Building a successful RN compensation model.
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Attitude of Health Personnel↗
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Compensation models of certified nurse-midwives in clinical practice.
Nurse-midwives have been recognized for decades as clinically effective health care providers for infants and women. Little information exists, however, as to how these clinically effective professionals are compensated for their services. The article presents five compensation models for certified nurse-midwives (CNMs), demonstrating the financial benefits and cost of each using a hypothetical case study format and composite data from current CNM practices in the United States. From these templates, CNMs can apply their own financial and productivity data to construct a financial analysis of their productivity against their current financial compensation.
Certification↗
The impact of social support networks on adult health.
Knowledge of the determinants of adult health offers important implications for planning policy that may affect the overall level of health and thus the costs of health care. One potentially important factor that has not been incorporated in previous research is the amount of information individuals have concerning health care or methods of preventive care. This study uses the number of social support networks and the degree of contact individuals have with them as an alternative measure of information. This measure of information is incorporated into an economic model based partly on Becker's Human Capital framework. Social support networks are found to have virtually no impact in explaining health outcomes for illnesses over which the individual has little control. However, when a broader range of illnesses is considered, social support networks do play a role in producing better health.
Educational Status↗
A cost-effectiveness analysis of strategies to reduce infant mortality.
This study compares the cost effectiveness of various health inputs and government programs in reducing race-specific neonatal mortality or death in the first 27 days of life. Approximately two thirds of all infant deaths occur within this period. The programs and inputs at issue are teenage family planning use; the supplemental food program for women, infants, and children (WIC); use of community health centers and maternal and infant care projects; abortion; prenatal care; and neonatal intensive care. Using an economic model of the family as the analytic framework, effectiveness is determined by using ordinary least squares and two-stage least squares to estimate infant health production functions across large counties in the United States in 1977. Estimates of costs are from a number of published sources. We find the early initiation of prenatal care to be the most cost-effective means of reducing the neonatal mortality rate for blacks and whites. Moreover, blacks benefit more per dollar of input use than whites. Neonatal intensive care, although the most effective means of reducing neonatal mortality rates, is one of the least cost-effective strategies.
Child Health Services↗
Patient selection in the Medicare End-Stage Renal Disease Program.
Since the inception of the Medicare End-Stage Renal Disease (ESRD) Program in 1972, the number of persons qualifying for this benefit has increased every year, even when controlling for growth of the US population. At the same time, the profile of the typical dialysis patient has changed dramatically over the years, with new enrollees tending to be older and sicker. This study attempts to explain case mix through an economic model of a dialysis provider who certifies eligibility of Medicare ESRD beneficiaries and manages their care. The model was tested using administrative data from the Medicare ESRD program and other sources. Results demonstrated that dialysis patient case mix is influenced by local area demand for medical care and factors such as competition or payment levels that might affect a provider's supply decisions.
Aged↗
Use of unopposed estrogen in women with uteri: prevalence, clinical implications, and economic consequence.
OBJECTIVE: Hormone replacement therapy with estrogen/progestin is the treatment of choice for relieving postmenopausal vasomotor symptoms and preventing urogenital atrophy and osteoporosis in women with intact uteri. However, despite the known increased incidence of endometrial hyperplasia when unopposed estrogen is used in such women, this progestin regimen has not been universally adopted. DESIGN: This study was conducted in a managed care organization to determine the extent of the use of unopposed estrogen in women with intact uteri. Pharmacy claims data for all women 55 years or older with claims for estrogen only from September 1, 1996, to December 31, 1996, were reviewed. A total of 5,209 records were identified, from which 480 were randomly selected. A survey of the members' physicians was then carried out to determine hysterectomy status and was confirmed by chart audit. RESULTS: Thirty-three (11%) of the members identified had not undergone hysterectomy. Follow-up physician contact revealed that five women did not have a uterus. Use of estrogen without opposing progestin was documented in a substantial percentage of files reviewed. It is of concern that with the documentation of the risks of endometrial hyperplasia and carcinoma in the intact uterus, unopposed therapy still occurs. In addition to the clinical costs, there are economic consequences to this practice. An economic model of unopposed estrogen use was created. A management cost of $1,504 for 3 years was estimated. CONCLUSIONS: Further educational efforts are needed to ensure the use of opposed estrogen in the woman with an intact uterus.
Algorithms↗
Thermotherapy and thermoablation for benign prostatic hyperplasia.
PURPOSE OF REVIEW: From all the available thermoablative methods for the treatment of symptomatic benign prostatic hyperplasia, transurethral microwave thermotherapy is considered as standard in minimally invasive management. The literature is enriched by several new studies on transurethral microwave thermotherapy, and thus this review presents up-to-date information about thermotherapy. RECENT FINDINGS: New studies have provided significant information regarding differences in outcome for devices with different protocols and selection criteria, confirming the superiority of high-energy programmes. Furthermore, monitoring of the intraprostatic temperature promises better clinical results by means of individualization of the treatment. Long-term results have been available and allow the evaluation of the fundamental issue of treatment durability. Improvement after high-energy transurethral microwave thermotherapy remains durable for more than 2.5 years. Randomized studies comparing this treatment with other established therapies for benign prostatic hyperplasia, including medical treatment and transurethral resection of the prostate, have also contributed to an evaluation of the morbidity, and costs of treatment. Clinical outcomes with transurethral microwave thermotherapy are in the range of those obtained with transurethral resection of the prostate and are superior to those of medical management. Retreatment after transurethral resection of the prostate emerges because of complications following the procedure, whereas retreatment after transurethral microwave thermotherapy is as a result of treatment failure. In addition, the rate of failure of medical management is almost seven times higher than that for transurethral microwave thermotherapy. Thus, the latter seems to play a dominant role in the economic models used to assess the cost-efficiency of different treatment modalities for benign prostatic hyperplasia. SUMMARY: The recent innovations in high-energy transurethral microwave thermotherapy provide better and more durable clinical outcomes and lower morbidity, and strengthen its position as an established treatment for benign prostatic hyperplasia. However, there is always room for improvement, so further research on therapeutic protocols, treatment monitoring and selection criteria are to be welcomed.
Aged↗
A review of current healthcare funding models.
As healthcare expenses grow, concern about how government and private agencies decide to allocate funds for healthcare resources and services also grows. Decisions for healthcare funding are not made arbitrarily but are based on sound ethical principles and practical considerations. This article is a review of 5 ethically based healthcare funding models discussed in the literature that are currently used to justify funding choices. If healthcare professionals and managers are better informed about the ethical reasoning behind funding choices, they could better determine which resource allocation alternatives to support. But where should we spend our resources? Although healthcare professionals have a duty to advocate for all healthcare recipients to receive a fair share of resources, the author concludes that our greater duty as a profession is to the good of society as a whole. Balancing allocation decisions by considering all of the competing healthcare funding models and the ethical bases for them is suggested rather than to advocate too strongly for favored models.
Choice Behavior↗
Bone mineral density of lumbar vertebral end plates in the aging male sand rat spine.
STUDY DESIGN: Lumbar vertebral segments from young and old male sand rats were assessed for quantitative determination of lumbar end plate bone mineral density. OBJECTIVES: To determine whether bone mineral density increases in the lumbar end plate with age in the male sand rat and to investigate its relationship to disc degeneration. SUMMARY OF THE BACKGROUND DATA: Few basic science studies evaluated the end plate and disc degeneration. The sand rat provides an excellent economical model in which disc degeneration is reliable and well characterized. METHODS: Bone mineral density data on cranial and caudal lumbar end plates of young (mean age 6.8 months) and old (mean age 23.3 months) male sand rats were assessed for changes related to age, lumbar position, and radiologic features. RESULTS: Mean bone mineral density was significantly greater in end plates in older compared to younger males (P <or= 0.0018). Mean end plate bone mineral density within young animals was not significantly different in levels L5 to L7; in old animals, bone mineral density was significantly different (greater) progressing from L5 to L7 (P < 0.0001). In older animals, mean end plate bone mineral density for each disc showed a significant increase with lower lumbar sites (P = 0.0068). Mean end plate bone mineral density was significantly greater in animals with radiographic evidence of disc wedging (P = 0.006). End plate bone mineral density correlated positively with age. CONCLUSIONS: Results provide quantitative bone mineral density data on end plate sclerosis in male sand rats. Data reveal site specificities and show that in old animals, end plate bone mineral density is greater than in young animals. Mean end plate bone mineral density was significantly greater at sites with radiographic disc wedging (P = 0.006). Data support the hypothesis that end plate sclerosis may play a role in disc degeneration.
Aging↗
The global pertussis initiative: process overview.
In 2001, the Global Pertussis Initiative was established as a scientific forum to analyze the status of pertussis globally and to evaluate various immunization strategies to improve disease control. Thirty-seven multidisciplinary experts from 17 countries participated. The initiative was conducted in 3 stages: assessment of the international epidemiology, diagnosis, health and economic burden, and prevention and treatment of pertussis; evaluation and prioritization of 7 immunization strategies to address the problems; and identification of solutions to surmount potential barriers to the implementation of these strategies. A health-economic model, created for the Initiative, analyzed the cost-effectiveness of the selected immunization strategies. Discussion, debate, and consensus were facilitated via a roundtable meeting, teleconferences and use of a closed, interactive website, allowing the participants to share data, knowledge, experience, and opinion. This article describes the processes undertaken to conduct the Initiative.
Communicable Disease Control↗
Context-dependent foraging decisions in rufous hummingbirds.
A core assumption implicit in economic models of animal choice is that subjects assign absolute utilities to options that are independent of the type and number of alternatives available. Humans sometimes appear to violate this assumption and employ relative, as opposed to absolute, currencies when making choices. Recent evidence suggests that animals too might sometimes employ relative choice mechanisms. We tested this idea by measuring the foraging preferences of rufous hummingbirds (Selasphorus rufus) faced with choices analogous to those in which human use of relative currencies is evident. The birds experienced three treatments: a binary choice between two artificial flower types designated concentration (20 microl, 40% sucrose solution) and volume (40 microl, 20%), and two trinary treatments in which a third decoy option (either concentration decoy: 10 microl, 30% or volume decoy: 30 microl, 10%) was added to the set. The birds' preferences differed significantly across the three treatments. In the trinary treatments, the effect of the decoy options was to increase the preference for the option that dominated the decoy. These results are similar to those reported in the human choice literature, and are compatible with the hummingbirds using a relative evaluation mechanism in decision making.
Animals↗
Water: the bloodstream of the biosphere.
Water, the bloodstream of the biosphere, determines the sustainability of living systems. The essential role of water is expanded in a conceptual model of energy dissipation, based on the water balance of whole landscapes. In this model, the underlying role of water phase changes--and their energy-dissipative properties--in the function and the self-organized development of natural systems is explicitly recognized. The energy-dissipating processes regulate the ecological dynamics within the Earth's biosphere, in such a way that the development of natural systems is never allowed to proceed in an undirected or random way. A fundamental characteristic of self-organized development in natural systems is the increasing role of cyclic processes while loss processes are correspondingly reduced. This gives a coincidental increase in system efficiency, which is the basis of growing stability and sustainability. Growing sustainability can be seen as an increase of ecological efficiency, which is applicable at all levels up to whole landscapes. Criteria for necessary changes in society and for the design of the measures that are necessary to restore sustainable landscapes and waters are derived.
Conservation of Natural Resources↗
Metamorphosis of plasma turbulence-shear-flow dynamics through a transcritical bifurcation.
The structural properties of an economical model for a confined plasma turbulence governor are investigated through bifurcation and stability analyses. A close relationship is demonstrated between the underlying bifurcation framework of the model and typical behavior associated with low- to high-confinement transitions such as shear-flow stabilization of turbulence and oscillatory collective action. In particular, the analysis evinces two types of discontinuous transition that are qualitatively distinct. One involves classical hysteresis, governed by viscous dissipation. The other is intrinsically oscillatory and nonhysteretic, and thus provides a model for the so-called dithering transitions that are frequently observed. This metamorphosis, or transformation, of the system dynamics is an important late side-effect of symmetry breaking, which manifests as an unusual nonsymmetric transcritical bifurcation induced by a significant shear-flow drive.
Journal Article↗
Effects of diversity on multiagent systems: minority games.
We consider a version of large population games whose agents compete for resources using strategies with adaptable preferences. The games can be used to model economic markets, ecosystems, or distributed control. Diversity of initial preferences of strategies is introduced by randomly assigning biases to the strategies of different agents. We find that diversity among the agents reduces their maladaptive behavior. We find interesting scaling relations with diversity for the variance and other parameters such as the convergence time, the fraction of fickle agents, and the variance of wealth, illustrating their dynamical origin. When diversity increases, the scaling dynamics is modified by kinetic sampling and waiting effects. Analyses yield excellent agreement with simulations.
Journal Article↗
Modeling the health care costs of geriatric inpatients.
This paper extends a method for modeling the survival of patients in hospitals to allow the expected cost to be estimated for the patients' accumulated duration of time in care. An extension of Bayesian network (BN) theory has previously been developed to model patients' survival time in hospitals with respect to the graphical and probabilistic representation of the interrelationships between the patients' clinical variables. Unlike previous BN techniques, this extended model can accommodate continuous times that are skewed in nature. This paper presents the theory behind such an approach and extends it by attaching a cost variable to the survival times, enabling the costing and efficient management of groups of patients in hospitals. An application of the model is illustrated by considering a group of 4260 patients admitted into the geriatric department of a U.K. hospital between 1994-1997. Results are derived for the distribution for their length of stay in the hospital and associated costs. The model's practical use is highlighted by illustrating how hospital managers could benefit using such a method for investigating the influence of future decisions and policy changes on the hospital's expenditure.
Computer Simulation↗
Multiperiod cellular network design via price-influenced simulated annealing (PISA).
Cellular telecommunications systems tend to be more flexible than traditional ones. As a result, traditional approaches to telecommunications network design are often inappropriate for the design of cellular networks, and approaches that explicitly incorporate the increased flexibility into the design process need to be developed. This paper presents one such multiperiod cellular network design problem and solves it via a hybrid heuristic that incorporates ideas from linear programming (LP) and simulated annealing (SA). Extensive computational results comparing the performance of the heuristic with the lower bound obtained from the LP relaxation are presented. These results indicate that this price-influenced simulated annealing (PISA) procedure is extremely efficient, consistently providing solutions with average gaps of 0.30% or less in fewer than 30 s.
Cell Phone↗
A functional-dependencies-based Bayesian networks learning method and its application in a mobile commerce system.
This paper presents a new method for learning Bayesian networks from functional dependencies (FD) and third normal form (3NF) tables in relational databases. The method sets up a linkage between the theory of relational databases and probabilistic reasoning models, which is interesting and useful especially when data are incomplete and inaccurate. The effectiveness and practicability of the proposed method is demonstrated by its implementation in a mobile commerce system.
Algorithms↗
Inside the sausage factory: improving estimates of the effects of health insurance expansion proposals.
The fate of a proposal to expand health insurance is influenced by predictions of the proposal's effects on the number of newly insured and the cost of new coverage. Estimates vary widely, for reasons that are often hard to discern and evaluate. This article describes and compares the frameworks and parameters used for insurance modeling. It examines conventions and controversies surrounding a series of modeling parameters: how individuals respond to a change in the price of coverage, the extent of participation in a new plan by those already privately insured, firms' behavior, and the value of public versus private coverage. The article also suggests ways of making models more transparent and proposes "reference case" guidelines for modelers so that consumers can compare modeling results.
Fees and Charges↗