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PubMed2006

A global socio-economic-medico-legal model for the sustainability of longitudinal electronic health records. Part 1.

OBJECTIVES: This paper pursues the challenge of sustaining lifetime electronic health records (EHRs) based on a comprehensive socio-economic-medico-legal model. The notion of a lifetime EHR extends the emerging concept of a longitudinal and cross-institutional EHR and is invaluable information for increasing patient safety and quality of care. METHODS: The challenge is how to compile and sustain a coherent EHR across the lifetime of an individual. Several existing and hypothetical models are described, analyzed and compared in an attempt to suggest a preferred approach. RESULTS: The vision is that lifetime EHRs should be sustained by new players in the healthcare arena, who will function as independent health record banks (IHRBs). Multiple competing IHRBs would be established and regulated following preemptive legislation. They should be neither owned by healthcare providers nor by health insurer/payers or government agencies. The new legislation should also stipulate that the records located in these banks be considered the medico-legal copies of an individual's records, and that healthcare providers no longer serve as the legal record keepers. CONCLUSIONS: The proposed model is not centered on any of the current players in the field; instead, it is focussed on the objective service of sustaining individual EHRs, much like financial banks maintain and manage financial assets. This revolutionary structure provides two main benefits: 1) Healthcare organizations will be able to cut the costs of long-term record keeping, and 2) healthcare providers will be able to provide better care based on the availability of a lifelong EHR of their new patients.

Humans↗
PubMed2006

A global socio-economic-medico-legal model for the sustainability of longitudinal electronic health records - part 2.

OBJECTIVES: This paper pursues the challenge of sustaining lifetime electronic health records (EHRs) based on a comprehensive socio-economic-medico-legal model. The notion of a lifetime EHR extends the emerging concept of a longitudinal and cross-institutional EHR and is invaluable information for increasing patient safety and quality of care. METHODS: The challenge is how to compile and sustain a coherent EHR across the lifetime of an individual. Several existing and hypothetical models are described, analyzed and compared in an attempt to suggest a preferred approach. RESULTS: The vision is that lifetime EHRs should be sustained by new players in the healthcare arena, who will function as independent health record banks (IHRBs). Multiple competing IHRBs would be established and regulated following preemptive legislation. They should be neither owned by healthcare providers nor by health insurer/payers or government agencies. The new legislation should also stipulate that the records located in these banks be considered the medico-legal copies of an individual's records, and that healthcare providers no longer serve as the legal record keepers. CONCLUSIONS: The proposed model is not centered on any of the current players in the field; instead, it is focussed on the objective service of sustaining individual EHRs, much like financial banks maintain and manage financial assets. This revolutionary structure provides two main benefits: 1) Healthcare organizations will be able to cut the costs of long-term record keeping, and 2) healthcare providers will be able to provide better care based on the availability of a lifelong EHR of their new patients.

Humans↗
PubMed1982

A model for the economical encoding of the visual image in cerebral cortex.

We propose a model for the first stage of the cortical transformation of the visual image based on the principle that the cortex encodes the information with the minimum number of channels mathematically needed. We restrict our model to be consistent with the data on size adaptations, the known relationships of acuity and the inverse of magnification factor with eccentricity, and the electrophysiological findings on the physiological uniformity of the striate cortex. Assuming that each hypercolumn analyzes a limited spatial domain, we apply the sampling theorem to show that only 16 channels, composed of 4 sizes, are needed for dimension. The extension to 2 dimensions leads to a possible scheme for the number, spacing, and orientational disposition of the elements, together with predictions about the number of inputs from the eyes and the total number of hypercolumns. Since all these predictions are consistent with physical and neural estimates, we conclude that the cortex may analyze the image along the lines we suggest.

Cerebral Cortex↗
PubMed2005

A partial budget model to estimate economic benefits of lactational treatment of subclinical Staphylococcus aureus mastitis.

Subclinical Staphylococcus aureus mastitis is rarely treated during lactation because it is widely believed to be uneconomical, although there are no economic studies that support this view. Partial budgeting was used to develop a deterministic simulation model to estimate the net cost or benefit of antibiotic treatment of subclinical S. aureus mastitis during lactation. Direct and indirect effects of treatment were taken into account, including prevention of clinical flare-ups and contagious transmission. Input variables were based on literature and on 2003-2004 prices in the Netherlands. When contagious transmission of S. aureus was likely (reproductive ratio R = 5.3), 3- and 8-d treatments resulted in an average net profit of 95.62 euros and 142.42 euros, respectively, compared with no treatment. When the probability of S. aureus transmission was low (R = 0.32), the average economic benefit of 3- or 8-d treatment was -21.12 euros and -57.70 euros, respectively. On low-transmission farms, 3-d treatment was profitable when the appropriate cows were selected for treatment using known risk factors for cure. Sensitivity analysis showed that the 6 most influential input variables in the model were chance of bacteriological cure, R, probability of culling, retention pay-off, and cost of antibiotics and bacterial culture. Although the economic outcome of lactational treatment of subclinical S. aureus mastitis is highly herd-, cow-, and strain-dependent, treatment is economically justified in many situations.

Animals↗
PubMed2001

The psychological sense of economic hardship: measurement models, validity, and cross-ethnic equivalence for urban families.

Poverty is a community stressor that disproportionally affects ethnic minority families. One aspect of programmatic research on poverty focuses on the psychological sense of economic hardship. In a study of 319 African American, European American, and Mexican American urban families, parents completed objective measures of economic status and scales of perceived economic hardship that were adapted from previous research. Measurement models identified a coherent construct of psychological sense of economic hardship that was essentially equivalent for mothers and fathers, English- and Spanish-speaking Mexican Americans, and the 3 ethnic groups. In support of the validity of this construct, relations between objective indicators of economic status and perceived economic hardship showed equivalence across these same groups.

Adolescent↗
PubMed1991

Establishing a family practice: a model to determine economic feasibility.

The availability of adequate health care is a major concern of urban and rural citizens. Community leaders and hospital administrators attempting to recruit family physicians and health care providers considering a specific community need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, a detailed survey of family practices geographically dispersed throughout Oklahoma was conducted in 1989. Data collected from family physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 12 months. Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing a family practice in a specific community. This model can be used to project the number of visits a community can generate for a prospective family physician, as well as the direct and indirect costs, gross revenue, and net income of the practice.

Adolescent↗
PubMed2001

Economic decision analysis model of screening for lung cancer.

The objective of this study was to evaluate the potential clinical and economic implications of an annual lung cancer screening programme based on helical computed tomography (CT). A decision analysis model was created using combined data from the Surveillance, Epidemiology and End Results (SEER) registry public-use database and published results from the Early Lung Cancer Action Project (ELCAP). We found that under optimal conditions in a high risk cohort of patients between 60 and 74 years of age, annual lung cancer screening over a period of 5 years appears to be cost effective at approximately $19000 per life year saved. A sensitivity analysis of the model to account for a 1-year decrease in survival benefit and changes in assumptions for incidence rate and costs generated cost effectiveness estimates ranging from approximately $10800 to $62000 per life year saved. Based on the assumptions embedded in this model, annual screening of high risk elderly patients for lung cancer may be cost effective under optimal conditions, but longer term data are needed to confirm if this will be borne out in practice.

Aged↗
PubMed1994

Establishing an internal medicine practice: a model to determine economic feasibility.

To make informed career decisions, physicians must acquire a basic knowledge in medical management and health care economics as they evaluate the potential survival and growth of a primary care practice. Health care providers considering a specific community and local leaders and hospital administrators attempting to recruit internal medicine physicians need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, we conducted a detailed survey of nonmetropolitan internal medicine generalists and primary care physicians. Data collected from internal medicine physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 24 months. Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing an internal medicine practice in a specific community. This model can be used to project the number of adult primary care visits a community can generate for a prospective physician, as well as to estimate the direct and indirect costs, annualized capital costs, gross revenue, and net income of the practice.

Adolescent↗
PubMedDate not supplied

Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research.

Medical, ethical, and societal concerns about costs, access, and quality of care are causing health care practitioners to consider a more comprehensive model for medical decision making. Consequently, interest in research to assess the outcomes of health care has been increasing. The purpose of this paper is to explicate a theoretical framework for identifying, collecting, and using outcomes data to assess the value of pharmaceutical treatment alternatives. Causal relationships between disease, health outcomes, and decisions about medical care interventions (eg, treatment with pharmaceutical products and services) are proposed to address limitations inherent in the traditional medical decision-making model. The Economic, Clinical, and Humanistic Outcomes (ECHO) model depicts the value of a pharmaceutical product or service as a combination of traditional clinical-based outcomes with more contemporary measures of economic efficiency and quality. This integrated approach provides a theoretical basis for considering potential trade-offs among economic, clinical, and humanistic variables in optimizing the allocation of health care resources. The ECHO model is a preliminary step to modeling outcomes from pharmaceutical treatments and services. Data collection instruments need to be developed, and the proposed relationships among outcomes variables should be established empirically. The ECHO model should assist health services researchers in planning, conducting, and evaluating pharmaceutical products and services from a multidimensional perspective.

Causality↗
PubMed2004

[The costs of asthma in France: an economic analysis by a Markov model].

INTRODUCTION: In France about 3.5 million people suffer from asthma, with an estimated annual cost of 1.5 billion euros. Few data on the components of the cost are available. To develop a medico-economic model to identify the mean annual cost of a patient with asthma together with the components of the cost and the consequences of different modalities of management (out-patient and in-patient). METHODS: A first degree homogeneous Markov model was constructed, based on published data, to identify the different states of health of asthmatic patients, their development and probabilities of change from one to another. RESULTS: The mean annual cost of asthma is 631 +/- 299 euros; 298 euros for stable patients, 1,052 for those who have at least one acute attack and 3,811 for those hospitalised. Actions leading to better control of the disease in the community (prevention and management of attacks) would produce a larger reduction in mean costs than actions undertaken in patients seen as an emergency or admitted to hospital. CONCLUSIONS: From the point of view of society better control of asthma in the community is the most effective strategy to reduce expenditure.

Asthma↗
PubMedDate not supplied

Improving the quality of data used in environmental economics research.

Valuing environmental goods through contingent valuation and through other survey techniques is difficult because of the lack of traditional markets for those goods. EPA provides leadership in overcoming these challenges, using focus groups, workshops, handbooks, and teams of distinguished economists to obtain more reliable economic data from the surveys. Agency economists have provided leadership in employing production economics tools to identify win-win approaches to solve pervasive and neglected environmental problems. In addition, we exploit the speed of sophisticated computers, building field runoff models into economic models and aggregating results from tens of thousands of field sites. These very flexible models provide much more credible, site-specific analyses than previous models, and they offer flexible and efficient remedies to support Total Maximum Daily Loads and other new programs.

Agriculture↗
PubMed1988

Economic costs and benefits of treating mild hypertension: results from a cross-sectional model.

The economic value of treating mild hypertension in New Zealand was analysed using computer-based models which compared the major costs and benefits of treatment for 1 year in a notional population (n = 250,000) comprising equal numbers of middle-aged (45-65 yr) and elderly (greater than 65 yr) patients. The costs were those of the drugs and medical charges plus those of incidental illness in life years added by treatment. The benefits were increased productive output obtained by lower mortality and savings due to stroke treatment avoided in treated patients. Calculations were based on the age-specific risks attributable to hypertension found in observational studies, and on the actual benefits of treatment found in two clinical studies. Two models were studied. In model 1, not all hypertensive patients are diagnosed and not all treated patients are at risk. There was a large net cost with all measures of risk and/or benefit, varying from $80.5 m to $40.0 m. Model 2 assumed that all and only patients with hypertension are treated, and the corresponding figures were $71.4 m to -$9.6 m (ie, net benefit of $9.6 m), respectively. The net benefit was obtained only at the highest values of risk and risk reversal, and was due mainly to increased productive output in treated patients. Models were also sensitive to other factors such as altered drug costs. Calculation of the net cost of treating hypertension requires accurate evaluation of the attributable risk.

Aged↗
PubMed2006

When does "economic man" dominate social behavior?

The canonical model in economics considers people to be rational and self-regarding. However, much evidence challenges this view, raising the question of when "Economic Man" dominates the outcome of social interactions, and when bounded rationality or other-regarding preferences dominate. Here we show that strategic incentives are the key to answering this question. A minority of self-regarding individuals can trigger a "noncooperative" aggregate outcome if their behavior generates incentives for the majority of other-regarding individuals to mimic the minority's behavior. Likewise, a minority of other-regarding individuals can generate a "cooperative" aggregate outcome if their behavior generates incentives for a majority of self-regarding people to behave cooperatively. Similarly, in strategic games, aggregate outcomes can be either far from or close to Nash equilibrium if players with high degrees of strategic thinking mimic or erase the effects of others who do very little strategic thinking. Recently developed theories of other-regarding preferences and bounded rationality explain these findings and provide better predictions of actual aggregate behavior than does traditional economic theory.

Competitive Behavior↗
PubMed1998

Malthus to Solow.

"A unified growth theory is developed that accounts for the roughly constant living standards displayed by world economies prior to 1800 as well as the growing living standards exhibited by modern industrial economies. Our theory also explains the industrial revolution, which is the transition from an era when per capita incomes are stagnant to one with sustained growth.... [The authors] use a standard growth model with...[several] technologies. The first, denoted the 'Malthus' technology, requires land, labor and reproducible capital as inputs. The second, denoted the 'Solow' technology, does not require land. [The authors] show that in the early stages of development, only the Malthus technology is used and, due to population growth, living standards are stagnant despite technological progress. Eventually, technological progress causes the Solow technology to become profitable and both technologies are employed. At this point, living standards improve since population growth has less influence on per capita income growth. In the limit, the economy behaves like a standard Solow growth model."

Demography↗