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Gasaway RB. How smart health leaders make intuitive decisions. Healthc Manage Forum 2024; 37:168-172. [PMID: 37950578 DOI: 10.1177/08404704231212781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
A rational decision-making process enables a leader to process information clearly and logically and thus allows for accurate perception and interpretation of the event. It is believed this process prevents leaders from excessively distorting reality and being impacted by cognitive biases, both of which are possible, particularly under stressful conditions. But what happens when the decision-making environment is rapidly changing and the leader does not have time to deploy a thorough, comprehensive rational decision-making process? In time-compressed decision-making environments, leaders must often make quick, accurate decisions, with incomplete, inaccurate, or rapidly changing information, under extremely stressful conditions. To improve the ability of a leader to make high-stress, time-compressed decisions under rapidly changing conditions, we offer the intuitive decision-making process as an alternative to rational decision-making and discuss five components essential to improve intuitive decision-making outcomes.
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Affiliation(s)
- Richard B Gasaway
- Situational Awareness Matters, Saint Paul, Minnesota, United States of America
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Abstract
In this Viewpoint a radiologist surveys the ascent of artificial intelligence (AI) in imaging and what the future likely holds for AI in this discipline.
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Affiliation(s)
- Saurabh Jha
- Department of Radiology, University of Pennsylvania, Philadelphia
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3
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Hamdan OHC, Libânio M, Costa VAF. Proposal of a regulatory index of quality of water supply services-RIQS. Environ Sci Pollut Res Int 2023; 30:93564-93581. [PMID: 37505391 DOI: 10.1007/s11356-023-28880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
Among the challenges faced by regulatory authorities in the water sector, the large number of municipal supply services to be inspected and the cost of on-site inspections are prominent. To overcome these issues, decisions regarding the priority of inspections based on indicators is an alternative. Therefore, this research aims to propose and evaluate the Regulatory Index of Quality of Water Supply Service (RIQS) to triage on-site inspections of water supply systems in cities of the state of Minas Gerais. The study was conducted with information from the Regulatory Agency of Water Supply and Sanitation Services of Minas Gerais (Arsae-MG). The methodology followed seven steps: (i) selection of available indicators; (ii) grouping of indicators according to their typology; (iii) screening of indicators; (iv) establishment of standardized scale; (v) evaluation of the relative importance of typologies and indicators, through the adaptation of the analytic hierarchy process (AHP); (vi) determination of the RIQS; and (vii) analysis of results. As a result, we selected 12 indicators to compose the RIQS, which deal with efficiency, effectiveness, and customer relationship. We noticed that the indicator of water supply service coverage (17.2%) had the highest weight in the calculation of the RIQS, and the index of requests for an inspection of the water connection served on time (2.1%) had the lowest weight. In addition, 95.1% of the 591 municipalities evaluated presented excellent or good performance. Based on these results, we show that the RIQS can be used to identify cities with low performance and prioritize inspections in the most urgent water systems. Furthermore, these outcomes reveal the possibility of extending and adapting the methodology to other regulatory agencies around the world for identifying the priority of inspections in water supply systems at a municipal level.
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Affiliation(s)
| | - Marcelo Libânio
- Sanitary and Environmental Engineering Department, Engineering School, Federal University of Minas Gerais, 6627, Antonio Carlos Ave., Belo Horizonte, 31270-901, Brazil
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4
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Ford EW. What Organizational Diagnostics Do You Use to Detect Management Issues? J Healthc Manag 2023; 68:299-301. [PMID: 37678821 DOI: 10.1097/jhm-d-23-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
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Belaro A, Paguirigan M, Cineas N. Design thinking: Developing system models of professional practice, care delivery, and shared governance. Nurs Manag (Harrow) 2023; 54:22-32. [PMID: 37253219 DOI: 10.1097/01.numa.0000937248.46034.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Albert Belaro
- At New York City Health + Hospitals, Central Office: Office of Patient Centered Care/Nursing Administration in New York, N.Y., Albert Belaro is the senior director, professional practice; Medel Paguirigan was the senior director, nursing education; and Natalia Cineas is the senior vice president, chief nursing executive, and co-chair of the Equity and Access Council
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Yang Y, Xu G, Li R. Official Turnover and Corporate ESG Practices: Evidence from China. Environ Sci Pollut Res Int 2023; 30:51422-51439. [PMID: 36809631 DOI: 10.1007/s11356-023-25828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
In recent years, environmental, social, and governance (ESG) have been extensive concerned. However, few studies have focused on the impact of situational factors on corporate ESG practice decisions. Based on this, using 9428 observations of Chinese A-share listed companies from 2009 to 2019, this paper attempts to explore the impact of local official turnover on corporate ESG practices, and analyzes the boundary effects of this impact from three aspects: region, industry, and corporate. Our results suggest that (1) official turnover can lead to changes in economic policies and redistribution of political resources, which can stimulate companies' "risk aversion motivation" and "development motivation" and thus promote their ESG practices; (2) this effect is more significant in the high degree of government intervention, the high level of industry competition and private corporates. (3) Further test finds that only when the official turnover abnormally and the regional economic development well, official turnover can significantly contribute to corporate ESG. This paper enriches the relevant research on the decision-making scenarios of corporate ESG practices from the macro-institutional perspective.
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Affiliation(s)
- Youde Yang
- Nanjing University of Science and Technology No, 200 Xiaolingwei Street, Xuanwu District, Nanjing, Jiangsu, China
| | - Guanghua Xu
- Nanjing University of Science and Technology No, 200 Xiaolingwei Street, Xuanwu District, Nanjing, Jiangsu, China.
| | - Ruiqian Li
- Heilongjiang University No, 74 Xufu Road, Nangang District, Harbin, Heilongjiang, China
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van der Scheer JW, Ansari A, McLaughlin M, Cox C, Liddell K, Burt J, George J, Kenny R, Cousens R, Leach B, McGowan J, Morley K, Willars J, Dixon-Woods M. Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework. BMC Public Health 2022; 22:1747. [PMID: 36109810 PMCID: PMC9476340 DOI: 10.1186/s12889-022-13993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes. METHODS We conducted a mixed-method consultation - a survey and semi-structured interviews during November-December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. RESULTS The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants' concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised. CONCLUSIONS The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.
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Affiliation(s)
- Jan W. van der Scheer
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Akbar Ansari
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Meredith McLaughlin
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
- Homerton College, Hills Rd, Cambridge, CB2 8PH UK
| | - Caitríona Cox
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Kathleen Liddell
- Faculty of Law, The David Williams Building, 10 West Rd, Cambridge, CB3 9DZ UK
| | - Jenni Burt
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Jenny George
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - Rebecca Kenny
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Ruth Cousens
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Brandi Leach
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - James McGowan
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH UK
| | - Mary Dixon-Woods
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
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Crooks K, Tully B, Allan L, Gillham K, Durrheim D, Wiggers J. Development and implementation of a shared governance model in a mainstream health unit: a case study of embedding Aboriginal voices in organisational decision making. AUST HEALTH REV 2022; 46:178-184. [PMID: 34937653 DOI: 10.1071/ah20369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
This case study focuses on the development and implementation of a governance structure and processes by a mainstream health unit that valued the principles of Aboriginal self-determination, empowerment and leadership by Aboriginal staff in organisational and service delivery decisions and elevated Aboriginal voices by embedding cultural inclusion in such decision making. Various models of embedding Aboriginal voices in the governance of the unit were developed and implemented over time. Ongoing review and reflection identified limitations and opportunities for improving the embedding of Aboriginal voices in organisational decision making. In 2017, Aboriginal staff and senior management implemented a joint governance model for providing strategic leadership of the unit with the objective of enhancing the delivery of culturally appropriate population health services for the benefit of Aboriginal communities. In its 3 years of operation to date, the model has provided strategic oversight of the organisation, implemented several strategic initiatives, including a cultural assessment process, maintaining and strengthening Aboriginal recruitment, monitoring employment vacancies, establishing a wellbeing leadership group, monitoring budget allocation and developing an Aboriginal data management protocol, and has provided additional professional development opportunities for Aboriginal staff. This case study demonstrates the feasibility, importance and benefits of engaging and embedding Aboriginal voices in the governance of a mainstream health service delivery unit, as well as the need for ongoing reflection and improvement. Further translation of the model to the operational levels of the unit is required. The governance model has the potential to be replicated in a tailored manner in other mainstream health units and organisations delivering services to Aboriginal peoples and communities. What is known about the topic? Aboriginal people continue to experience the poorest health outcomes of any population group in Australia. Closing the gap in Aboriginal health requires Aboriginal people to be active and equal participants in all levels of decision making. Governance of mainstream health organisations is predominantly positioned in the Western medical positivist paradigm, which fails to embed Aboriginal voices in organisational and service delivery decision making. What does this paper add? This case study describes the processes taken and the outcomes achieved thus far by a mainstream health service delivery unit developing and implementing a governance model that embedded Aboriginal perspectives in its decision making. It highlights that through commitment and persistence, as well as acknowledging the challenges of working between two worlds, it is possible to reconstruct existing governance models, allowing respectful and meaningful space for Aboriginal people to co-design and co-share the governance of health service delivery. This case study demonstrates the potential of the cultural governance model to be replicated and applied to other mainstream health service delivery units. What are the implications for practitioners? This case study highlights the need for health services to invest in employing and empowering Aboriginal people to co-develop and co-lead a shared approach to organisational governance through processes that are culturally safe, inclusive and appropriate.
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Affiliation(s)
- K Crooks
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - B Tully
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - L Allan
- Office of the Secretary, NSW Department of Education, Tamworth, NSW, Australia
| | - K Gillham
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - D Durrheim
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - J Wiggers
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
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Affiliation(s)
- Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy.
| | - Giampaolo Ghilardi
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Moon S, Armstrong J, Hutler B, Upshur R, Katz R, Atuire C, Bhan A, Emanuel E, Faden R, Ghimire P, Greco D, Ho CW, Kochhar S, Schaefer GO, Shamsi-Gooshki E, Singh JA, Smith MJ, Wolff J. Governing the Access to COVID-19 Tools Accelerator: towards greater participation, transparency, and accountability. Lancet 2022; 399:487-494. [PMID: 34902308 PMCID: PMC8797025 DOI: 10.1016/s0140-6736(21)02344-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023]
Abstract
The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to a catastrophic breakdown in global cooperation. ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of broad public importance. We traced the evolution of ACT-A's governance through publicly available documents and analysed it against three principles embedded in the founding mission statement of ACT-A: participation, transparency, and accountability. We found three challenges to realising these principles. First, the roles of the various organisations in ACT-A decision making are unclear, obscuring who might be accountable to whom and for what. Second, the absence of a clearly defined decision making body; ACT-A instead has multiple centres of legally binding decision making and uneven arrangements for information transparency, inhibiting meaningful participation. Third, the nearly indiscernible role of governments in ACT-A, raising key questions about political legitimacy and channels for public accountability. With global public health and billions in public funding at stake, short-term improvements to governance arrangements can and should now be made. Efforts to strengthen pandemic preparedness for the future require attention to ethical, legitimate arrangements for governance.
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Affiliation(s)
- Suerie Moon
- International Relations and Political Science Department & Interdisciplinary Programmes, Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jana Armstrong
- Independent Global Health Consultant, Geneva, Switzerland.
| | - Brian Hutler
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MA, USA
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rachel Katz
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, Accra, Ghana
| | - Anant Bhan
- Department of Community Medicine and Centre for Ethics, Yenepoya University, Mangalore, India
| | - Ezekiel Emanuel
- Global Initiatives and Healthcare Transformation Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruth Faden
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MA, USA
| | | | - Dirceu Greco
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Calvin Wl Ho
- Faculty of Law and Centre for Medical Ethics, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - G Owen Schaefer
- Centre for Biomedical Ethics, National University of Singapore, Singapore
| | - Ehsan Shamsi-Gooshki
- Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maxwell J Smith
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Jonathan Wolff
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Liao CH, Bercea S. Success factors of health promotion: Evaluation by DEMATEL and M-DEMATEL methods - A case study in a non-profit organization. PLoS One 2021; 16:e0260801. [PMID: 34874963 PMCID: PMC8651107 DOI: 10.1371/journal.pone.0260801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
Proper health knowledge and adequate motivation for health activities are key factors that influence an individual to adopt a healthy behavior. Health promotion positively influences progressive behaviors that seek to advance health potential, to continuously improve one's lifestyle. There are many health promotion indications constantly encouraging people to eat healthier food. Based on the successful experience of a non-profit organization promoting a healthier vegetarian diet, this research identifies the operating factors that lead to the success of health promotion. The formulation and implementation of the health promotion strategy must be combined with the key success factors in order to accomplish the objectives. This study assessed seven factors, evaluated using the proposed method. The proposed Decision Making Trial and Evaluation Laboratory (DEMATEL) method constructs the cause and effect model of health promotion, and places forward suggestions and strategies for improvement based on the evaluation of the results. This research compared the original DEMATEL with a Modified DEMATEL (M-DEMATEL) to identify the success factors of health promotion. According to the results of both methods, "leadership", "communication channel" and "budget" are the most important and influential factors when promoting healthy diets. The results have shown the connection and the difference between the two methods. The main purpose of this research is not to determine which method is the best method, instead, to derive the combined effect of both methods.
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Affiliation(s)
| | - Silviu Bercea
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Cluj-Napoca, Romania
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12
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Affiliation(s)
- Amber Orton
- Amber Orton is a consultant at Creative Health Care Management in Bloomington, Minn
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13
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
| | - Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
| | - Kevin A Klock
- Foundation for the National Institutes of Health, North Bethesda, Maryland
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Rickert J. On Patient Safety: How Can We Get More Nonphysicians on Medical Boards? Clin Orthop Relat Res 2021; 479:2139-2141. [PMID: 34463667 PMCID: PMC8445548 DOI: 10.1097/corr.0000000000001956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023]
Affiliation(s)
- James Rickert
- President, The Society for Patient Centered Orthopedics, Bloomington, IN, USA
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Brennan RW, Nelson N, Paul R. Estimating the effect of timetabling decisions on the spread of SARS-CoV-2 in medium-to-large engineering schools in Canada: an agent-based modelling study. CMAJ Open 2021; 9:E1252-E1259. [PMID: 34933883 PMCID: PMC8695572 DOI: 10.9778/cmajo.20200280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, universities transitioned to primarily online delivery, and it is important to understand what implications the transition back to in-person activities may have on spread of SARS-CoV-2 in the student population. The specific aim of our study was to provide insights into the effect of timetabling decisions on the spread of SARS-CoV-2 in a population of undergraduate engineering students. METHODS We developed an agent-based modelling simulation that used a Canadian first-year undergraduate engineering program with an enrolment of 180 students in 5 courses of 12.7 weeks in length. Each course involved 150 minutes of lectures and 110 minutes of tutorials or laboratories per week. We considered several online and in-person timetabling scenarios with different scheduling frequencies and section sizes, in combination with surveillance and testing interventions. The study was conducted from May 1 to Aug. 31, 2021. RESULTS When timetabling interventions were applied, we found a reduction in the mean number of students who were infected and that a containment of widespread outbreaks could be achieved. Timetables with online lectures and small (1/6 class capacity) tutorial or laboratory sections reduced the mean number of students who were infected by 83% and reduced the risk of large outbreaks that occurred with in-person lectures. We also found that spread of SARS-CoV-2 was less sensitive to class size than to contact frequency when a biweekly timetable was implemented (i.e., alternating online and in-person sections on a biweekly basis). Including a contact-tracing policy and randomized testing to the timetabling interventions helped to contain the spread of SARS-CoV-2 further. Vaccination coverage had the largest effect on reducing the number of students who were infected. INTERPRETATION Our modelling showed that by taking advantage of timetabling opportunities and applying appropriate interventions (contact tracing, randomized testing and vaccination), SARS-CoV-2 infections may be averted and disruptions (case isolations) reduced. However, given the emergence of SARS-CoV-2 variants, transitions from online to in-person classes should proceed cautiously from small biweekly classes, for example, to manage risk.
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Affiliation(s)
- Robert W Brennan
- Department of Mechanical and Manufacturing Engineering (Brennan, Paul), University of Calgary, Calgary, Alta.; Department of Engineering and Information Technology (Nelson), Conestoga University, Cambridge, Ont.
| | - Nancy Nelson
- Department of Mechanical and Manufacturing Engineering (Brennan, Paul), University of Calgary, Calgary, Alta.; Department of Engineering and Information Technology (Nelson), Conestoga University, Cambridge, Ont
| | - Robyn Paul
- Department of Mechanical and Manufacturing Engineering (Brennan, Paul), University of Calgary, Calgary, Alta.; Department of Engineering and Information Technology (Nelson), Conestoga University, Cambridge, Ont
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16
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Affiliation(s)
- Kaija Lockhart
- Kaija Lockhart is the nursing excellence coordinator at Logan Health Medical Center in Kalispell, Mont
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17
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Affiliation(s)
| | - Jeremy M Kahn
- Department of Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
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18
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Abstract
Purpose Decision Making Trial and Evaluation Laboratory (DEMATEL) and Interpretive Structural Modeling (ISM) are commonly used separately, but also may be combined per their common characteristics to identify causal relationships and hierarchical structure among factors in complex systems with a relatively small computational burden. The purpose of this study is to establish an improved DEMATEL-ISM integration approach to remedy the disadvantages of the traditional DEMATEL-ISM integration method. A case study was conducted to compare the proposed improved integration approach against the traditional integration method, and to validate its feasibility and effectiveness. Methods The proposed improved DEMATEL-ISM integration approach has two main parts: a threshold determination via maximum mean de-entropy (MMDE) method and an additional transitivity check process. The factors influencing China’s rural-urban floating population’s willingness to participate in social insurance was analyzed as a case study. Results The traditional and improved methods show notable differences in the hierarchical factor structure and the inner influence relationship among factors that they respectively reveal. The traditional integration approach results in some irrationality, while the improved approach does not. Originality This study confirms the importance of proper threshold determination and reachability matrix transitivity checking during DEMATEL-ISM integration. The improved approach includes a scientific threshold determination method based on the MMDE method, plus a transitivity check of the reachability matrix with necessary corrections to ensure its soundness. It can be straightforwardly operated at a relatively low computational burden while providing accurate analysis results.
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Affiliation(s)
- Jih-Kuang Chen
- Economics and Management College, Zhaoqing University, Zhaoqing, China
- * E-mail:
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19
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Affiliation(s)
- Felicity A E Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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Yang HM, Lombardi Junior LP, Castro FFM, Yang AC. Mathematical modeling of the transmission of SARS-CoV-2-Evaluating the impact of isolation in São Paulo State (Brazil) and lockdown in Spain associated with protective measures on the epidemic of CoViD-19. PLoS One 2021; 16:e0252271. [PMID: 34129608 PMCID: PMC8205178 DOI: 10.1371/journal.pone.0252271] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (CoViD-19), with the fatality rate in elder (60 years old or more) being much higher than young (60 years old or less) patients, was declared a pandemic by the World Health Organization on March 11, 2020. A mathematical model considering young and elder subpopulations under different fatality rates was formulated based on the natural history of CoViD-19 to study the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The model considered susceptible, exposed, asymptomatic, pre-symptomatic, mild CoViD-19, severe CoViD-19, and recovered compartments, besides compartments of isolated individuals and those who were caught by test. This model was applied to study the epidemiological scenario resulting from the adoption of quarantine (isolation or lockdown) in many countries to control the rapid propagation of CoViD-19. We chose as examples the isolation adopted in São Paulo State (Brazil) in the early phase but not at the beginning of the epidemic, and the lockdown implemented in Spain when the number of severe CoViD-19 cases was increasing rapidly. Based on the data collected from São Paulo State and Spain, the model parameters were evaluated, and we obtained a higher estimation for the basic reproduction number R0 (9.24 for São Paulo State, and 8 for Spain) compared to the currently accepted estimation of R0 around 2 using the SEIR (susceptible, exposed, infectious, and recovered compartments) model. In comparison with the lockdown in Spain, the relatively early adoption of the isolation in São Paulo State resulted in enlarging the period of the first wave of the epidemic and delaying its peak. The model allowed to explain the flattening of the epidemic curves by quarantine when associated with the protective measures (face mask, washing hands with alcohol and gel, and social distancing) adopted by the population. The description of the epidemic under quarantine and protections can be a background to foreseen the epidemiological scenarios from the release strategies, which can help guide public health policies by decision-makers.
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Affiliation(s)
- Hyun Mo Yang
- Department of Applied Mathematics, State University of Campinas, Campinas, São Paulo, Brazil
| | | | - Fábio Fernandes Morato Castro
- Division of Allergy and Immunology, General Hospital of the Medicine School of University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ariana Campos Yang
- Division of Allergy and Immunology, General Hospital of the Medicine School of University of São Paulo, São Paulo, São Paulo, Brazil
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Lucas NV, Rosenbaum J, Isenberg DL, Martin R, Schreyer KE. Upgrades to intensive care: The effects of COVID-19 on decision-making in the emergency department. Am J Emerg Med 2021; 49:100-103. [PMID: 34098327 PMCID: PMC8172306 DOI: 10.1016/j.ajem.2021.05.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/06/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The initial surge of critically ill patients in the COVID-19 pandemic severely disrupted processes at acute care hospitals. This study examines the frequency and causes for patients upgraded to intensive care unit (ICU) level care following admission from the emergency department (ED) to non-critical care units. Methods The number of ICU upgrades per month was determined, including the percentage of upgrades noted to have non-concordant diagnoses. Charts with non-concordant diagnoses were examined in detail as to the ED medical decision-making, clinical circumstances surrounding the upgrade, and presence of a diagnosis of COVID-19. For each case, a cognitive bias was assigned. Results The percentage of upgraded cases with non-concordant diagnoses increased from a baseline range of 14–20% to 41.3%. The majority of upgrades were due to premature closure (72.2%), anchoring (61.1%), and confirmation bias (55.6%). Conclusion Consistent with the behavioral literature, this suggests that stressful ambient conditions affect cognitive reasoning processes.
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Affiliation(s)
- Nicole V Lucas
- Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States
| | - Jennifer Rosenbaum
- Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States
| | - Derek L Isenberg
- Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States
| | - Richard Martin
- Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States
| | - Kraftin E Schreyer
- Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States.
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22
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Congly SE, Shaheen AA, Swain MG. Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. PLoS One 2021; 16:e0251741. [PMID: 34019560 PMCID: PMC8139490 DOI: 10.1371/journal.pone.0251741] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients. METHODS A decision-analytic model was created using a payer's perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed. RESULTS For ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group. CONCLUSIONS SWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD.
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Affiliation(s)
- Stephen E. Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary Alberta, Canada
- * E-mail:
| | - Abdel Aziz Shaheen
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
| | - Mark G. Swain
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
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Speroni KG, Wisner K, Stafford A, Haines F, Al-Ruzzieh MA, Walters C, Budhathoki C. Effect of Shared Governance on Nurse-Sensitive Indicator and Satisfaction Outcomes: An International Comparison. J Nurs Adm 2021; 51:287-296. [PMID: 33882557 DOI: 10.1097/nna.0000000000001014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND Nursing governance and effects on nurse-related outcomes are not well studied. METHODS Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.
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Affiliation(s)
- Karen Gabel Speroni
- Author Affiliations : Nursing Research Consultant, Johns Hopkins Bayview Medical Center, and Adjunct Faculty (Dr Speroni), Johns Hopkins School of Nursing, Baltimore, Maryland; Magnet® Program Director (Dr Wisner), Salinas Valley Memorial Healthcare System; Clinical Nurse Educator, Perioperative Services, and Infection Preventionist (Dr Stafford), University of Maryland Shore Regional Health, Easton, Maryland; Magnet® Program Director (Ms Haines), King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; Chief Nursing Officer (Dr Al-Ruzzieh), King Hussein Cancer Center, Amman, Jordan; and Senior Director Hospital Capacity Management & Emergency Nursing Services (Dr Walters), Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Associate Professor (Dr Budhathoki), School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Cyfert S, Chwiłkowska-Kubala A, Szumowski W, Miśkiewicz R. The process of developing dynamic capabilities: The conceptualization attempt and the results of empirical studies. PLoS One 2021; 16:e0249724. [PMID: 33914761 PMCID: PMC8084234 DOI: 10.1371/journal.pone.0249724] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/23/2021] [Indexed: 12/03/2022] Open
Abstract
While most researchers interested in the concept of dynamic capabilities focus their attention on analyzing how companies transform their resources to compete in their environment, the process of developing dynamic capabilities is treated as a marginal issue. Although the literature suggests various approaches to developing dynamic capabilities, they are formulated in general terms, and doubts can be raised about the links between actions. There is also a lack of empirical research indicating the links between activities in the process of developing dynamic capabilities and their influence on the effectiveness of an organization. The aim of the study is to formulate a proposal for a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of a company and to determine the links between the activities in the model. The theoretical contribution of the paper consists in presenting a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of the company. The results presented in the paper refer to an empirical examination of the model of developing dynamic capabilities, covering five activities: searching for opportunities; knowledge management and learning; coordination; configuration and reconfiguration; and organizational adaptation. The study also includes an examination of the possible impact the components of the dynamic capabilities building process have on a company’s performance. The study uses the survey method and data was obtained from top managers. The conclusion, based on data from 471 Polish companies, was made using structural equation modelling. The results of the empirical research suggest that the individual activities in the process of developing dynamic capabilities are interconnected, and through mutual interactions and couplings, they positively affect the economic effectiveness of an enterprise. The results indicate that searching for opportunities is the precursor, and the main factor influencing the other activities in the process, which suggests that managers should focus on improving activities in this area.
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Affiliation(s)
- Szymon Cyfert
- Department of Organization and Management Theory, Poznań University of Economics and Business, Poznań, Poland
| | - Anna Chwiłkowska-Kubala
- Department of Organization and Management Theory, Poznań University of Economics and Business, Poznań, Poland
- * E-mail:
| | - Witold Szumowski
- Department of Organization and Management Theory, Wrocław University of Economics and Business, Wrocław, Poland
| | - Radosław Miśkiewicz
- Faculty of Organization and Management, Silesian University of Technology, Gliwice, Poland
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26
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Jombart T. Why development of outbreak analytics tools should be valued, supported, and funded. Lancet Infect Dis 2021; 21:458-459. [PMID: 33444558 PMCID: PMC7832113 DOI: 10.1016/s1473-3099(20)30996-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Thibaut Jombart
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; UK Public Health Rapid Support Team, London, UK; Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
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27
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Rispoli R, Diamond ME, Balsano M, Cappelletto B. Spine Surgery in Italy in the COVID-19 Era: Proposal for Assessing and Responding to the Regional State of Emergency. World Neurosurg 2021; 145:e1-e6. [PMID: 32777401 PMCID: PMC7413088 DOI: 10.1016/j.wneu.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022]
Abstract
In December 2019, coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei province, from where it spread rapidly worldwide. COVID-19 characteristics (increased infectivity, rapid spread, and general population susceptibility) pose a great challenge to hospitals. Infectious disease, pulmonology, and intensive care units have been strengthened and expanded. All other specialties have been compelled to suspend or reduce clinical and elective surgical activities. The profound effects on spine surgery call for systematic approaches to optimizing the diagnosis and treatment of spinal diseases. Based on the experience of one Italian region, we draw an archetype for assessing the current and predicted level of stress in the health care system, with the aim of enabling hospitals to make better decisions during the pandemic. Further, we provide a framework that may help guide strategies for adapting surgical spine care to the conditions of epidemic surge.
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Affiliation(s)
- Rossella Rispoli
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, Presidio Ospedaliero SMM, Udine, Italy.
| | - Mathew E Diamond
- Tactile Perception and Learning Laboratory, International School for Advanced Studies (SISSA), Trieste, Italy
| | - Massimo Balsano
- Regional Spine Department, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy
| | - Barbara Cappelletto
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, Presidio Ospedaliero SMM, Udine, Italy
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Gilbert M, Sulikhan N, Uphyrkina O, Goncharuk M, Kerley L, Castro EH, Reeve R, Seimon T, McAloose D, Seryodkin IV, Naidenko SV, Davis CA, Wilkie GS, Vattipally SB, Adamson WE, Hinds C, Thomson EC, Willett BJ, Hosie MJ, Logan N, McDonald M, Ossiboff RJ, Shevtsova EI, Belyakin S, Yurlova AA, Osofsky SA, Miquelle DG, Matthews L, Cleaveland S. Distemper, extinction, and vaccination of the Amur tiger. Proc Natl Acad Sci U S A 2020; 117:31954-31962. [PMID: 33229566 PMCID: PMC7749280 DOI: 10.1073/pnas.2000153117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Canine distemper virus (CDV) has recently emerged as an extinction threat for the endangered Amur tiger (Panthera tigris altaica). CDV is vaccine-preventable, and control strategies could require vaccination of domestic dogs and/or wildlife populations. However, vaccination of endangered wildlife remains controversial, which has led to a focus on interventions in domestic dogs, often assumed to be the source of infection. Effective decision making requires an understanding of the true reservoir dynamics, which poses substantial challenges in remote areas with diverse host communities. We carried out serological, demographic, and phylogenetic studies of dog and wildlife populations in the Russian Far East to show that a number of wildlife species are more important than dogs, both in maintaining CDV and as sources of infection for tigers. Critically, therefore, because CDV circulates among multiple wildlife sources, dog vaccination alone would not be effective at protecting tigers. We show, however, that low-coverage vaccination of tigers themselves is feasible and would produce substantive reductions in extinction risks. Vaccination of endangered wildlife provides a valuable component of conservation strategies for endangered species.
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Affiliation(s)
- Martin Gilbert
- Cornell Wildlife Health Center, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853;
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
- Wildlife Conservation Society, Bronx, NY 10460
| | - Nadezhda Sulikhan
- Federal Scientific Center of the East Asia Terrestrial Biodiversity, Far Eastern Branch of Russian Academy of Sciences, Vladivostok 690022, Russia
- Land of the Leopard National Park, Vladivostok 690068, Russia
| | - Olga Uphyrkina
- Federal Scientific Center of the East Asia Terrestrial Biodiversity, Far Eastern Branch of Russian Academy of Sciences, Vladivostok 690022, Russia
| | - Mikhail Goncharuk
- Zoological Society of London, London NW1 4RY, United Kingdom
- Primorskaya State Agricultural Academy, Ussuriisk 692510, Russia
| | - Linda Kerley
- Zoological Society of London, London NW1 4RY, United Kingdom
- United Administration of Lazovsky Zapovednik and Zov Tigra National Park, Lazo 692890, Russia
- Autonomous Noncommercial Organization "Amur," Lazo 692890, Russia
| | - Enrique Hernandez Castro
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Richard Reeve
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | | | | | - Ivan V Seryodkin
- Pacific Geographical Institute, Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia
- Far Eastern Federal University, Vladivostok 690091 Russia
| | - Sergey V Naidenko
- A. N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow 119071, Russia
| | - Christopher A Davis
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Gavin S Wilkie
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Sreenu B Vattipally
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Walt E Adamson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Chris Hinds
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Emma C Thomson
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Brian J Willett
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Margaret J Hosie
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Nicola Logan
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Michael McDonald
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Robert J Ossiboff
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610
| | | | - Stepan Belyakin
- Institute of Molecular and Cellular Biology, Siberian Branch of the Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Anna A Yurlova
- Institute of Molecular and Cellular Biology, Siberian Branch of the Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Steven A Osofsky
- Cornell Wildlife Health Center, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | | | - Louise Matthews
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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Abstract
Research has shown that the use of big data can modify operational processes in organizations. However, little research has been conducted on overcoming resistance to the process changes needed for adoption of big data technologies. In this article, we address this gap in the literature by investigating the impact of interactive data visualization on decision-making around operational process changes with big data. Our goal is to demonstrate how the choice of visualization of workflow and operational processes impacts decisions to embrace real-time, big data technology. To do so, we conduct a case study of patient/provider interactions in a large health care practice and compare the initial state with a revised workflow using a big data, real-time analytics platform. We then investigate the impact of the data visualization strategy on decision-making to implement operational changes caused by big data. The study demonstrates that interactive data visualization of operational processes can be an enabler in overcoming organizational resistance to big data technologies in a change-resistant organization. The concomitant benefit is that big data analytics is placed directly into the hands of primary decision makers.
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Affiliation(s)
- Gloria Phillips-Wren
- Department of Information Systems, Law and Operations, Sellinger School of Business and Management, Loyola University Maryland, Baltimore, Maryland, USA
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Zang X, Jalal H, Krebs E, Pandya A, Zhou H, Enns B, Nosyk B. Prioritizing Additional Data Collection to Reduce Decision Uncertainty in the HIV/AIDS Response in 6 US Cities: A Value of Information Analysis. Value Health 2020; 23:1534-1542. [PMID: 33248508 PMCID: PMC7705607 DOI: 10.1016/j.jval.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The ambitious goals of the US Ending the HIV Epidemic initiative will require a targeted, context-specific public health response. Model-based economic evaluation provides useful guidance for decision making while characterizing decision uncertainty. We aim to quantify the value of eliminating uncertainty about different parameters in selecting combination implementation strategies to reduce the public health burden of HIV/AIDS in 6 US cities and identify future data collection priorities. METHODS We used a dynamic compartmental HIV transmission model developed for 6 US cities to evaluate the cost-effectiveness of a range of combination implementation strategies. Using a metamodeling approach with nonparametric and deep learning methods, we calculated the expected value of perfect information, representing the maximum value of further research to eliminate decision uncertainty, and the expected value of partial perfect information for key groups of parameters that would be collected together in practice. RESULTS The population expected value of perfect information ranged from $59 683 (Miami) to $54 108 679 (Los Angeles). The rank ordering of expected value of partial perfect information on key groups of parameters were largely consistent across cities and highest for parameters pertaining to HIV risk behaviors, probability of HIV transmission, health service engagement, HIV-related mortality, health utility weights, and healthcare costs. Los Angeles was an exception, where parameters on retention in pre-exposure prophylaxis ranked highest in contributing to decision uncertainty. CONCLUSIONS Funding additional data collection on HIV/AIDS may be warranted in Baltimore, Los Angeles, and New York City. Value of information analysis should be embedded into decision-making processes on funding future research and public health intervention.
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Affiliation(s)
- Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Hawre Jalal
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Haoxuan Zhou
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Benjamin Enns
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Woods BS, Sideris E, Palmer S, Latimer N, Soares M. Partitioned Survival and State Transition Models for Healthcare Decision Making in Oncology: Where Are We Now? Value Health 2020; 23:1613-1621. [PMID: 33248517 DOI: 10.1016/j.jval.2020.08.2094] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Partitioned survival models (PSMs) are routinely used to inform reimbursement decisions for oncology drugs. We discuss the appropriateness of PSMs compared to the most common alternative, state transition models (STMs). METHODS In 2017, we published a National Institute for Health and Care Excellence (NICE) Technical Support Document (TSD 19) describing and critically reviewing PSMs. This article summarizes findings from TSD 19, reviews new evidence comparing PSMs and STMs, and reviews recent NICE appraisals to understand current practice. RESULTS PSMs evaluate state membership differently from STMs and do not include a structural link between intermediate clinical endpoints (eg, disease progression) and survival. PSMs directly consider clinical trial endpoints and can be developed without access to individual patient data, but limit the scope for sensitivity analyses to explore clinical uncertainties in the extrapolation period. STMs facilitate these sensitivity analyses but require development of robust survival models for individual health-state transitions. Recent work has shown PSMs and STMs can produce substantively different survival extrapolations and that extrapolations from STMs are heavily influenced by specification of the underlying survival models. Recent NICE appraisals have not generally included both model types, reviewed individual clinical event data, or scrutinized life-years accrued in individual health states. CONCLUSIONS The credibility of survival predictions from PSMs and STMs, including life-years accrued in individual health states, should be assessed using trial data on individual clinical events, external data, and expert opinion. STMs should be used alongside PSMs to support assessment of clinical uncertainties in the extrapolation period, such as uncertainty in post-progression survival.
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Affiliation(s)
- Beth S Woods
- Centre for Health Economics, University of York, York, UK.
| | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Nick Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
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Breite MD, Breite CN, Sheaffer WW, Soh IY, Davila VJ, Money SR, Stone WM, Tarsa SJ, Meltzer AJ. Carotid endarterectomy surgeon volumes in contemporary practice: A comparison to randomized trial inclusion criteria. Am J Surg 2020; 222:241-244. [PMID: 33223073 DOI: 10.1016/j.amjsurg.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/15/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clinical decisions regarding the utility of carotid revascularization are informed by randomized controlled trial (RCT) results. However, RCTs generally require participating surgeons to meet strict inclusion criteria with respect to procedure volume. The purpose of this study was to compare annual surgeon volume for carotid endarterectomy (CEA) in contemporary practice to RCT inclusion thresholds. METHODS Surgeon volume thresholds were identified in 17 RCTs evaluating the efficacy of CEA (1986-present, n = 17). Contemporary annual surgeon volumes (2012-2017) were identified by aggregating data from the Medicare Provider Utilization Database and Healthcare Cost and Utilization Project Network (HCUP), and compared to RCT inclusion thresholds. Further comparisons were performed over time, and across specialties (i.e., vascular surgeon vs. other, based on board certification associated with provider NPI). RESULTS Minimal surgeon volume in 17 RCTs ranged from 10 to 25 CEA annually when specific case volumes were required. From 2012 to 2017, CEA incidence in Medicare beneficiaries declined from 68,608 to 56,004 and became increasingly consolidated in fewer providers (7,331 vs. 6,626). However, in 2016 only 26.2% of surgeons performing CEA in Medicare beneficiaries would have met the least stringent volume requirement (10 CEA/year). Only 6.5% of surgeons performing CEA met the most stringent RCT volume threshold (25 cases/year) during the same time period. In 2017, 819 vascular surgeons (25.5% of those certified in the specialty) performed >10 CEA in Medicare beneficiaries. CONCLUSIONS The majority of surgeons performing CEA do not meet the annual volume thresholds required for participation in the RCTs that have evaluated the efficacy of carotid revascularization. Given the established volume-outcome relationship in CEA, the disparity between surgeon experience in the context of RCTs versus contemporary practice is concerning. These findings have potential implications for informed decision-making, hospital privileging, and regionalization of care.
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Affiliation(s)
- Matthew D Breite
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States.
| | - Christine N Breite
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - William W Sheaffer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - Ina Y Soh
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - Victor J Davila
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - Samuel R Money
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - William M Stone
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - Stephen J Tarsa
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
| | - Andrew J Meltzer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, United States
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Meadmore K, Fackrell K, Recio-Saucedo A, Bull A, Fraser SDS, Blatch-Jones A. Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice. PLoS One 2020; 15:e0239757. [PMID: 33151954 PMCID: PMC7644005 DOI: 10.1371/journal.pone.0239757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.
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Affiliation(s)
- Katie Meadmore
- Wessex Institute, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Kathryn Fackrell
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | | | - Abby Bull
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Simon D. S. Fraser
- Wessex Institute, University of Southampton, Southampton, United Kingdom
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Muzumdar S, Grant-Kels JM, Feng H. Medical student dermatology rotations in the context of COVID-19. J Am Acad Dermatol 2020; 83:1557-1558. [PMID: 32592884 PMCID: PMC7311902 DOI: 10.1016/j.jaad.2020.06.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/05/2022]
MESH Headings
- Academic Medical Centers/organization & administration
- Academic Medical Centers/standards
- Betacoronavirus/pathogenicity
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Decision Making, Organizational
- Dermatology/education
- Dermatology/organization & administration
- Dermatology/standards
- Education Department, Hospital/organization & administration
- Education Department, Hospital/standards
- Education, Medical, Undergraduate/organization & administration
- Education, Medical, Undergraduate/standards
- Humans
- Infection Control/standards
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- SARS-CoV-2
- Students, Medical
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Affiliation(s)
- Sonal Muzumdar
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Chen G, Peirce V, Marsh W. Evaluation of the National Institute for Health and Care Excellence Diagnostics Assessment Program Decisions: Incremental Cost-Effectiveness Ratio Thresholds and Decision-Modifying Factors. Value Health 2020; 23:1300-1306. [PMID: 33032773 DOI: 10.1016/j.jval.2020.04.1835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The National Institute for Health and Care Excellence (NICE) Diagnostics Assessment Programme (DAP) evaluates the cost-effectiveness of diagnostic technologies. A decision-making process benchmarking the incremental cost-effectiveness ratio (ICER) against a threshold while considering decision-modifying factors is common to NICE evaluations. This study investigated whether DAP decisions are consistent with the ICER thresholds described in the DAP manual, and to assess the impact of decision-modifying factors. METHODS DAP evaluations published before March 2018 were reviewed, and the following items were extracted: diagnostic technologies evaluated, decision problems assessed, Diagnostics Advisory Committee (DAC) decisions, incremental quality-adjusted life years (QALYs), incremental costs, ICERs considered to be most plausible by the DAC, and decision justifications. RESULTS All 30 evaluations were reviewed; 8 were excluded because the DAC concluded there was "insufficient evidence" for decision making. In the remaining 22 evaluations, 91 decision problems were identified for further analysis, of which 52, 15, and 24 received "recommended," "not recommended," and "not recommended-only in research" guidance, respectively. The overall consistency rate of the DAC decisions with the £20 000/QALY threshold was 73.6%. Diagnostic technologies that were not recommended, despite an ICER less than £20 000/QALY, were associated with a larger number of decision-modifying factors favoring the comparator, versus recommended diagnostic technologies with ICERs less than £20 000/QALY. For technologies with ICERs greater than £20 000/QALY, the number of decision-modifying factors was comparable for positive and negative recommendations. CONCLUSIONS Most DAP decisions were consistent with the ICER threshold. However, cost-effectiveness was not the only determining factor in decision making; recommendations also considered patient- and healthcare-centric factors and uncertainty.
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Abstract
Cornelia Betsch (a psychologist, University of Erfurt), Vittoria Colizza (a computational epidemiologist, INSERM), Sara del Valle (a computational epidemiologist, Los Alamos National Laboratory), Chikwe Ihekweazu (a public health epidemiologist, Nigeria Centre for Disease Control) and Carmela Troncoso (a data security specialist, EPFL) talked to Nature Communications about their experience with COVID-19 response and their vision on a new system for disease surveillance and control, providing a view on how this should interact with policy making.
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Affiliation(s)
| | | | - Sean W Glenn
- Administrative Services, Mayo Clinic, Phoenix, AZ
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Bosun-Arije FS, Ling J, Graham Y, Hayes C. Organisational factors influencing non-pharmacological management of type 2 diabetes mellitus (T2DM) in public hospitals across Lagos, Nigeria: A qualitative study of nurses' perspectives. Diabetes Res Clin Pract 2020; 166:108288. [PMID: 32615277 DOI: 10.1016/j.diabres.2020.108288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/24/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence and incidence of Type 2 Diabetes mellitus (T2DM) are significantly increasing in Nigeria. Effective management of the condition, in clinical settings, can be achieved with a minimal financial cost, but this is often overlooked. It is crucial to understand organisational factors influencing non-pharmacological management of T2DM in Nigerian public hospitals for effective management of patients diagnosed with the condition. AIM To examine healthcare delivery services influencing patient management and seek approaches to heighten optimisation of patient health outcomes. METHODS Adopting a qualitative case study design, we used the Constant Comparative Method and semi-structured questions to interview17 nurses in public hospitals across Lagos. Using the five stages of the Framework Analysis process, the transcribed interviews were thematically analysed. RESULTS Nurses suggested that a complex, multifaceted system constituted organisational factors influencing T2DM management in public hospitals across Lagos, Nigeria. Specific factors identified were levels of available information and knowledge, relationship, policy and decision-making management. These factors were, in turn, linked to political, infrastructural, health professional and the environments within which patients were given health services. CONCLUSIONS The study revealed a significant gap in the organisation of care for individuals diagnosed with T2DM in public hospitals across Lagos. Timely and affordable strategies have been highlighted to secure effective care delivery to patients.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Decision Making, Organizational
- Delivery of Health Care/organization & administration
- Delivery of Health Care/standards
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/nursing
- Diabetes Mellitus, Type 2/therapy
- Female
- Health Knowledge, Attitudes, Practice
- Health Services/standards
- Hospitals, Public/organization & administration
- Hospitals, Public/standards
- Hospitals, Public/statistics & numerical data
- Humans
- Male
- Middle Aged
- Nigeria/epidemiology
- Nurses/organization & administration
- Nurses/psychology
- Nurses/standards
- Nurses/statistics & numerical data
- Perception
- Practice Patterns, Nurses'/organization & administration
- Practice Patterns, Nurses'/standards
- Practice Patterns, Nurses'/statistics & numerical data
- Qualitative Research
- Socioeconomic Factors
- Surveys and Questionnaires
- Treatment Outcome
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Affiliation(s)
- Foluke Stella Bosun-Arije
- Manchester Metropolitan University, Faculty of Health, Psychology and Social Care, Department of Nursing, United Kingdom.
| | - Jonathan Ling
- University of Sunderland, City Campus, Chester road, SR1 3SD Sunderland, United Kingdom.
| | - Yitka Graham
- University of Sunderland, City Campus, Chester road, SR1 3SD Sunderland, United Kingdom.
| | - Catherine Hayes
- University of Sunderland, City Campus, Chester road, SR1 3SD Sunderland, United Kingdom.
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Berlin J. Road to Recovery: COVID-19 Tests, Bends, and Breaks Texas Practices. Tex Med 2020; 116:20-25. [PMID: 32866271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist's practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving - and trying their best to prepare for future threats - others weren't so lucky. On-the-ground experiences align with the Texas Medical Association's Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other - challenging or torpedoing the viability of various practice types.
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Jalali A, Lonsdale H, Do N, Peck J, Gupta M, Kutty S, Ghazarian SR, Jacobs JP, Rehman M, Ahumada LM. Deep Learning for Improved Risk Prediction in Surgical Outcomes. Sci Rep 2020; 10:9289. [PMID: 32518246 PMCID: PMC7283236 DOI: 10.1038/s41598-020-62971-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
The Norwood surgical procedure restores functional systemic circulation in neonatal patients with single ventricle congenital heart defects, but this complex procedure carries a high mortality rate. In this study we address the need to provide an accurate patient specific risk prediction for one-year postoperative mortality or cardiac transplantation and prolonged length of hospital stay with the purpose of assisting clinicians and patients' families in the preoperative decision making process. Currently available risk prediction models either do not provide patient specific risk factors or only predict in-hospital mortality rates. We apply machine learning models to predict and calculate individual patient risk for mortality and prolonged length of stay using the Pediatric Heart Network Single Ventricle Reconstruction trial dataset. We applied a Markov Chain Monte-Carlo simulation method to impute missing data and then fed the selected variables to multiple machine learning models. The individual risk of mortality or cardiac transplantation calculation produced by our deep neural network model demonstrated 89 ± 4% accuracy and 0.95 ± 0.02 area under the receiver operating characteristic curve (AUROC). The C-statistics results for prediction of prolonged length of stay were 85 ± 3% accuracy and AUROC 0.94 ± 0.04. These predictive models and calculator may help to inform clinical and organizational decision making.
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Affiliation(s)
- Ali Jalali
- Predictive Analytics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA.
- Department of Anesthesia and Pain Medicine at Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA.
| | - Hannah Lonsdale
- Department of Anesthesia and Pain Medicine at Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Nhue Do
- Pediatric Cardiac Surgery, Department of Surgery at Vanderbilt University, Nashville, TN, 37240, USA
| | - Jacquelin Peck
- Department of Anesthesiology at Mount Sinai Hospital, Miami Beach, FL, 33140, USA
| | - Monesha Gupta
- Division of Cardiology at Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Shelby Kutty
- Department of Pediatrics, at Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Sharon R Ghazarian
- Health Informatics Core, Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | | | - Mohamed Rehman
- Department of Anesthesia and Pain Medicine at Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Luis M Ahumada
- Predictive Analytics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
- Department of Anesthesia and Pain Medicine at Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
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O'Brien D. Challenges to Strategic Planning. Acad Med 2020; 95:820. [PMID: 32452853 DOI: 10.1097/acm.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- David O'Brien
- Emeritus director of institutional planning, Stanford University School of Medicine, and principal, Anderson Brulé Architects, Stanford, California;
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Abstract
Sandro Galea and co-authors discuss a forthcoming Collection on data science and social determinants of health.
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Affiliation(s)
- Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
- * E-mail:
| | - Salma M. Abdalla
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
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Watkins JB, Sullivan SD, Sampsel E, Fullerton DS“P, Graff JS, Fry RN, Lee J, Tam IM, Avey SG. Evolution of the AMCP Format for Formulary Submissions. J Manag Care Spec Pharm 2020; 26:696-700. [PMID: 32463780 PMCID: PMC10391300 DOI: 10.18553/jmcp.2020.26.6.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES No funding was required for this project. The authors are or have been members of the Format Executive Committee.
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Affiliation(s)
- John B. Watkins
- Residency Program Director, Premera Blue Cross, Mountlake Terrace, Washington, and Affiliate Professor of Pharmacy, University of Washington, Seattle
| | - Sean D. Sullivan
- Dean, School of Pharmacy and Professor of Pharmacy, Health Services and Medicine, University of Washington, Seattle
| | - Elizabeth Sampsel
- Senior Director, Payer, Provider and Partner Alliances, Xcenda, Palm Harbor, Florida
| | | | - Jennifer S. Graff
- Vice President Comparative Effectiveness Research, National Pharmaceutical Council, Washington, DC
| | - Richard N. Fry
- Former FMCP Director of Programs, Leland, North Carolina
| | - Jeff Lee
- Associate Dean for Academic Affairs, Lipscomb University College of Pharmacy, Nashville, Tennessee
| | - Iris M. Tam
- Senior Director, HEOR, Patient Access & Value, Coeus Consulting Group, Daly City, California
| | - Steven G. Avey
- Executive Director Emeritus, AMCP Foundation, Alexandria, Virginia
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Lamblin A, de Montgolfier S. COVID-19 and ethical considerations: Valuable decision-making tools from the leading medical societies in France. Anaesth Crit Care Pain Med 2020; 39:365-366. [PMID: 32414630 PMCID: PMC7204662 DOI: 10.1016/j.accpm.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Antoine Lamblin
- Department of Civilian and Military Anaesthesia, Édouard-Herriot Hospital, Lyon University Hospital, 5, place d'Arsonval, 69003 Lyon, France; UMR ADéS 7268, Aix-Marseille University/EFS/CNRS, Espace éthique méditerranéen, University Hospital La Timone (adults), Marseille, France.
| | - Sandrine de Montgolfier
- IRIS Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156 CNRS - 997 Inserm - EHESS - UP13, 74, rue Marcel Cachin, 93017 Bobigny
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Abstract
Most business-as-usual scenarios for farming under changing climate regimes project that the agriculture sector will be significantly impacted from increased temperatures and shifting precipitation patterns. Perhaps ironically, agricultural production contributes substantially to the problem with yearly greenhouse gas (GHG) emissions of about 11% of total anthropogenic GHG emissions, not including land use change. It is partly because of this tension that Climate Smart Agriculture (CSA) has attracted interest given its promise to increase agricultural productivity under a changing climate while reducing emissions. Considerable resources have been mobilized to promote CSA globally even though the potential effects of its widespread adoption have not yet been studied. Here we show that a subset of agronomic practices that are often included under the rubric of CSA can contribute to increasing agricultural production under unfavorable climate regimes while contributing to the reduction of GHG. However, for CSA to make a significant impact important investments and coordination are required and its principles must be implemented widely across the entire sector.
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Affiliation(s)
- Alessandro De Pinto
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, United States of America
- * E-mail:
| | - Nicola Cenacchi
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Ho-Young Kwon
- Energy Systems Division, Argonne National Laboratories, Lemont, IL, United States of America
| | - Jawoo Koo
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Shahnila Dunston
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, United States of America
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Garrison LP, Zamora B, Li M, Towse A. Augmenting Cost-Effectiveness Analysis for Uncertainty: The Implications for Value Assessment-Rationale and Empirical Support. J Manag Care Spec Pharm 2020; 26:400-406. [PMID: 32223599 PMCID: PMC10391119 DOI: 10.18553/jmcp.2020.26.4.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES This study received unrestricted funding from the Pharmaceutical Research Manufacturers of America. The authors also do consulting, personally or through their employment, with numerous pharmaceutical manufacturers, payers, and other stakeholders with a general interest in this subject matter.
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Affiliation(s)
- Louis P. Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | | | - Meng Li
- Leonard D. Schaeffer Center For Health Policy & Economics, University of Southern California, Los Angeles
| | - Adrian Towse
- Office of Health Economics, London, United Kingdom
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Abstract
OBJECTIVE The objective of this study was to develop a French value set for the EQ-5D-5L, for academic and clinical research, and for regulatory requirements for price-setting of drugs and medical devices. METHOD This study used the standardized valuation protocol developed by EuroQol, using computer-assisted personal interview software. A representative sample of 1048 French residents were interviewed by a market research company, under the supervision of the research team. Health states were valued using composite time trade-off and a discrete choice experiment. Modeling was used to create values for the 3125 possible health states. The composite time trade-off data were modeled using a Tobit model with censored observations at -1 and correcting for heteroscedasticity. A conditional logit model was used for the discrete choice results, and both models were combined using a hybrid model. An adjusted hybrid model was tested to correct for imbalance in the sample on age and sex compared with the general population. A comparison with the 3-level (3L) value set was performed. RESULTS The adjusted model was preferred to comply with the representativeness of the general population. It provided a value set for which all coefficients were logically consistent. Values ranged from - 0.525 to 1. The distribution of values presented a shift towards higher values versus the 3L value set. Ranking of dimensions changed. Pain and discomfort and mobility were the dimensions with the highest potential for disutility compared with mobility and self-care for the 3L instrument. CONCLUSIONS This study provides a value set based on societal preferences of the French population, using an improved descriptive instrument of health-related quality-of-life health states. It will contribute to improve the quality of cost-effectiveness analysis in the French context and help stimulate disease-specific quality-of-life references for academic-, institutional-, and industry-promoted studies.
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Affiliation(s)
- Luiz Flavio Andrade
- Ecole Supérieure de Sciences Economiques et Commerciales (ESSEC Business School), 3, Avenue Bernard Hirsch, CS 50105, Cergy Pontoise, France
| | - Kristina Ludwig
- Euroqol Research Foundation, Marten Meesweg 107, 3068 AV Rotterdam, The Netherlands
| | | | - Mark Oppe
- Axentiva Solutions, Calle Calvario, 271-1 B, 38340 Tacoronte, Tenerife Spain
| | - Gérard de Pouvourville
- Ecole Supérieure de Sciences Economiques et Commerciales (ESSEC Business School), 3, Avenue Bernard Hirsch, CS 50105, Cergy Pontoise, France
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Muthathi IS, Levin J, Rispel LC. Decision space and participation of primary healthcare facility managers in the Ideal Clinic Realisation and Maintenance programme in two South African provinces. Health Policy Plan 2020; 35:302-312. [PMID: 31872256 PMCID: PMC7152727 DOI: 10.1093/heapol/czz166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 02/05/2023] Open
Abstract
In South Africa, the introduction of a national health insurance (NHI) system is the most prominent health sector reform planned to achieve universal health coverage in the country. Primary health care (PHC) is the foundation of the proposed NHI system. This study draws on policy implementation theory and Bossert's notion of decision space to analyse PHC facility managers' decision space and their participation in the implementation of the Ideal Clinic Realisation and Maintenance (ICRM) programme. We conducted a cross-sectional survey among 127 PHC facility managers in two districts in Gauteng and Mpumalanga provinces. A self-administered questionnaire elicited socio-demographic information, the PHC managers' participation in the conceptualization and implementation of the ICRM programme, their decision space and an optional open-ended question for further comments. We obtained a 100% response rate. The study found that PHC facility managers reported lack of involvement in the conceptualization of the ICRM programme, high levels of participation in implementation [mean score 5.77 (SD ±0.90), and overall decision space mean score of 2.54 (SD ±0.34)]. However, 17 and 21% of participants reported narrow decision space on the critical areas of the availability of essential medicines and on basic resuscitation equipment respectively. The qualitative data revealed the unintended negative consequences of striving for 'ideal clinic status', namely that of creating an illusion of compliance with the ICRM standards. The study findings suggest the need for greater investment in the health workforce, special efforts to involve frontline managers and staff in health reforms, as well as provision of adequate resources, and an enabling practice environment.
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Affiliation(s)
- Immaculate Sabelile Muthathi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
| | - Laetitia C Rispel
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
- Centre for Health Policy & Department of Science and Innovation/National Research Foundation Research Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa
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Wammes JJG, Frederix G, Govaert P, Determann D, Evers S, Paulus A, Stadhouders N, Jeurissen P, Oortwijn W, Adang EMM. Case-studies of displacement effects in Dutch hospital care. BMC Health Serv Res 2020; 20:263. [PMID: 32228590 PMCID: PMC7106895 DOI: 10.1186/s12913-020-05086-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under a constrained health care budget, cost-increasing technologies may displace funds from existing health services. However, it is unknown what services are displaced and how such displacement takes place in practice. The aim of our study was to investigate how the Dutch hospital sector has dealt with the introduction of cost-increasing health technologies, and to present evidence of the relative importance of three main options to deal with cost-increases in health care: increased spending, increased efficiency, or displacement of other services. METHODS We conducted six case-studies and interviewed 84 professionals with various roles and responsibilities (practitioners, heads of clinical department, board of directors, insurers, and others) to investigate how they experienced decision making in response to the cost pressure of cost-increasing health technologies. Transcripts were analyzed thematically in Atlas.ti on the basis of an item list. RESULTS Direct displacement of high-value care due to the introduction of new technologies was not observed; respondents primarily pointed to increased spending and efficiency measures to accommodate the introduction of the cost-increasing technologies. Respondents found it difficult to identify the opportunity costs; partly due to limited transparency in the internal allocation of funds within a hospital. Furthermore, respondents experienced the entry of new technologies and cost-containment as two parallel processes that are generally not causally linked: cost containment was experienced as a permanent issue to level costs and revenues, independent from entry of new technologies. Furthermore, the way of financing was found important in displacement in the Netherlands, especially as there is a separate budget for expensive drugs. This budget pressure was found to be reallocated horizontally across departments, whereas the budget pressure of other services is primarily reallocated vertically within departments or divisions. Respondents noted that hospitals have reacted to budget pressures primarily through a narrowing in the portfolio of their services, and a range of (other) efficiency measures. The board of directors is central in these processes, insurers are involved only to a limited extent. CONCLUSIONS Our findings indicate that new technologies were generally accommodated by greater efficiency and increased spending, and that hospitals sought savings or efficiency measures in response to cumulative cost pressures rather than in response to single cost-increasing technologies.
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Affiliation(s)
- Joost Johan Godert Wammes
- Radboud university medical center, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Geert Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paulien Govaert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Aggie Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Niek Stadhouders
- Radboud university medical center, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Patrick Jeurissen
- Radboud university medical center, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Wija Oortwijn
- Radboud university medical center, Health Evidence, Nijmegen, Netherlands
| | - Eddy M M Adang
- Radboud university medical center, Health Evidence, Nijmegen, Netherlands
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