the role of the gateway in processing collected air quality data and its reliable dissemination to end-users through a web-server is emphasized. A mechanism for the backup and the restoration of the collected data in the case of Internet outage is presented. The system is adapted to an open-source Internet-of-Things (IoT) web-server platform, called Emoncms, for live monitoring and long-term storage of the collected IAQM data. A modular IAQM architecture is adopted, which results in a smart scalable system that allows seamless integration of various sensing technologies, wireless sensor networks (WSNs) and smart mobile standards. The paper gives full hardware and software details of the proposed solution. Sample IAQM results collected in various locations are also presented to demonstrate the abilities of the system. PMID:29443893

Comparison of historical medical spending patterns among the BRICS and G7.

PubMed

Jakovljevic, Mihajlo Michael

2016-01-01

The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon. Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013. Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.

Productive Curriculum Time.

ERIC Educational Resources Information Center

Walberg, Herbert J.; And Others

1994-01-01

Discusses productive use of time and its effects on academic success, reviewing research on how students spend their time, describing relationships between allocated, engaged, and productive time and exploring psychological perspectives related to time and curriculum. Curricular and instructional modifications to increase productive time and…

Quality and Cost in Thoracic Surgery.

PubMed

Medbery, Rachel L; Force, Seth D

2017-08-01

The value of health care is defined as health outcomes (quality) achieved per dollars spent (cost). The current national health care landscape is focused on minimizing spending while optimizing patient outcomes. With the introduction of minimally invasive thoracic surgery, there has been concern about added cost relative to improved outcomes. Moreover, differences in postoperative hospital care further drive patient outcomes and health care costs. This article presents a comprehensive literature review on quality and cost in thoracic surgery and aims to investigate current challenges with regard to achieving the greatest value for our patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing skills in clinical leadership for ward sisters.

PubMed

Fenton, Katherine; Phillips, Natasha

The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

a Gross Error Elimination Method for Point Cloud Data Based on Kd-Tree

NASA Astrophysics Data System (ADS)

Kang, Q.; Huang, G.; Yang, S.

2018-04-01

Point cloud data has been one type of widely used data sources in the field of remote sensing. Key steps of point cloud data's pro-processing focus on gross error elimination and quality control. Owing to the volume feature of point could data, existed gross error elimination methods need spend massive memory both in space and time. This paper employed a new method which based on Kd-tree algorithm to construct, k-nearest neighbor algorithm to search, settled appropriate threshold to determine with result turns out a judgement that whether target point is or not an outlier. Experimental results show that, our proposed algorithm will help to delete gross error in point cloud data and facilitate to decrease memory consumption, improve efficiency.

The relationship between computer games and quality of life in adolescents

PubMed Central

Dolatabadi, Nayereh Kasiri; Eslami, Ahmad Ali; Mostafavi, Firooze; Hassanzade, Akbar; Moradi, Azam

2013-01-01

Background: Term of doing computer games among teenagers is growing rapidly. This popular phenomenon can cause physical and psychosocial issues in them. Therefore, this study examined the relationship between computer games and quality of life domains in adolescents aging 12-15 years. Materials and Methods: In a cross-sectional study using the 2-stage stratified cluster sampling method, 444 male and female students in Borkhar were selected. The data collection tool consisted of 1) World Health Organization Quality Of Life – BREF questionnaire and 2) personal information questionnaire. The data were analyzed by Pearson correlation, Spearman correlation, chi-square, independent t-tests and analysis of covariance. Findings: The total mean score of quality of life in students was 67.11±13.34. The results showed a significant relationship between the age of starting to play games and the overall quality of life score and its fourdomains (range r=–0.13 to –0.18). The mean of overall quality of life score in computer game users was 68.27±13.03 while it was 64.81±13.69 among those who did not play computer games and the difference was significant (P=0.01). There were significant differences in environmental and mental health domains between the two groups (P<0.05). However, there was no significant relationship between BMI with the time spent and the type of computer games. Conclusion: Playing computer games for a short time under parental supervision can have positive effects on quality of life in adolescents. However, spending long hours for playing computer games may have negative long-term effects. PMID:24083270

A landscape analysis of universal health coverage for mothers and children in South Asia.

PubMed

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest.

A landscape analysis of universal health coverage for mothers and children in South Asia

PubMed Central

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest. PMID:28588912

Topical antimicrobial agents for the treatment of chronic wounds.

PubMed

Ousey, Karen; McIntosh, Caroline

2009-09-01

Chronic wounds are commonly observed in acute and community settings. The management of chronic wounds represents a significant proportion of health-care resources and makes up a substantial amount of contact time with community-based nurses spending approximately 25% to 50% of their time treating wounds. Chronic wounds often exhibit increased bacterial burden that can negatively impact upon patients, reduce their quality of life and substantially increase treatment costs for health care providers. Antibiotic resistance has become a major medical and public health problem, and interest has been generated in the use of topical therapies to manage wound infection. This article presents an overview of the historical use of honey, silver and iodine for the treatment of infected wounds progressing through to modern day use and the current evidence base for the use of these antimicrobial agents in the management of infected wounds.

Cost Savings Effects of Olanzapine as Long Term Treatment for Bipolar Disorder

PubMed Central

Zhang, Yuting

2007-01-01

Newer and more expensive drugs account for most of the recent rapid growth of spending on prescription drugs in the past nine years. But if more expensive drugs can reduce the use of other types of health care services, total health care costs might fall. In this paper, I investigate the “drug-offset” hypothesis for an atypical antipsychotic drug, olanzapine, compared to lithium, to treat bipolar disorder. I use a propensity-score method to match on observed variables. Then, using various identification strategies, namely interrupted time series, differencing strategies, and an instrument-variable approach, I find that olanzapine does not reduce spending on other types of medical care services, compared with lithium. Olanzapine users spend $330 per month more than lithium users on non-drug health care services after drug treatment and $470 more per month on total health care spending, contradicting the “drug-offset” hypothesis in this case. JEL classification: H51; I1; I18; C1; C2 PMID:18806303

Getting Teachers Excited about Student Feedback: It's All in the Ask

ERIC Educational Resources Information Center

Robinson, Carly; Finefter-Rosenblum, Ilana; Benshoof, Christopher; Gehlbach, Hunter

2016-01-01

Until recently, asking K-12 students--who spend hundreds of hours with their teachers annually--to weigh in on their teachers' performance was considered taboo. Many have questioned students' capacities to provide reliable, fair feedback on teaching quality. Media outlets report that teacher unions staunchly oppose integrating student feedback in…

Increased Use of Productivity Management Can Help Control Government Costs.

DTIC Science & Technology

1983-11-10

estimated that 34 percent of agency spend- ing reductions made to balance the budget in fiscal year 1984 can be attributed to the productivity program. The...result in the services 5. [] use of employee incentives (9) of some employees no longer being required in the unit in which they 6. [) quality of worklife

Green Schools: The Color of Money

ERIC Educational Resources Information Center

Riedel, Chris

2008-01-01

When Arthur Stellar came to Massachusetts' Taunton Public Schools in 2005, he knew that part of his job as superintendent would be cost cutting. That's no easy task without sacrificing the quality of education the district provided. How to decrease what you spend without eliminating vital resources? One way, Stellar says, is to assess what you're…

Information Technology Adoption and Procedural Performance in Health Care

ERIC Educational Resources Information Center

Shi, Yunfeng

2010-01-01

This dissertation studies two specific topics on information technologies in health care industry. (1) The status and change of integrated health care delivery system level IT spending and hospital level IT adoption between 1999 and 2006. (2) The potential link between hospital level IT adoptions and quality as quantified by procedural performance…

The Need for Educational Freedom in the Nation's Capital. Policy Analysis.

ERIC Educational Resources Information Center

Lartigue, Casey J.

This report asserts that the the District of Columbia Public Schools (DCPS) are failing. The report claims that teacher incompetence, bureaucratic corruption, crumbling infrastructure, violence, lax academic standards, and wasteful spending are some of the many problems, and children attending the DCPS are not receiving a quality education.…

The President's Budget: New Investments, a Vision for Vulnerable Youth

ERIC Educational Resources Information Center

Bird, Kisha

2014-01-01

President Obama's Fiscal Year (FY) 2015 budget, released on March 4, reflects the Administration's commitment to helping low-income individuals and vulnerable families access pathways to economic mobility, healthy development, and high quality of life. The budget proposal adheres to spending levels established in the Bipartisan Budget…

Class Size, Pre-Kindergarten, and Educational Adequacy: Costs and Funding Options for Florida. Policy Brief.

ERIC Educational Resources Information Center

Harris, Douglas N.

2004-01-01

Since 1998, Florida voters have passed three amendments that pressure state officials to increase education spending. The 1998 amendment introduced constitutional language establishing the importance of education to the state and its citizens, requiring "adequate provision?for a uniform, efficient, safe, secure, and high quality system of free…

Schools: The Evidence on Academies, Resources and Pupil Performance. Paper No. EA023

ERIC Educational Resources Information Center

McNally, Sandra

2015-01-01

England's performance in international tests of student achievement continues to be disappointing. Further improvement is essential not only for students' themselves but also for economic growth. This briefing considers the impact of Academies, school spending and teacher quality. Research evidence suggests that it is right to protect school…

As Medical Costs Soar, Health-Services Researchers Ask, What Works and What Doesn't?

ERIC Educational Resources Information Center

Wheeler, David L.

1990-01-01

Disenchantment with and heavy spending on health care has made policymakers more interested in health care research. The federal Agency for Health Care and Policy Research, university consortia for health-services research, and establishment of a national database are elements in a new focus on quality of care. (MSE)

Redesigning Continuing Education in the Health Professions

ERIC Educational Resources Information Center

National Academies Press, 2010

2010-01-01

Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions…

Changes in Post-acute Care in the Medicare Shared Savings Program

PubMed Central

McWilliams, J. Michael; Gilstrap, Lauren G.; Stevenson, David G.; Chernew, Michael E.; Huskamp, Haiden A.; Grabowski, David C.

2017-01-01

Importance Post-acute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit post-acute spending has implications for the importance and design of other payment models that include post-acute care. Objective To assess changes in post-acute spending and utilization associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. Design and Setting Using fee-for-service Medicare claims from 2009–2014, we conducted difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO providers (control group) before vs. after entry into the MSSP. We estimated differential changes separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Participants Random 20% sample of beneficiaries with 25,544,650 patient-years, 8,395,426 hospital admissions, and 1,595,352 SNF stays from 2009–2014. Exposure Patient attribution to an ACO in the MSSP. Main Outcomes and Measures Post-acute spending, discharge to a facility, length of SNF stays, readmissions, use of highly-rated SNFs, and mortality, adjusted for patient characteristics. Results For the 2012 cohort of ACOs, MSSP participation was associated with an overall reduction in post-acute spending (differential change in 2014 for ACOs vs. control group: −$106/beneficiary or −9.0%; P=0.003) that was driven by differential reductions in inpatient utilization, discharges to facilities rather than home (−0.6 percentage points or −2.7%; P=0.03), and length of SNF stays (−0.60 days/stay or −2.2%; P=0.002). Reductions in SNF use and length of stay were due largely to within-hospital or within-SNF changes in care specifically for ACO patients. MSSP participation was associated with smaller significant reductions in SNF spending in 2014 for the 2013 ACO cohort but not in the 2013 or 2014 cohort’s first year of participation. Estimates were similar for ACOs with and without financial ties to hospitals. MSSP participation was not associated with significant changes in 30-day readmissions, use of highly-rated SNFs, or mortality. Conclusion and Relevance Participation in the MSSP has been associated with significant reductions in post-acute spending without ostensible deterioration in quality. Spending reductions were more consistent with clinicians working within hospitals and SNFs to influence care for ACO patients than with hospital-wide initiatives by ACOs or use of preferred SNFs. PMID:28192556

A Survey of the Current Utilization of Asynchronous Education Among Emergency Medicine Residents in the United States

PubMed Central

Schlein, Sarah; Doctor, Shaneen; Stroud, Susan; Dawson, Matthew; Fix, Megan

2014-01-01

Problem Medical education is transitioning from traditional learning methods. Resident interest in easily accessible education materials is forcing educators to reevaluate teaching methodology. Approach To determine emergency medicine residents’ current methods of and preferences for obtaining medical knowledge, the authors created a survey and sent it to residents, at all levels of training throughout the United States, whose e-mail addresses were available via their residency’s official Web site (June–December 2012). The eight-question voluntary survey asked respondents about demographics, their use of extracurricular time, and the materials they perceived as most beneficial. The authors used descriptive statistics to analyze results. Outcomes Of the 401 residents who received the e-mailed survey, 226 (56.3%) completed it. Of these, 97.7% reported spending at least one hour per week engaging in extracurricular education, and 34.5% reported spending two to four hours per week (P < .001). Time listening to podcasts was the most popular (reported by 35.0% of residents), followed by reading textbooks (33.6%) and searching Google (21.4%; P < .001). Residents endorsed podcasts as the most beneficial (endorsed by 70.3%) compared with textbooks (endorsed by 54.3%), journals (36.5%), and Google (33.8%; P < .001). Most respondents reported evaluating the quality of evidence or reviewing references “rarely” or less than half the time. A majority (80.0%) selected the topics they accessed based on recent clinical encounters. Next Steps The results suggest that residents are using more open access interactive multimedia tools. Medical educators must engage with current learners to guide appropriate use of these. PMID:24556776

Validation of an Open-Source Tool for Measuring Carotid Lumen Diameter and Intima-Media Thickness.

PubMed

Manterola, Hugo Luis; Lo Vercio, Lucas; Díaz, Alejandro; Del Fresno, Mariana; Larrabide, Ignacio

2018-05-14

In low- and middle-income regions, a relatively large number of deaths occur from cardiovascular disease or stroke. Carotid intima-media thickness (cIMT) and carotid lumen diameter (cLD) are strong indicators of cardiovascular event risk and stenosis severity, respectively. The interactive open-source software described here, Cimtool, is based on active contours for measuring these indicators in clinical practice and thus helping in preventive diagnosis and treatment. Cimtool was validated using carotid phantoms and real images obtained using ultrasound. Expert users measured cIMT and cLD in regular practice and also with Cimtool. The results obtained with Cimtool were then compared with the results for the manual approach in terms of measurement agreement, time spent on the measurements and usability. Intra-observer variability when using Cimtool was also analyzed. Statistical analysis revealed strong agreement between the manual method and Cimtool (p > 0.01 for cIMT and cLD). The correlation coefficient for both cIMT and cLD measurements was r > 0.9. Moreover, this software allowed the users to spend considerably less time on each measurement (3.5 min per study versus 50 s with Cimtool on average). An open-source, interactive, validated tool for measuring cIMT and cLD clinically was thus developed. Compared with the manual approach, Cimtool's straightforward measurement flow allows the user to spend less time per measurement and has less standard deviation. The coefficients of variation for measurements and intra-observer variability were lower than those reported for recent automated approaches, even with low-quality images. Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Private enrollments and expenditure on education: Some macro trends

NASA Astrophysics Data System (ADS)

Tan, Jee-Peng

1985-12-01

Many less-developed countries (LDCs) are today facing difficulties in the financing of education. On the one hand, state budgetary allocations to the sector are already very high, and appear likely to grow only slowly, if at all. At the same time, however, the demand for education is rising, not least because of demographic pressures. Without changes in the system, both to reduce unit costs through improving efficiency and to mobilize additional resources for the sector, the level of educational development, particularly in the poorest LDCs, is likely to remain low. Coupled with the stagnation in public spending on education, the data suggest that total national spending in the sector has tended to decline as GDP grew. This trend should perhaps be discouraged since education contributes significantly to economic development. One way of doing so is to increase the share of private participation in total spending in the sector, for example, by increasing the role of private education, especially where it is weak and declining over time.

An Approach to Forecasting Health Expenditures, with Application to the U.S. Medicare System

PubMed Central

Lee, Ronald; Miller, Timothy

2002-01-01

Objective To quantify uncertainty in forecasts of health expenditures. Study Design Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. Data Sources/Study Setting A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Principal Findings Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. Conclusions History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high–low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP. PMID:12479501

The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

PubMed

Busch, Alisa B; Yoon, Frank; Barry, Colleen L; Azzone, Vanessa; Normand, Sharon-Lise T; Goldman, Howard H; Huskamp, Haiden A

2013-02-01

The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so.

Associations of quality of sleep with lifestyle factors and profile of studies among Lithuanian students.

PubMed

Preišegolavičiūtė, Evelina; Leskauskas, Darius; Adomaitienė, Virginija

2010-01-01

The objective of the study was to analyze associations among quality of sleep, profile of the studies, and lifestyle factors among the students of three different study profiles (medicine, economics, and law). A total of 405 randomly selected students from the first and fourth years of studies from 4 different universities in Lithuania answered the standardized questionnaires consisting of two parts: 1) the Pittsburgh Sleep Quality Index (PSQI) for subjective evaluation of sleep quality; 2) the questionnaire about sleep and lifestyle habits and impact of poor sleep on the quality of life developed by the researchers. More than half (59.4%) of the students scored higher than 5 on the PSQI, which allowed suspecting sleep disorders. A significant difference in the frequency of poor sleepers was found regarding the profile of studies (P<0.05) showing the highest frequency of sleep disturbances among medical students. There was a significant correlation between quality of sleep and subjective evaluation of quality of life (P<0.01). Medical students experienced the highest impact of poor sleep on the quality of life (P=0.008). Students studying before going to sleep, spending more time studying, and having less leisure time had worse quality of sleep (P<0.01). A significant difference was found among three profiles of studies regarding the anxiety about studies (P<0.0005) and subjective estimation of success in studies (χ²=27.9, P<0.0005), showing the highest anxiety and worst satisfaction among students of medicine. The incidence of sleep problems is high among students in Lithuania, reaching 59.4%. Medical students have worse quality of sleep and worse impact of poor sleep on the quality of life compared to students of law and economics. A significant difference was found between medical students and their peers in other profiles of studies regarding their attitudes and habits related to studies: medical students spent more time for studying, were more anxious about studies and less satisfied with the results, studied more often before going to sleep.

Access to health information on the internet: a public health issue?

PubMed

Moretti, Felipe Azevedo; Oliveira, Vanessa Elias de; Silva, Edina Mariko Koga da

2012-01-01

To progress in the understanding of the user profile and of search trends for health information on the internet. Analyses were performed based on 1,828 individuals who completed an electronic questionnaire available on a very popular health website. At the same time, through the "elite survey" method, 20 specialists were interviewed, aiming at assessing quality control strategies regarding health information disseminated online. A predominance of female users who research information for themselves (= 90%), who consider the internet one of their main sources of health information (86%), and who spend from 5 to 35 hours online every week (62%) was verified. High reliability is assigned to information from specialists (76%), and low reliability to television, radio, or blogs (14%). It can be concluded that the internet is proving to be a major source of health information for the population, and that website certification is a strategy to be contemplated to improve the quality of information and to promote public health.

Nurses' perceptions of the impact of electronic health records on work and patient outcomes.

PubMed

Kossman, Susan P; Scheidenhelm, Sandra L

2008-01-01

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.

Dynamic Analyses of Result Quality in Energy-Aware Approximate Programs

NASA Astrophysics Data System (ADS)

RIngenburg, Michael F.

Energy efficiency is a key concern in the design of modern computer systems. One promising approach to energy-efficient computation, approximate computing, trades off output precision for energy efficiency. However, this tradeoff can have unexpected effects on computation quality. This thesis presents dynamic analysis tools to study, debug, and monitor the quality and energy efficiency of approximate computations. We propose three styles of tools: prototyping tools that allow developers to experiment with approximation in their applications, online tools that instrument code to determine the key sources of error, and online tools that monitor the quality of deployed applications in real time. Our prototyping tool is based on an extension to the functional language OCaml. We add approximation constructs to the language, an approximation simulator to the runtime, and profiling and auto-tuning tools for studying and experimenting with energy-quality tradeoffs. We also present two online debugging tools and three online monitoring tools. The first online tool identifies correlations between output quality and the total number of executions of, and errors in, individual approximate operations. The second tracks the number of approximate operations that flow into a particular value. Our online tools comprise three low-cost approaches to dynamic quality monitoring. They are designed to monitor quality in deployed applications without spending more energy than is saved by approximation. Online monitors can be used to perform real time adjustments to energy usage in order to meet specific quality goals. We present prototype implementations of all of these tools and describe their usage with several applications. Our prototyping, profiling, and autotuning tools allow us to experiment with approximation strategies and identify new strategies, our online tools succeed in providing new insights into the effects of approximation on output quality, and our monitors succeed in controlling output quality while still maintaining significant energy efficiency gains.

Characterizing urban areas with good sound quality: development of a research protocol.

PubMed

van Kempen, Elise; Devilee, Jeroen; Swart, Wim; van Kamp, Irene

2014-01-01

Due to rapid urbanization, the spatial variation between wanted and unwanted sounds will decrease or even disappear. Consequently, the characteristics of (urban) areas where people can temporarily withdraw themselves from urban stressors such as noise may change or become increasingly scarce. Hardly any research has been carried out into the positive health effects of spending time in areas with a good sound quality. One of the problems is that an overview of what aspects determines good sound quality in urban areas and how these are interrelated is lacking. This paper reviews the literature pertaining to the sound quality of urban areas. Aim is to summarize what is known about the influence of social, spatial, and physical aspects other than sounds, on peoples' perception of urban sound qualities. Literature from both conventional sound research and from the so-called soundscape field, published between 2000 and the beginning of 2013 in English or Dutch, was evaluated. Although a general set of validated indicators that can be directly applied, is not available yet, a set of indicators was derived from the literature. These form the basis of a study protocol that will be applied in "Towards a Sustainable acoustic Environment", a project that aims to describe sound qualities at a low-scale level. Key-elements of this study protocol, including a questionnaire and the systematic audit of neighborhoods, were presented in this paper.

An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care.

PubMed

Hibbard, Judith H; Greene, Jessica; Sofaer, Shoshanna; Firminger, Kirsten; Hirsh, Judith

2012-03-01

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers-those who offer higher quality and lower prices-and thus contribute to the broader goal of controlling national health care spending. However, communicating this information effectively is more challenging than it might first appear. For example, consumers are more interested in the quality of health care than in its cost, and many perceive a low-cost provider to be substandard. In this study of 1,421 employees, we examined how different presentations of information affect the likelihood that consumers will make high-value choices. We found that a substantial minority of the respondents shied away from low-cost providers, and even consumers who pay a larger share of their health care costs themselves were likely to equate high cost with high quality. At the same time, we found that presenting cost data alongside easy-to-interpret quality information and highlighting high-value options improved the likelihood that consumers would choose those options. Reporting strategies that follow such a format will help consumers understand that a doctor who provides higher-quality care than other doctors does not necessarily cost more.

The Impact of Green House Adoption on Medicare Spending and Utilization.

PubMed

Grabowski, David C; Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter

2016-02-01

To evaluate the impact of the Green House (GH) model of nursing home care on Medicare acute hospital, other hospital, skilled nursing facility, and hospice spending and utilization. Medicare claims and enrollment data from 2005 through 2010 merged with resident-level minimum data set (MDS) assessments. Using a difference-in-differences framework, we compared Medicare Part A and hospice expenditures and utilization in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nonadopting nursing homes. We applied the same method for residents of GH homes and for residents of "legacy" homes, the original nursing homes that stay open alongside the GH home(s). The adoption of GH had no detectable impact on Medicare Part A (plus hospice) spending and utilization across all residents living in the nursing home. When we analyzed residents living in GH homes and legacy units separately, however, we found that the adoption of the GH model reduced overall annual Medicare Part A spending by $7,746 per resident, although this appeared to be partially offset by an increase in spending in legacy homes. To the extent that the GH model reduces Medicare spending, adopting nursing homes do not receive any of the related Medicare savings under traditional payment mechanisms. New approaches that are currently being developed and piloted, which better align financial incentives for providers and payers, could incentivize greater adoption of the GH model. © Health Research and Educational Trust.

Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals

PubMed Central

Stukel, Therese A.; Fisher, Elliott S.; Alter, David A.; Guttmann, Astrid; Ko, Dennis T.; Fung, Kinwah; Wodchis, Walter P.; Baxter, Nancy N.; Earle, Craig C.; Lee, Douglas S.

2012-01-01

Context The extent to which better spending produces higher-quality care and better patient outcomes in a universal health care system with selective access to medical technology is unknown. Objective To assess whether acute care patients admitted to higher-spending hospitals have lower mortality and readmissions. Design, Setting, and Patients The study population comprised adults (> 18 years) in Ontario, Canada, with a first admission for acute myocardial infarction (AMI) (n=179 139), congestive heart failure (CHF) (n=92 377), hip fracture (n=90 046), or colon cancer (n=26 195) during 1998–2008, with follow-up to 1 year. The exposure measure was the index hospital’s end-of-life expenditure index for hospital, physician, and emergency department services. Main Outcome Measures The primary outcomes were 30-day and 1-year mortality and readmissions and major cardiac events (readmissions for AMI, angina, CHF, or death) for AMI and CHF. Results Patients’ baseline health status was similar across hospital expenditure groups. Patients admitted to hospitals in the highest- vs lowest-spending intensity terciles had lower rates of all adverse outcomes. In the highest- vs lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF; fully adjusted relative 30-day mortality rates were 0.93 (95% CI, 0.89–0.98) for AMI, 0.81 (95% CI, 0.76–0.86) for CHF, 0.74 (95% CI, 0.68–0.80) for hip fracture, and 0.78 (95% CI, 0.66–0.91) for colon cancer. Results for 1-year mortality, readmissions, and major cardiac events were similar. Higher-spending hospitals had higher nursing staff ratios, and their patients received more inpatient medical specialist visits, interventional (AMI cohort) and medical (AMI and CHF cohorts) cardiac therapies, preoperative specialty care (colon cancer cohort), and postdischarge collaborative care with a cardiologist and primary care physician (AMI and CHF cohorts). Conclusion Among Ontario hospitals, higher spending intensity was associated with lower mortality, readmissions, and cardiac event rates. PMID:22416099

Effects of Age, Season, Gender and Urban-Rural Status on Time-Activity: Canadian Human Activity Pattern Survey 2 (CHAPS 2)

PubMed Central

Matz, Carlyn J.; Stieb, David M.; Davis, Karelyn; Egyed, Marika; Rose, Andreas; Chou, Benedito; Brion, Orly

2014-01-01

Estimation of population exposure is a main component of human health risk assessment for environmental contaminants. Population-level exposure assessments require time-activity pattern distributions in relation to microenvironments where people spend their time. Societal trends may have influenced time-activity patterns since previous Canadian data were collected 15 years ago. The Canadian Human Activity Pattern Survey 2 (CHAPS 2) was a national survey conducted in 2010–2011 to collect time-activity information from Canadians of all ages. Five urban and two rural locations were sampled using telephone surveys. Infants and children, key groups in risk assessment activities, were over-sampled. Survey participants (n = 5,011) provided time-activity information in 24-hour recall diaries and responded to supplemental questionnaires concerning potential exposures to specific pollutants, dwelling characteristics, and socio-economic factors. Results indicated that a majority of the time was spent indoors (88.9%), most of which was indoors at home, with limited time spent outdoors (5.8%) or in a vehicle (5.3%). Season, age, gender and rurality were significant predictors of time activity patterns. Compared to earlier data, adults reported spending more time indoors at home and adolescents reported spending less time outdoors, which could be indicative of broader societal trends. These findings have potentially important implications for assessment of exposure and risk. The CHAPS 2 data also provide much larger sample sizes to allow for improved precision and are more representative of infants, children and rural residents. PMID:24557523

Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care.

PubMed

Wright, Stella; McSherry, Wilfred

2014-07-01

To demonstrate how a national programme aimed to increase the amount of direct time nurses spend with patients', impacts on both staff and patient experience. The Productive Ward is an improvement programme developed by the NHS Institute for Innovation and Improvement (2007, http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html) which aims to enable nurses to work more efficiently by reviewing process and practice, thus releasing more time to spend on direct patient care. However, there is little empirical published research around the programme, particularly concerning impact, sustainability and the patient perspective. This manuscript presents the findings from qualitative interviews involving both staff and patients. Semi-structured one-to-one interviews were conducted with patients (n = 8) and staff (n = 5) on five case study wards. Seven focus groups were held according to staff grade (n = 29). Despite initial scepticism, most staff embraced the opportunity and demonstrated genuine enthusiasm and energy for the programme. Patients were generally complimentary about their experience as an inpatient, reporting that staff made them feel safe, comfortable and cared for. Findings showed that the aims of the programme were partially met. The implementation of Productive Ward was associated with significant changes to the ward environment and improvements for staff. The programme equipped staff with skills and knowledge which acted as a primer for subsequent interventions. However, there was a lack of evidence to demonstrate that Productive Ward released time for direct patient care in all areas that implemented the programme. Developing robust performance indicators including a system to capture reinvestment of direct care time would enable frontline staff to demonstrate impact of the programme. Additionally, staff will need to ensure that reorganisation and instability across the NHS do not affect sustainability and viability of the Productive Ward in the long term. © 2013 John Wiley & Sons Ltd.

Can superior natural amenities create high-quality employment opportunities? The case of nonconsumptive river recreation in central Idaho

USGS Publications Warehouse

McKean, J.R.; Johnson, D.M.; Johnson, Richard L.; Taylor, R.G.

2005-01-01

Central Idaho has superior environmental amenities, as evidenced by exceptionally high-value tourism, such as guided whitewater rafting. The focus of our study concerns the attainment of high-quality jobs in a high-quality natural environment. We estimate cumulative wage rate effects unique to nonconsumptive river recreation in central Idaho for comparison with other sectors. The cumulative effects are based on a detailed survey of recreation spending and a modified synthesized input–output model. Cumulative wage rate effects support using the abundance of environmental amenities to expand and attract high-wage, environmentally sensitive firms, as opposed to expanded tourism to improve employment quality.

Parental Work Schedules and Adolescent Risky Behaviors

PubMed Central

Han, Wen-Jui; Miller, Daniel P.; Waldfogel, Jane

2013-01-01

Using a large contemporary data set, the National Longitudinal Survey of Youth-Child Supplement (NLSY-CS), this paper examines the effects of parental work schedules on adolescent risky behaviors at age 13 or 14 and the mechanisms that might explain them. Structural equation modeling suggests mothers who worked more often at night spent significantly less time with children and had lower quality home environments, and these mediators were significantly linked to adolescent risky behaviors. Similar effects were not found for evening work schedules, while other types of maternal and paternal nonstandard work schedules were linked to higher parental knowledge of children’s whereabouts, which led to lower levels of adolescent risky behaviors. Subgroup analyses revealed that males, those in families with low incomes, and those whose mothers never worked at professional jobs may particularly be affected by mothers working at nights, due to spending less time together, having a lower degree of maternal closeness, and experiencing lower quality home environments. In addition, the effects of maternal night shifts were particularly pronounced if children were in the preschool or middle-childhood years when their mothers worked those schedules. Implications and avenues for future research are discussed. PMID:20822236

The identification of Volatile Organic Compound's emission sources in indoor air of living spaces, offices and laboratories

NASA Astrophysics Data System (ADS)

Kultys, Beata

2018-01-01

Indoor air quality is important because people spend most of their time in closed rooms. If volatile organic compounds (VOCs) are present at elevated concentrations, they may cause a deterioration in human well-being or health. The identification of indoor emission sources is carried out by comparison indoor and outdoor air composition. The aim of the study was to determinate the concentration of VOCs in indoor air, where there was a risk of elevated levels due to the kind of work type carried out or the users complained about the symptoms of a sick building followed by an appropriate interpretation of the results to determine whether the source of the emission in the tested room occurs. The air from residential, office and laboratory was tested in this study. The identification of emission sources was based on comparison of indoor and outdoor VOCs concentration and their correlation coefficients. The concentration of VOCs in all the rooms were higher or at a similar level to that of the air sampled at the same time outside the building. Human activity, in particular repair works and experiments with organic solvents, has the greatest impact on deterioration of air quality.

Machine-Learning Algorithms to Code Public Health Spending Accounts

PubMed Central

Leider, Jonathon P.; Resnick, Beth A.; Alfonso, Y. Natalia; Bishai, David

2017-01-01

Objectives: Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. Methods: We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Results: Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Conclusions: Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation. PMID:28363034

Machine-Learning Algorithms to Code Public Health Spending Accounts.

PubMed

Brady, Eoghan S; Leider, Jonathon P; Resnick, Beth A; Alfonso, Y Natalia; Bishai, David

Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation.

The price of conserving avian phylogenetic diversity: a global prioritization approach

PubMed Central

Nunes, Laura A.; Turvey, Samuel T.; Rosindell, James

2015-01-01

The combination of rapid biodiversity loss and limited funds available for conservation represents a major global concern. While there are many approaches for conservation prioritization, few are framed as financial optimization problems. We use recently published avian data to conduct a global analysis of the financial resources required to conserve different quantities of phylogenetic diversity (PD). We introduce a new prioritization metric (ADEPD) that After Downlisting a species gives the Expected Phylogenetic Diversity at some future time. Unlike other metrics, ADEPD considers the benefits to future PD associated with downlisting a species (e.g. moving from Endangered to Vulnerable in the International Union for Conservation of Nature Red List). Combining ADEPD scores with data on the financial cost of downlisting different species provides a cost–benefit prioritization approach for conservation. We find that under worst-case spending $3915 can save 1 year of PD, while under optimal spending $1 can preserve over 16.7 years of PD. We find that current conservation spending patterns are only expected to preserve one quarter of the PD that optimal spending could achieve with the same total budget. Maximizing PD is only one approach within the wider goal of biodiversity conservation, but our analysis highlights more generally the danger involved in uninformed spending of limited resources. PMID:25561665

The price of conserving avian phylogenetic diversity: a global prioritization approach.

PubMed

Nunes, Laura A; Turvey, Samuel T; Rosindell, James

2015-02-19

The combination of rapid biodiversity loss and limited funds available for conservation represents a major global concern. While there are many approaches for conservation prioritization, few are framed as financial optimization problems. We use recently published avian data to conduct a global analysis of the financial resources required to conserve different quantities of phylogenetic diversity (PD). We introduce a new prioritization metric (ADEPD) that After Downlisting a species gives the Expected Phylogenetic Diversity at some future time. Unlike other metrics, ADEPD considers the benefits to future PD associated with downlisting a species (e.g. moving from Endangered to Vulnerable in the International Union for Conservation of Nature Red List). Combining ADEPD scores with data on the financial cost of downlisting different species provides a cost-benefit prioritization approach for conservation. We find that under worst-case spending $3915 can save 1 year of PD, while under optimal spending $1 can preserve over 16.7 years of PD. We find that current conservation spending patterns are only expected to preserve one quarter of the PD that optimal spending could achieve with the same total budget. Maximizing PD is only one approach within the wider goal of biodiversity conservation, but our analysis highlights more generally the danger involved in uninformed spending of limited resources.

Effects of a consumer driven health plan on pharmaceutical spending and utilization.

PubMed

Parente, Stephen T; Feldman, Roger; Chen, Song

2008-10-01

To compare pharmaceutical spending and utilization in a consumer driven health plan (CDHP) with a three-tier pharmacy benefit design, and to examine whether the CDHP creates incentives to reduce pharmaceutical spending and utilization for chronically ill patients, generic or brand name drugs, and mail-order drugs. Retrospective insurance claims analysis from a large employer that introduced a CDHP in 2001 in addition to a point of service (POS) plan and a preferred provider organization (PPO), both of which used a three-tier pharmacy benefit. Difference-in-differences regression models were estimated for drug spending and utilization. Control variables included the employee's income, age, and gender, number of covered lives per contract, election of flexible spending account, health status, concurrent health shock, cohort, and time trend. Results. CDHP pharmaceutical expenditures were lower than those in the POS cohort in 1 year without differences in the use of brand name drugs. We find limited evidence of less drug consumption by CDHP enrollees with chronic illnesses, and some evidence of less generic drug use and more mail-order drug use among CDHP members. The CDHP is cost-neutral or cost-saving to both the employer and the employee compared with three-tier benefits with no differences in brand name drug use. © Health Research and Educational Trust.

Assessing child time-activity patterns in relation to indoor cooking fires in developing countries: a methodological comparison.

PubMed

Barnes, Brendon; Mathee, Angela; Moiloa, Kebitsamang

2005-01-01

Indoor air pollution, caused by the indoor burning of biomass fuels, has been associated with an increased risk of child acute respiratory infections in developing countries. The amount of time that children spend in proximity to fires is a crucial determinant of the health impact of indoor air pollution. Researchers are reliant on social scientific methods to assess exposure based on child location patterns in relation to indoor fires. The inappropriate use of methods could lead to misclassification of exposure. The aim of this paper is to compare two methods (observations and questionnaire interview) with video analysis (which is thought to offer a more accurate assessment of exposure) in rural South African villages. Compared to video analysis, results show that observations may underestimate the amount of time that children spend very close (within 1.5 m) to fires. This is possibly due to reactivity caused by the presence of an observer. The questionnaire interview offers a more accurate assessment of the amounts of time that children spend within 1.5 m of fires at the expense of a detailed behavioural analysis. By drawing on the strengths and weaknesses of each, this paper discusses the appropriateness of methods to different research contexts.

Who children spend time with after school: associations with objectively recorded indoor and outdoor physical activity.

PubMed

Pearce, Matthew; Page, Angie S; Griffin, Tom P; Cooper, Ashley R

2014-03-30

Understanding how the determinants of behaviour vary by context may support the design of interventions aiming to increase physical activity. Such factors include independent mobility, time outdoors and the availability of other children. At present little is known about who children spend their time with after school, how this relates to time spent indoors or outdoors and activity in these locations. This study aimed to quantify who children spend their time with when indoors or outdoors and associations with moderate to vigorous physical activity (MVPA). Participants were 427 children aged 10-11 from Bristol, UK. Physical activity was recorded using an accelerometer (Actigraph GT1M) and matched to Global Positioning System receiver (Garmin Foretrex 201) data to differentiate indoor and outdoor location. Children self-reported who they spent time with after school until bed-time using a diary. Each 10 second epoch was coded as indoors or outdoors and for 'who with' (alone, friend, brother/sister, mum/dad, other grown-up) creating 10 possible physical activity contexts. Time spent and MVPA were summarised for each context. Associations between time spent in the different contexts and MVPA were examined using multiple linear regression adjusting for daylight, age, deprivation and standardised body mass index. During the after school period, children were most often with their mum/dad or alone, especially when indoors. When outdoors more time was spent with friends (girls: 32.1%; boys: 28.6%) than other people or alone. Regression analyses suggested hours outdoors with friends were positively associated with minutes of MVPA for girls (beta-coefficient [95% CI]: 17.4 [4.47, 30.24]) and boys (17.53 [2.76, 32.31]). Being outdoors with brother/sister was associated with MVPA for girls (21.2 [14.17, 28.25]) but not boys. Weaker associations were observed for time indoors with friends (girls: 4.61 [1.37, 7.85]; boys: (7.42 [2.99, 11.85]) and other adults (girls: 5.33 [2.95, 7.71]; boys: (4.44 [1.98, 6.90]). Time spent alone was not associated with MVPA regardless of gender or indoor/outdoor location. Time spent outdoors with other children is an important source of MVPA after school. Interventions to increase physical activity may benefit from fostering friendship groups and limiting the time children spend alone.

Who children spend time with after school: associations with objectively recorded indoor and outdoor physical activity

PubMed Central

2014-01-01

Background Understanding how the determinants of behaviour vary by context may support the design of interventions aiming to increase physical activity. Such factors include independent mobility, time outdoors and the availability of other children. At present little is known about who children spend their time with after school, how this relates to time spent indoors or outdoors and activity in these locations. This study aimed to quantify who children spend their time with when indoors or outdoors and associations with moderate to vigorous physical activity (MVPA). Methods Participants were 427 children aged 10–11 from Bristol, UK. Physical activity was recorded using an accelerometer (Actigraph GT1M) and matched to Global Positioning System receiver (Garmin Foretrex 201) data to differentiate indoor and outdoor location. Children self-reported who they spent time with after school until bed-time using a diary. Each 10 second epoch was coded as indoors or outdoors and for ‘who with’ (alone, friend, brother/sister, mum/dad, other grown-up) creating 10 possible physical activity contexts. Time spent and MVPA were summarised for each context. Associations between time spent in the different contexts and MVPA were examined using multiple linear regression adjusting for daylight, age, deprivation and standardised body mass index. Results During the after school period, children were most often with their mum/dad or alone, especially when indoors. When outdoors more time was spent with friends (girls: 32.1%; boys: 28.6%) than other people or alone. Regression analyses suggested hours outdoors with friends were positively associated with minutes of MVPA for girls (beta-coefficient [95% CI]: 17.4 [4.47, 30.24]) and boys (17.53 [2.76, 32.31]). Being outdoors with brother/sister was associated with MVPA for girls (21.2 [14.17, 28.25]) but not boys. Weaker associations were observed for time indoors with friends (girls: 4.61 [1.37, 7.85]; boys: (7.42 [2.99, 11.85]) and other adults (girls: 5.33 [2.95, 7.71]; boys: (4.44 [1.98, 6.90]). Time spent alone was not associated with MVPA regardless of gender or indoor/outdoor location. Conclusions Time spent outdoors with other children is an important source of MVPA after school. Interventions to increase physical activity may benefit from fostering friendship groups and limiting the time children spend alone. PMID:24679149

The Canadian Human Activity Pattern Survey: report of methods and population surveyed.

PubMed

Leech, J A; Wilby, K; McMullen, E; Laporte, K

1996-01-01

The assessment of health risk due to environmental contaminants depends upon accurate estimates of the distribution of population exposures. Exposure assessment, in turn, requires information on the time people spend in micro-environments and their activities during periods of exposure. This paper describes preliminary results including study methodology and population sampled in a large Canadian survey of time-activity patterns. A 24-hour diary recall survey was performed in 2381 households (representing a 65% response rate) to describe in detail the timing, location and activity pattern of one household member (the adult or child with the next birthday). Four cities (Toronto, Vancouver, Edmonton and Saint John, NB) and their suburbs were sampled by random-digit dialling over a nine-month period in 1994/1995. Supplemental questionnaires inquiring about sociodemographic information, house and household characteristics and potential exposure to toxins in the air and water were also administered. In general, the results show that respondents spend the majority of their time indoors (88.6%) with smaller proportions of time outdoors (6.1%) and in vehicles (5.3%). Children under the age of 12 spend more time both indoors and outdoors and less time in transit than do adults. The data from this study will be used to define more accurately the exposure of Canadians to a variety of toxins in exposure assessment models and to improve upon the accuracy of risk assessment for a variety of acute and chronic health effects known or suspected to be related to environmental exposures.

Generational Differences In U.S. Public Spending, 1980–2000

PubMed Central

Pati, Susmita; Keren, Ron; Alessandrini, Evaline A.; Schwarz, Donald F.

2013-01-01

The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980–2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children’s programs suffered during recessions. Public discussion about the current imbalance in public spending is needed. PMID:15371377

Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval.

PubMed

Prasad, Vinay; Mailankody, Sham

2017-11-01

A common justification for high cancer drug prices is the sizable research and development (R&D) outlay necessary to bring a drug to the US market. A recent estimate of R&D spending is $2.7 billion (2017 US dollars). However, this analysis lacks transparency and independent replication. To provide a contemporary estimate of R&D spending to develop cancer drugs. Analysis of US Securities and Exchange Commission filings for drug companies with no drugs on the US market that received approval by the US Food and Drug Administration for a cancer drug from January 1, 2006, through December 31, 2015. Cumulative R&D spending was estimated from initiation of drug development activity to date of approval. Earnings were also identified from the time of approval to the present. The study was conducted from December 10, 2016, to March 2, 2017. Median R&D spending on cancer drug development. Ten companies and drugs were included in this analysis. The 10 companies had a median time to develop a drug of 7.3 years (range, 5.8-15.2 years). Five drugs (50%) received accelerated approval from the US Food and Drug Administration, and 5 (50%) received regular approval. The median cost of drug development was $648.0 million (range, $157.3 million to $1950.8 million). The median cost was $757.4 million (range, $203.6 million to $2601.7 million) for a 7% per annum cost of capital (or opportunity costs) and $793.6 million (range, $219.1 million to $2827.1 million) for a 9% opportunity costs. With a median of 4.0 years (range, 0.8-8.8 years) since approval, the total revenue from sales of these 10 drugs since approval was $67.0 billion compared with total R&D spending of $7.2 billion ($9.1 billion, including 7% opportunity costs). The cost to develop a cancer drug is $648.0 million, a figure significantly lower than prior estimates. The revenue since approval is substantial (median, $1658.4 million; range, $204.1 million to $22 275.0 million). This analysis provides a transparent estimate of R&D spending on cancer drugs and has implications for the current debate on drug pricing.

An Indoor Monitoring System for Ambient Assisted Living Based on Internet of Things Architecture

PubMed Central

Marques, Gonçalo; Pitarma, Rui

2016-01-01

The study of systems and architectures for ambient assisted living (AAL) is undoubtedly a topic of great relevance given the aging of the world population. The AAL technologies are designed to meet the needs of the aging population in order to maintain their independence as long as possible. As people typically spend more than 90% of their time in indoor environments, indoor air quality (iAQ) is perceived as an imperative variable to be controlled for the inhabitants’ wellbeing and comfort. Advances in networking, sensors, and embedded devices have made it possible to monitor and provide assistance to people in their homes. The continuous technological advancements make it possible to build smart objects with great capabilities for sensing and connecting several possible advancements in ambient assisted living systems architectures. Indoor environments are characterized by several pollutant sources. Most of the monitoring frameworks instantly accessible are exceptionally costly and only permit the gathering of arbitrary examples. iAQ is an indoor air quality system based on an Internet of Things paradigm that incorporates in its construction Arduino, ESP8266, and XBee technologies for processing and data transmission and micro sensors for data acquisition. It also allows access to data collected through web access and through a mobile application in real time, and this data can be accessed by doctors in order to support medical diagnostics. Five smaller scale sensors of natural parameters (air temperature, moistness, carbon monoxide, carbon dioxide, and glow) were utilized. Different sensors can be included to check for particular contamination. The results reveal that the system can give a viable indoor air quality appraisal in order to anticipate technical interventions for improving indoor air quality. Indeed indoor air quality might be distinctively contrasted with what is normal for a quality living environment. PMID:27869682