[Profile of the Emergency demand and influence of televised soccer games on an extra-hospital center in the Tafalla health care district. Navarre, Spain].

Science.gov (United States)

Pérez-Ciordia, Ignacio; Catalán Fabo, Francisca; Zalacain Nicolay, Fernando; Barriendo Antoñanzas, Maite; Solaegui Diaz de Guereñu, Ramón; Guillén Grima, Francisco

2003-01-01

The demand placed on both hospital as well as extrahospital emergency care units currently continues to increase at a growing rate. This study has a twofold objective: the quantification and study of the personal characteristics of the users who are demanding emergency care and assessing whether televised soccer games have any bearing on the utilization of emergency care services. A longitudinal descriptive study (9,723 users demanding care) and study of cases and controls (1,284 users demanding care) according to whether or not a soccer game was being televised by means of a logistic regression model. The associations were quantified by means of the odds ratio (OR). Those dealt with by telephone or in infirmaries were not included in the study. A total 10.6% of the demand involved home visits, 4.8% of this total having been sent to hospital. A total 13.3% of the demand corresponds to individuals visiting from other healthcare districts, a total of 65 being overusers of emergency care (8 or more visits). The month of August (32.3%). Sundays (44.56%) and the 12:00 p.m.-2:00 p.m. timeframe (8.38%) are the times when the greatest demand for care occurs, the differences being statistically significant. Televised soccer games were associated to a 19.8% (p emergency care units has been found to exist, a major part of the demand being concentrated at highly specific points in time. A major degree of care is provided to those visiting from outside their own healthcare districts. Television soccer game broadcasts is associated with the greater utilization of the emergency care services.

Factors influencing long term dynamics of health care supply and demand

NARCIS (Netherlands)

Smits, M.T.; Roos, E.; Pries-Heje, J.; Chiasson, M.; Wareham, J.; Busquets, X.; Valor, J.

2012-01-01

Governments and other policy makers use long-term planning models to support workforce planning decisions for regulating care markets and to ensure accurate balancing between care supply and demand. Our aim is to understand long-term effects of workforce planning decisions on care markets, in order

Health care demand elasticities by type of service.

Science.gov (United States)

Ellis, Randall P; Martins, Bruno; Zhu, Wenjia

2017-09-01

We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0.44), specialists visits (-0.32), MRIs (-0.29) and mental health/substance abuse (-0.26), and lower elasticities for prevention visits (-0.02) and emergency rooms (-0.04). Demand response is lower for children, in larger firms, among hourly waged employees, and for sicker people. Overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent. Copyright © 2017 Elsevier B.V. All rights reserved.

The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

Science.gov (United States)

Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

2017-03-15

Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager

[Patient-related complexity in nursing care - Collective case studies in the acute care hospital].

Science.gov (United States)

Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn

2018-06-04

Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

[Health care economics, uncertainty and physician-induced demand].

Science.gov (United States)

Domenighetti, G; Casabianca, A

1995-10-21

The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

Burnout and connectedness in the job demands-resources model: studying palliative care volunteers and their families.

Science.gov (United States)

Huynh, Jasmine-Yan; Winefield, Anthony H; Xanthopoulou, Despoina; Metzer, Jacques C

2012-09-01

This study examined the role of burnout and connectedness in the job demands-resources (JD-R) model among palliative care volunteers. It was hypothesized that (a) exhaustion mediates the relationship between demands and depression, and between demands and retention; (b) cynicism mediates the relationship between resources and retention; and (c) connectedness mediates the relationship between resources and retention. Hypotheses were tested in 2 separate analyses: structural equation modeling (SEM) and path analyses. The first was based on volunteer self-reports (N = 204), while the second analysis concerned matched data from volunteers and their family members (N = 99). While strong support was found for cynicism and connectedness as mediators in both types of analyses, this was not altogether the case for exhaustion. Implications of these findings for the JD-R model and volunteer organizations are discussed.

Increased care demand and medical costs after falls in nursing homes: A Delphi study.

Science.gov (United States)

Sterke, Carolyn Shanty; Panneman, Martien J; Erasmus, Vicki; Polinder, Suzanne; van Beeck, Ed F

2018-04-21

To estimate the increased care demand and medical costs caused by falls in nursing homes. There is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence-based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding. A three-round Delphi study. A panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best-case, a typical-case and a worst-case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages. In case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst-case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170. Falls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls. This study could aid decision-making on investing in appropriate implementation of falls prevention interventions in nursing homes. © 2018 John Wiley & Sons Ltd.

Planning for subacute care: predicting demand using acute activity data.

Science.gov (United States)

Green, Janette P; McNamee, Jennifer P; Kobel, Conrad; Seraji, Md Habibur R; Lawrence, Suanne J

2016-01-01

Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) care following acute in-patient episodes provided in Australian hospitals. Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre. Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs. Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning. What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of subacute care, it is timely to find improved methods of estimating demand for this type of care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions. What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the

[Municipal planning of care services between competition neutrality and demand planning. An example of care structure planning in Rhineland-Palatinate].

Science.gov (United States)

Klie, T; Pfundstein, T

2010-04-01

In times of demographic and social change, it is increasingly important to ensure the availability of care services to cover the growing demand. With the implementation of the German long-term insurance act in 1994, the responsibility of states and municipalities was maintained; however, given the long-term care legislation's market orientation and competition neutrality, the classic instruments for demand planning and supervision of infrastructure developments were lost. This leads to new challenges for states and municipalities: their conventional objective-oriented planning lacks professional and juridical legitimization. Calculations of requirements must relate to methodology and professional expertise. In order to exercise their influence on infrastructure development, instruments of demand planning other than subsidization are required. Using the example of Rheinland-Pfalz (Rhineland-Palatinate) and the newly implemented care structure planning, the concept of care monitoring is introduced, and instruments to influence infrastructure development are outlined.

Estimation of the Demand for Hospital Care After a Possible High-Magnitude Earthquake in the City of Lima, Peru.

Science.gov (United States)

Bambarén, Celso; Uyen, Angela; Rodriguez, Miguel

2017-02-01

Introduction A model prepared by National Civil Defense (INDECI; Lima, Peru) estimated that an earthquake with an intensity of 8.0 Mw in front of the central coast of Peru would result in 51,019 deaths and 686,105 injured in districts of Metropolitan Lima and Callao. Using this information as a base, a study was designed to determine the characteristics of the demand for treatment in public hospitals and to estimate gaps in care in the hours immediately after such an event. A probabilistic model was designed that included the following variables: demand for hospital care; time of arrival at the hospitals; type of medical treatment; reason for hospital admission; and the need for specialized care like hemodialysis, blood transfusions, and surgical procedures. The values for these variables were obtained through a literature search of the databases of the MEDLINE medical bibliography, the Cochrane and SciELO libraries, and Google Scholar for information on earthquakes over the last 30 years of over magnitude 6.0 on the moment magnitude scale. If a high-magnitude earthquake were to occur in Lima, it was estimated that between 23,328 and 178,387 injured would go to hospitals, of which between 4,666 and 121,303 would require inpatient care, while between 18,662 and 57,084 could be treated as outpatients. It was estimated that there would be an average of 8,768 cases of crush syndrome and 54,217 cases of other health problems. Enough blood would be required for 8,761 wounded in the first 24 hours. Furthermore, it was expected that there would be a deficit of hospital beds and operating theaters due to the high demand. Sudden and violent disasters, such as earthquakes, represent significant challenges for health systems and services. This study shows the deficit of preparation and capacity to respond to a possible high-magnitude earthquake. The study also showed there are not enough resources to face mega-disasters, especially in large cities. Bambarén C , Uyen A

Explaining regional variation in home care use by demand and supply variables.

Science.gov (United States)

van Noort, Olivier; Schotanus, Fredo; van de Klundert, Joris; Telgen, Jan

2018-02-01

In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17-23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services. Copyright © 2017. Published by Elsevier B.V.

The impact of demand management strategies on parents’ decision-making for out-of-hours primary care: findings from a survey in The Netherlands

Science.gov (United States)

Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

2017-01-01

Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. Results The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; 95% CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; 95% CI 0.08 to 0.32). Overview of medical cost (OR 0.59; 95% CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; 95% CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Conclusion Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. PMID:28487458

The impact of demand management strategies on parents' decision-making for out-of-hours primary care: findings from a survey in The Netherlands.

Science.gov (United States)

Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

2017-05-09

To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Overweight and Obesity and the Demand for Primary Physician Care

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Greve, Jane

-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...

Effect of Health Insurance on Demand for Outpatient Medical Care in ...

African Journals Online (AJOL)

ahavugimana

objective of this paper is to examine factors influencing outpatient care demand in ..... Endogeneity of health insurance arises because the decision to purchase health ... insurance plan, or by purchasing privately a generous coverage. Existing ...

Demand and supply-based operating modes--a framework for analyzing health care service production.

Science.gov (United States)

Lillrank, Paul; Groop, P Johan; Malmström, Tomi J

2010-12-01

The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. The arguments in this article apply new reasoning to the previous literature. The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply-based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Job demands-resources predicting burnout and work engagement among Belgian home health care nurses: A cross-sectional study.

Science.gov (United States)

Vander Elst, Tinne; Cavents, Carolien; Daneels, Katrien; Johannik, Kristien; Baillien, Elfi; Van den Broeck, Anja; Godderis, Lode

A better knowledge of the job aspects that may predict home health care nurses' burnout and work engagement is important in view of stress prevention and health promotion. The Job Demands-Resources model predicts that job demands and resources relate to burnout and work engagement but has not previously been tested in the specific context of home health care nursing. The present study offers a comprehensive test of the Job-Demands Resources model in home health care nursing. We investigate the main and interaction effects of distinctive job demands (workload, emotional demands and aggression) and resources (autonomy, social support and learning opportunities) on burnout and work engagement. Analyses were conducted using cross-sectional data from 675 Belgian home health care nurses, who participated in a voluntary and anonymous survey. The results show that workload and emotional demands were positively associated with burnout, whereas aggression was unrelated to burnout. All job resources were associated with higher levels of work engagement and lower levels of burnout. In addition, social support buffered the positive relationship between workload and burnout. Home health care organizations should invest in dealing with workload and emotional demands and stimulating the job resources under study to reduce the risk of burnout and increase their nurses' work engagement. Copyright © 2016 Elsevier Inc. All rights reserved.

Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

Science.gov (United States)

Dunn, Abe

2016-07-01

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.

Health care on demand: four telehealth priorities for 2016.

Science.gov (United States)

Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

2016-01-01

Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term.

A multigroup analysis of the job demands-resources model in four home care organizations

NARCIS (Netherlands)

Bakker, A.B.; Demerouti, E.; Taris, A.W. (Toon); Schaufeli, W.B.; Schreurs, Paul J.G.

2003-01-01

The job demands-resources (JD-R) model was tested in a study among 3,092 employees working in 1 of 4 different home care organizations. The central assumption in the model is that burnout develops when certain job demands are high and when job resources are limited because such negative working

Preliminary energy demand studies for Ireland: base case and high case for 1980, 1985 and 1990

Energy Technology Data Exchange (ETDEWEB)

Henry, E W

1981-01-01

The framework of the Base Case and the High Case for 1990 for Ireland, related to the demand modules of the medium-term European Communities (EC) Energy Model, is described. The modules are: Multi-national Macre-economic Module (EURECA); National Input-Output Model (EXPLOR); and National Energy Demand Model (EDM). The final results of the EXPLOR and EDM are described; one set related to the Base Case and the other related to the High Case. The forecast or projection is termed Base Case because oil prices are assumed to increase with general price inflation, at the same rate. The other forecast is termed High Case because oil prices are assumed to increase at 5% per year more rapidly than general price inflation. The EXPLOR-EDM methodology is described. The lack of data on energy price elasticities for Ireland is noted. A comparison of the Base Case with the High Case is made. (MCW)

Influence of the demand information quality on planning process accuracy in supply chain. Case studies

Directory of Open Access Journals (Sweden)

Natalia Szozda

2013-06-01

Full Text Available Background: Identification and analysis of factors that affect the accuracy of demand planning process across the supply chain is one of the most important problems which influence the effectiveness of its material and information flows. Material and methods: On the basis of demand planning process investigation authors define the main elements affecting the right supply chain performance level and investigate the possible connections between demand information quality and demand planning process accuracy. Later, an overview of some recent developments in the analyzed research area is provided. Results: Based on the literature review, there is described the defined factors impact on the accuracy of demand plan in each echelon for case companies. There are considered three cases. The examples illustrate supply chains of different manufacturing companies. The focus is placed on demand planning across the supply chains. The issue of determining the accuracy of future sales plans in each echelon of supply chains and factors affecting it are raised. Taking into account the case companies demand planning process analyses, there are defined possible quality measures, that are possible to be used when forecasting the customer demand. Conclusions: One of the most important and difficult planning area in the companies is becoming planning demand. Errors in planning are reflected not just in the business resource planning but also in the entire supply chain. Presented cases show that many factors affect the proper demand planning process in the supply chain, like e.g.  information technologies, lead-time, or number of supplied materials. As it can be seen from the case studies, the model of collecting information from the market plays an important role in the demand planning process.

Acceleration in the care of older adults: new demands as predictors of employee burnout and engagement.

Science.gov (United States)

Kubicek, Bettina; Korunka, Christian; Ulferts, Heike

2013-07-01

This paper introduces the concept of acceleration-related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well-being. Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration-related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job-related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well-being of employees. Survey. Between March-June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration-related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication). Hierarchical regression analyses show that acceleration-related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration-related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration-related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion. Results illustrate that new demands resulting from social acceleration generate potential challenges for on-the-job learning and potential risks to employees' health and well-being. © 2012 Blackwell Publishing Ltd.

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

OpenAIRE

Montgomery Anthony; Panagopoulou Efharis; Costa Patricia

2014-01-01

Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demand...

Consumer Demand on Halal Cosmetics and Personal Care Products in Indonesia

Directory of Open Access Journals (Sweden)

Muniaty Aisyah

2016-12-01

Full Text Available This research aims to analyze the influential factors involved in Moslem consumers’ decision to purchase halal cosmetics and personal care products in Indonesia by using the Theory of Planned Behavior. 100 questionnaires were analyzed using Structural Equation Modeling, collected from respondents of female consumers who purchased Wardah cosmetics and personal care products in South Jakarta and South Tangerang. The findings show that attitude, subjective norm, perceived behavioral control and purchase intention are positively related to the consumers’ decision to purchase halal cosmetics and personal care products. By addressing the consumers’ traits that can predict halal cosmetics and personal care products necessity, marketers could generate proper marketing strategies to validate consumers’ demand which in turn will stimulate the growth of halal products industry in Indonesia.DOI: 10.15408/aiq.v9i1.1867

Measuring performance in health care: case-mix adjustment by boosted decision trees.

Science.gov (United States)

Neumann, Anke; Holstein, Josiane; Le Gall, Jean-Roger; Lepage, Eric

2004-10-01

The purpose of this paper is to investigate the suitability of boosted decision trees for the case-mix adjustment involved in comparing the performance of various health care entities. First, we present logistic regression, decision trees, and boosted decision trees in a unified framework. Second, we study in detail their application for two common performance indicators, the mortality rate in intensive care and the rate of potentially avoidable hospital readmissions. For both examples the technique of boosting decision trees outperformed standard prognostic models, in particular linear logistic regression models, with regard to predictive power. On the other hand, boosting decision trees was computationally demanding and the resulting models were rather complex and needed additional tools for interpretation. Boosting decision trees represents a powerful tool for case-mix adjustment in health care performance measurement. Depending on the specific priorities set in each context, the gain in predictive power might compensate for the inconvenience in the use of boosted decision trees.

The compatibility of future doctors' career intentions with changing health care demands

NARCIS (Netherlands)

van Offenbeek, M.A.G.; Kiewiet, D.J.; Oosterhuis, M.

Background: In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of

Demands and Job Resources in the Child Care Workforce: Swiss Lead Teacher and Assistant Teacher Assessments

Science.gov (United States)

Bloechliger, Olivia R.; Bauer, Georg F.

2016-01-01

Center-based child care has been struggling with poor health and high turnover rates of child care staff and their adverse impact on care quality for decades. Yet little is known about personal and structural antecedents of job resources and job demands that are valid predictors of health and turnover in the child care workforce. Research…

Out-of-hours demand in primary care: frequency, mode of contact and reasons for encounter in Switzerland.

Science.gov (United States)

Huber, Carola A; Rosemann, Thomas; Zoller, Marco; Eichler, Klaus; Senn, Oliver

2011-02-01

To investigate the demand for traditional out-of-hours general practitioner (GP) emergency care in Switzerland including GPs' satisfaction and reasons for encounter (RFE). During a 2-month period (2009), a questionnaire-based, cross-sectional study was performed in GPs participating in the mandatory out-of-hours service in the city of Zurich, Switzerland. The number and mode of patient contacts were assessed to investigate the demand for GP care in traditional out-of-hours services. GPs and patient characteristics, including RFE according to the International Classification of Primary Care, were noted. Descriptive statistics and non-parametric tests were conducted. Out of the 295 out-of-hours episodes during the study period, 148 (50%) duty periods were documented by a total of 93 GPs (75% men) with a mean (SD) age of 48.0 (6.2) years. The median (interquartile range) number of out-of-hours contacts was 5 (3-8) and the demand for home visits was significantly more common compared with practice and telephone consultations. A total of 112 different RFEs were responsible for the 382 documented patient contacts with fever accounting for the most common complaint (13.9%). Although 80% of GPs agreed to be satisfied overall with their profession as primary care provider, 57.6% among them were dissatisfied with the current out-of-hours service. Inappropriate payment and interference with their daily work in practice were most frequently reported. Our findings indicate that there is still strong patient demand for out-of-hours care with special need for home visits, suggesting that new organizational models such as integrating GPs into emergency care may not be an appropriate approach for all patients. Therefore, the ongoing reorganization of the out-of-hours-service in many health care systems has to be evaluated carefully in order not to miss important patient needs. © 2010 Blackwell Publishing Ltd.

Balanced scorecard application in the health care industry: a case study.

Science.gov (United States)

Kocakülâh, Mehmet C; Austill, A David

2007-01-01

Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry.

Ethics consultation on demand: concepts, practical experiences and a case study.

Science.gov (United States)

Reiter-Theil, S

2000-06-01

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study.

Market Design for Rapid Demand Response - The Case of Kenya

OpenAIRE

Kurt Nielsen; Tseganesh Wubale Tamirat

2014-01-01

We suggest a market design for rapid demand response in electricity markets. The solution consists of remotely controlled switches, meters, forecasting models as well as a flexible auction market to set prices and select endusers job by job. The auction market motivates truth-telling and makes it simple to involve the endusers in advance and to activate demand response immediately. The collective solution is analyzed and economic simulations are conducted for the case of Kenya. Kenya has been...

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

Science.gov (United States)

Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

2012-01-01

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

Intra-household work timing: the effect on joint activities and the demand for child care

NARCIS (Netherlands)

van Klaveren, C.; Maassen van den Brink, H.; van Praag, B.

2011-01-01

This study examines whether couples time their work hours and how this work timing influences child care demand and the time that spouses jointly spend on leisure, household chores, and child care. By using an innovative matching strategy, this study identifies the timing of work hours that cannot

Survey on demand of the aged people for college volunteers in home nursing care service

Directory of Open Access Journals (Sweden)

Tian Meng

2017-01-01

Full Text Available Objects: To study the demand of the aged community residents for college volunteers in home nursing care service and its influence factors. Methods: Questionnaires on the aged residents’ expectation and requirements for college volunteers in home nursing care was prepared on basis of studies of reference books, study materials and pre-investigation, and then the questionnaires was completed by means of convenient sampling of 200 aged residents. Results The demand and expectation of the elderly for college volunteers in health care and spiritual comfort was strong. The old people who have more children, living alone and often feel lonely are more likely to need college volunteers. Conclusions: Volunteers should be arranged reasonably according to the needs of the aged people, and priority should be given to those who have more children, living alone and often feel lonely.

Economic Analysis of Urban Fuelwood Demand - The case of Harare in Zimbabwe

NARCIS (Netherlands)

Chambwera, M.

2004-01-01

This study carries out an economic analysis of the demand for fuelwood in urban areas using Harare, the capital city of Zimbabwe, as a case study. The demand for fuelwood in urban areas is one of the causes of several environmental and health problems in Africa, where the up to 90% of energy

Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units.

Science.gov (United States)

Zwijsen, S A; Gerritsen, D L; Eefsting, J A; Smalbrugge, M; Hertogh, C M P M; Pot, A M

2015-01-01

Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to diminishing the challenging behaviour of residents, improve job satisfaction and reduce the care staff's feelings of burnout. To determine the effects of a care programme for the challenging behaviour of nursing home residents with dementia on the burnout, job satisfaction and job demands of care staff. The care programme was implemented according to a stepped wedge design in which care units were randomly divided over five groups with different time points of starting with implementation. 17 Dutch dementia special care units. Care staff members of the 17 units. The care programme consists of an education package and of various structured assessment tools that guide professionals through the multidisciplinary detection, analysis, treatment and evaluation of treatment of challenging behaviour. Burnout, job satisfaction and job demands were measured before implementation, halfway through the implementation process and after all the care units had implemented the care programme. Burnout was measured with the Dutch version of the Maslach burnout inventory (UBOS-C, three subscales); job satisfaction and job demands were measured with subscales of the Leiden Quality of Work Questionnaire. Mixed model analyses were used to determine effects. Care staff could not be blinded for the intervention. Of the 1441 questionnaires, 645 were returned (response 45%, 318 control measurements, 327 intervention measurements) by 380 unique care staff members. Significant effects were found on job satisfaction (0.93, 95% CI 0.48-1.38). On the other outcomes, no significant changes in the scores were found. Positive effects of using the Grip on Challenging behaviour care programme were found on job

[Implementation of nurse demand managment in primary health care service providers in Catalonia].

Science.gov (United States)

Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma

2017-11-01

To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Emotional job demands and the role of matching job resources: a cross-sectional survey study among health care workers.

Science.gov (United States)

de Jonge, Jan; Le Blanc, Pascale M; Peeters, Maria C W; Noordam, Hanneke

2008-10-01

Research on emotional labour in health care work has not yet revealed under what conditions emotional job demands have an impact on employee health and well-being. There is a need for more theory to unveil the black box of emotional labour processes. To test the moderating role of matching (i.e. emotional) and non-matching (i.e. cognitive) job resources in the relation between emotional job demands and employee health/well-being (i.e. emotional exhaustion, employee creativity, and work motivation). A cross-sectional survey with anonymous questionnaires was conducted. A large organization for residential elderly care with eight locations in an urban area in the Netherlands. Questionnaires were distributed to 1259 health care workers, of which 826 people returned the questionnaire (66% response rate). In addition to descriptive statistics, multivariate multiple regression analysis (LISREL 8.54) with cross-validation was conducted. Findings showed that emotional job resources moderated the relation between emotional job demands and health/well-being outcomes. Firstly, emotional job resources were able to moderate the relation between emotional job demands and emotional exhaustion. Secondly, both emotional job resources and, to a lesser extent, cognitive job resources were able to moderate the relation between emotional job demands and positive well-being outcomes (i.e. employee creativity and work motivation). Finally, cross-validation showed that parameter estimates did not vary across subsamples. Job resources could compensate for resources lost through meeting the requirements of emotional job demands, thereby reducing stress-reactions and increasing well-being. Providing health care workers with more, preferably matching, job resources could make emotional job demands less stressful, and even stimulating and challenging. Future longitudinal studies should investigate the interplay of emotional job demands and (matching) job resources more profoundly.

Explaining worker strain and learning: how important are emotional job demands?

Science.gov (United States)

Taris, Toon W; Schreurs, Paul J G

2009-05-01

This study examined the added value of emotional job demands in explaining worker well-being, relative to the effects of task characteristics, such as quantitative job demands, job control, and coworker support. Emotional job demands were expected to account for an additional proportion of the variance in well-being. Cross-sectional data were obtained from 11,361 female Dutch home care employees. Hierarchical stepwise regression analysis demonstrated that low control, low support and high quantitative demands were generally associated with lower well-being (as measured in terms of emotional exhaustion, dedication, professional accomplishment and learning). Moreover, high emotional demands were in three out of four cases significantly associated with adverse well-being, in these cases accounting for an additional 1-6% of the variance in the outcome variables. In three out of eight cases the main effects of emotional demands on well-being were qualified by support and control, such that high control and high support either buffered the adverse effects of high emotional demands on well-being or increased the positive effects thereof. All in all, high emotional demands are as important a risk factor for worker well-being as well-established concepts like low job control and high quantitative job demands.

Health Literacy Demands of Patient-Reported Evaluation Tools in Orthopedics: A Mixed-Methods Case Study.

Science.gov (United States)

Hadden, Kristie; Prince, Latrina Y; Barnes, C Lowry

In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.

Overweight and Obesity Among Wage-Earners and the Demand for Primary Physician Care

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Greve, Jane

-earners aged 25-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight or obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent...

When Health Care Insurance Does Not Make A Difference – The Case of Health Care ‘Made in China’

NARCIS (Netherlands)

H.P. van Dalen (Hendrik)

2006-01-01

textabstractDoes medical insurance affect health care demand and in the end contribute to improvements in the health status? Evidence for China for the year 2004, by means of the China Health and Nutrition Survey (CHNS), shows that health insurance does not affect health care demand in a significant

The construction of a decision tool to analyse local demand and local supply for GP care using a synthetic estimation model.

Science.gov (United States)

de Graaf-Ruizendaal, Willemijn A; de Bakker, Dinny H

2013-10-27

This study addresses the growing academic and policy interest in the appropriate provision of local healthcare services to the healthcare needs of local populations to increase health status and decrease healthcare costs. However, for most local areas information on the demand for primary care and supply is missing. The research goal is to examine the construction of a decision tool which enables healthcare planners to analyse local supply and demand in order to arrive at a better match. National sample-based medical record data of general practitioners (GPs) were used to predict the local demand for GP care based on local populations using a synthetic estimation technique. Next, the surplus or deficit in local GP supply were calculated using the national GP registry. Subsequently, a dynamic internet tool was built to present demand, supply and the confrontation between supply and demand regarding GP care for local areas and their surroundings in the Netherlands. Regression analysis showed a significant relationship between sociodemographic predictors of postcode areas and GP consultation time (F [14, 269,467] = 2,852.24; P 1,000 inhabitants in the Netherlands covering 97% of the total population. Confronting these estimated demand figures with the actual GP supply resulted in the average GP workload and the number of full-time equivalent (FTE) GP too much/too few for local areas to cover the demand for GP care. An estimated shortage of one FTE GP or more was prevalent in about 19% of the postcode areas with >1,000 inhabitants if the surrounding postcode areas were taken into consideration. Underserved areas were mainly found in rural regions. The constructed decision tool is freely accessible on the Internet and can be used as a starting point in the discussion on primary care service provision in local communities and it can make a considerable contribution to a primary care system which provides care when and where people need it.

[Job Demands-Resources, exhaustion and work engagement in a long-term care institution].

Science.gov (United States)

Conway, P M; Neri, L; Campanini, P; Francioli, L; Camerino, D; Punzi, S; Fichera, G P; Costa, G

2012-01-01

In this study, we aimed at testing the main hypotheses of the Job Demands-Resources model (JD-R) in a sample of employees (n = 205, mainly healthcare workers) of a long-term care institution located in Northern Italy. Hierarchical linear regression analyses show that almost all job demands considered were significantly associated with higher general psycho-physical exhaustion (beta ranging from 0.14 to 0.29), whereas more unfavourable scores in all job resources were associated with lower work engagement (from -0.27 to -0.51). However, also significant cross-over associations were observed, mainly between job resources and exhaustion, with effect sizes comparable with those found for the relationships between job demands and exhaustion. Hence, our study only partially supports the JD-R model. Implications of results for work-related stress management are finally discussed.

Computerized health information and the demand for medical care.

Science.gov (United States)

Wagner, Todd H; Jimison, Holly B

2003-01-01

Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care. The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%. In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.

Forecasting demand for single-period products : A case study in the apparel industry

NARCIS (Netherlands)

Mostard, Julien; Teunter, Ruud; de Koster, Rene

2011-01-01

The problem considered is that of forecasting demand for single-period products before the period starts. We study this problem for the case of a mail order apparel company that needs to order its products pre-season. The lack of historical demand data implies that other sources of data are needed.

Exploring the Factor Structure of the Job Demands-Resources Measure With Patient Violence on Direct Care Workers in the Home Setting.

Science.gov (United States)

Byon, Ha Do; Harrington, Donna; Storr, Carla L; Lipscomb, Jane

2017-08-01

Workplace violence research in health care settings using the Job Demands-Resources (JD-R) framework is hindered by the lack of comprehensive examination of the factor structure of the JD-R measure when it includes patient violence. Is patient violence a component of job demands or its own factor as an occupational outcome? Exploratory factor analysis and confirmatory factor analysis were conducted using a sample of direct care workers in the home setting (n = 961). The overall 2-construct JD-R structure persisted. Patient violence was not identified as a separate factor from job demands; rather, two demand factors emerged: violence/emotional and workload/physical demands. Although the three-factor model fits the data, the two-factor model with patient violence being a component of job demands is a parsimonious and effective measurement framework.

Confronting evidence: individualised care and the case for shared decision-making.

LENUS (Irish Health Repository)

Ryan, P

2014-11-01

In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients\\' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients\\' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.

Mass Housing and Changings in Housing Demand, Case of Diyarbakir, Turkey

OpenAIRE

M. Oguz Sinemillioglu; Can Tuncay Akın; Havva Özyılmaz

2005-01-01

The aim of this study is to analyze changings in housing demand, especially in term of house size in Diyarbakır case, in Turkey. Though Housing in Turkey is in a free market system, there is a Mass Housing Administration (TOKÃ ) has been doing mass houses for, relatively, middle class income people. Diyarbakır, one of the cities that TOKÃ has done two thousand houses, has taken too much migration, so that the demand in housing form and structure has different alterations. This process should ...

On Medical Progress and Health Care Demand: A Ces Perspective Using the Grossman Model of Health Status.

Science.gov (United States)

Batinti, Alberto

2015-12-01

I propose an application of the pure-consumption version of the Grossman model of health care demand, where utility depends on consumption and health status and health status on medical care and health technology. I derive the conditions under which an improvement in health care technology leads to an increase/decrease in health care consumption. In particular, I show how the direction of the effect depends on the relationship between the constant elasticity of substitution parameters of the utility and health production functions. I find that, under the constancy assumption, the ratio of the two elasticity of substitution parameters determines the direction of a technological change on health care demand. On the other hand, the technology share parameter in the health production function contributes to the size but not to the direction of the technological effect. I finally explore how the ratio of the elasticity of substitution parameters work in measurement and practice and discuss how future research may use the theoretical insight provided here. Copyright © 2014 John Wiley & Sons, Ltd.

Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

NARCIS (Netherlands)

Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.

2014-01-01

Background: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care

Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review

NARCIS (Netherlands)

van Oostveen, Catharina J.; Ubbink, Dirk T.; Huis In Het Veld, Judith G.; Bakker, Piet J.; Vermeulen, Hester

2014-01-01

Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and

Opportunities for Automated Demand Response in California Agricultural Irrigation

Energy Technology Data Exchange (ETDEWEB)

Olsen, Daniel [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Aghajanzadeh, Arian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McKane, Aimee [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-08-01

Pumping water for agricultural irrigation represents a significant share of California’s annual electricity use and peak demand. It also represents a large source of potential flexibility, as farms possess a form of storage in their wetted soil. By carefully modifying their irrigation schedules, growers can participate in demand response without adverse effects on their crops. This report describes the potential for participation in demand response and automated demand response by agricultural irrigators in California, as well as barriers to widespread participation. The report first describes the magnitude, timing, location, purpose, and manner of energy use in California. Typical on-­farm controls are discussed, as well as common impediments to participation in demand response and automated demand response programs. Case studies of demand response programs in California and across the country are reviewed, and their results along with overall California demand estimates are used to estimate statewide demand response potential. Finally, recommendations are made for future research that can enhance the understanding of demand response potential in this industry.

Demand-based provision of housing, welfare and care services to elderly clients: from policy to daily practice through operations management.

Science.gov (United States)

de Blok, Carolien; Meijboom, Bert; Luijkx, Katrien; Schols, Jos

2009-03-01

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation's policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.

Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method.

Science.gov (United States)

Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul

2007-10-01

This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities. John Wiley & Sons, Ltd.

Managing the impact of growing low-acuity demand on ambulance services

OpenAIRE

KATHRYN JEAN EASTWOOD

2018-01-01

Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...

Demand-driven land evaluation; with case studies in Santa Catarina-Brazil

NARCIS (Netherlands)

Bacic, I.L.Z.

2003-01-01

The main objective of this thesis is to improve use and usefulness of information for rural land use decisions based on an operational demand-driven approach for land evaluation with case studies in Santa Catarina State, Brazil. To achieve this objective, the following research questions were

Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units

NARCIS (Netherlands)

Zwijsen, S.A.; Gerritsen, D.L.; Eefsting, J.A.; Smalbrugge, M.; Hertogh, C.M.P.M.; Pot, A.M.

2015-01-01

Background: Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to

Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units

NARCIS (Netherlands)

Zwijsen, S.A.; Gerritsen, D.L.; Eefsting, J.A.; Smalbrugge, M.; Hertogh, C.M.; Pot, A.M.

2015-01-01

BACKGROUND: Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to

How Intense Policy Demanders Shape Postreform Politics: Evidence from the Affordable Care Act.

Science.gov (United States)

Rocco, Philip; Haeder, Simon F

2018-04-01

The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda. Copyright © 2018 by Duke University Press.

Demand forecast: a case study at a meat agribusiness in west Santa Catarina

Directory of Open Access Journals (Sweden)

Cleunice Zanella

2016-03-01

Full Text Available Based on demand forecasts, companies plan production, financial and personnel scenarios, both in the long and short term. The forecasts are essential, especially for companies working with a push production system, for which there is no sale of collateral. They should therefore plan their production and financial systems with the aim of meeting the demand forecast of their products or services. Thus, this study was conducted at a meat agribusiness located in Chapecó, in the state of Santa Catarina, in order to analyze the demand forecasting methods used by the company. It is a case study with a qualitative approach. Data collection was conducted through semi-structured interviews with the operations manager, commercial manager and analysts who respond to the demand forecasts made. The main results highlight the use of both quantitative and qualitative methods, as well as indicating the importance of demand forecasts for the planning of the company

BDA special care case mix model.

Science.gov (United States)

Bateman, P; Arnold, C; Brown, R; Foster, L V; Greening, S; Monaghan, N; Zoitopoulos, L

2010-04-10

Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

Health Demands Characteristics and Quality of Life in the Elderly Monitored in the Primary Care

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Jéssica Maria Arouca de Miranda

2017-02-01

Full Text Available Background: To characterize the demands of health and quality of elderly peoplemonitored in the primary care of Rio Grande do Norte/Brazil. Methods and Findings: This is a descriptive, cross-sectional study of a quantitative approach with elderly patients monitored by the primary care. The sample was given for convenience, obtaining 120 participants. The research was conducted through an interview with theapplication of the following questionnaires: Mini Mental State Examination, Socio-demographic Data and Pain Characteristics, Short-Form-36, Mini Nutritional Assessment, the primary activities of daily living, the instrumental activities of daily living, Prism 7 and the Geriatric Depression Scale. Data analysis was performed using the SPSS statistical program, in which descriptive and association tests were used.The main demands were related to functionality, followed by nutritional and geriatric depression. The quality of life presented worse results in the domain of general health status and better scores in the emotional and mental health aspects. Regarding the dimensions, the physical health obtained aworse score. Conclusion: Based on the characterization of the health demands found, it is suggested to perform other studies with the same population, enabling to plan and implementing a multidimensional intervention and improving the quality of life of the elderly people. Keywords: Elderly; Quality of Life; Aging; Elderly Health; Nursing.

Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique.

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Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio

2014-12-01

We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care-seeking within 24 hours and care-seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers' ability to assess and treat illnesses can lead to improved care-seeking and utilisation, and community ownership for iCCM.

Effects of intensivist coverage in a post-anaesthesia care unit on surgical patients' case mix and characteristics of the intensive care unit.

Science.gov (United States)

Kastrup, Marc; Seeling, Matthes; Barthel, Stefan; Bloch, Andy; le Claire, Marie; Spies, Claudia; Scheller, Matthias; Braun, Jan

2012-07-18

There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients. The administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared. The relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.

Stimulating the demand for dental care: An application of Ajzen and Fishbein's theory of reasoned action.

NARCIS (Netherlands)

Hoogstraten, J.; de Haan, W.; ter Horst, G.

1985-01-01

Applied I. Ajzen and M. Fishbein's (1980) attitude-behavior model to the problem of stimulating the demand for dental care with 329 members (aged 21-50 yrs) of health insurance companies who had not received regular dental treatment and/or certificate of dental fitness for at least 2 1/2 yrs.

Stress and Burnout in Demanding Nursing Home Care : A literature review of the causes, prevention and coping strategies

OpenAIRE

Yang, Di

2017-01-01

Nursing job is generally related to intense pressure and high-level burnout because of its high demanding, challenging and stressful professional characteristic. Nursing staff in elderly home and long-term care facilities particularly experience higher level of physical job demands, more emotional exhaustion and lower level of job satisfaction than those in other units, thus bringing out higher burnout ratio among the nursing staffs. The main aim of this study was to reveal the causing factor...

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China

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Jing Luo

2017-01-01

Full Text Available A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI.” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

Buffering Effect of Job Resources in the Relationship between Job Demands and Work-to-Private-Life Interference: A Study among Health-Care Workers

OpenAIRE

Viotti, Sara; Converso, Daniela

2016-01-01

Background: The present study aims at investigating whether and how (1) job demands and job resources are associated with work-to-private-life interference (WLI) and (2) job resources moderate the relationship between job demands and WLI. Methods: Data were collected by a self-report questionnaire from three hospitals in Italy. The sample consisted of 889 health-care workers. Results: All job demands (i.e., quantitative demands, disproportionate patient expectations, and verbal aggressi...

Clarifying perspectives: Ethics case reflection sessions in childhood cancer care.

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Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

2016-06-01

Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child's growing autonomy are known ethical concerns that involve the whole professional team around the child's care. The purpose of this study was to explore healthcare professionals' experiences of participating in ethics case reflection sessions in childhood cancer care. Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Healthcare professionals working at a publicly funded children's hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. The children's and their parents' integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants' articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child

Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

Science.gov (United States)

Ahmed, Osman I

2016-01-01

With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

History of demand side management and classification of demand response control schemes

NARCIS (Netherlands)

Lampropoulos, I.; Kling, W.L.; Ribeiro, P.F.; Berg, van den J.

2013-01-01

The scope of this paper is to provide a review on the topic of demand side management. A historical overview provides a critical insight to applied cases, while the discovery of new evidence calls for reconsideration of the design of demand response control schemes. The developments at the demand

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

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Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

The old care paradigm is dead, long live the new sustainable care paradigm: how can GP commissioning consortia meet the demand challenges of 21st century healthcare?

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Mackenzie, James

2011-07-01

There are many challenges facing the health system in the 21st century - the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services - an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key part of this shift is the recognition that the health system does not operate in a vacuum and that strategic commissioning decisions must take account of wider determinants of health and well-being, and operate within the finite limits of the planet's natural resources. The sustainable development principle of balancing financial, social and environmental considerations is crucial in managing demand for health services and ensuring that the health system is resilient to risks of resource uncertainty and a changing climate. Building sustainability into the governance and contracting processes of GP commissioning consortia will help deliver efficiency savings, impact on system productivity, manage system risk and help manage demand through the health co-benefits of taking a whole systems approach to commissioning decisions. Commissioning services from providers committed to corporate social responsibility and sustainable business practices allows us to move beyond a health system that cures people reactively to one in which the health of individuals and populations is managed proactively through prevention and education. The opportunity to build sustainability principles into the culture of GP commissioning consortia upfront should be seized now to ensure the new model of commissioning endures and is fit for the future.

Responding to demand for inpatient care in the process of health development

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S Asefzadeh

2005-05-01

Full Text Available During recent decades, many changes are happening in health sector and countries are trying to respond to the increasing health demands of people. Although hospitals have important role in health delivery system of any country, numerous factors have to be taken into account before establishing a new hospital in certain area. During recent decades, in many developing countries, new hospitals are built and equipped with sophisticated plant, without any scientific investigation. This means wastage of scarce resources. This paper aims to introduce need assessment methodology to establish hospitals and discuss the criteria to be met prior to their construction in the process of health care development.

Stochastic model of forecasting spare parts demand

OpenAIRE

Ivan S. Milojević; Rade V. Guberinić

2012-01-01

If demand is known for the whole planning period (complete information), then this type of demand or a supply system is deterministic. In the simplest cases, the demand per time unit is constant. If demand levels change over time following a precisely determined and pre-known principle, this type of demand is also classified as deterministic. This quality of demand is very rare. In most cases demand is the product of a process, for example TMS maintenance, whose progression cannot be predicte...

Medicaid Crowd-Out of Private Long-Term Care Insurance Demand : Evidence from the Health and Retirement Survey

NARCIS (Netherlands)

Brown, J.R.; Coe, N.B.; Finkelstein, A.

2006-01-01

This paper provides empirical evidence of Medicaid crowd out of demand for private long-term care insurance. Using data on the near- and young-elderly in the Health and Retirement Survey, our central estimate suggests that a $10,000 decrease in the level of assets an individual can keep while

A primer on on-demand polymerase chain reaction technology.

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Spencer, Maureen; Barnes, Sue; Parada, Jorge; Brown, Scott; Perri, Luci; Uettwiller-Geiger, Denise; Johnson, Helen Boehm; Graham, Denise

2015-10-01

Efforts to reduce health care-associated infections (HAIs) have grown in both scale and sophistication over the past few decades; however, the increasing threat of antimicrobial resistance and the impact of new legislation regarding HAIs on health care economics make the fight against them all the more urgent. On-demand polymerase chain reaction (PCR) technology has proven to be a highly effective weapon in this fight, offering the ability to accurately and efficiently identify disease-causing pathogens such that targeted and directed therapy can be initiated at the point of care. As a result, on-demand PCR technology has far-reaching influences on HAI rates, health care outcomes, hospital length of stay, isolation days, patient satisfaction, antibiotic stewardship, and health care economics. The basics of on-demand PCR technology and its potential to impact health care have not been widely incorporated into health care education and enrichment programs for many of those involved in infection control and prevention, however. This article serves as a primer on on-demand PCR technology and its ramifications. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

What is case management in palliative care? An expert panel study

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van der Plas Annicka G M

2012-06-01

Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.

Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

Science.gov (United States)

Mariko, Mamadou

2003-03-01

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect

DYNAMIC ABC STORAGE POLICY IN ERRATIC DEMAND ENVIRONMENTS

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Benjamin Pierre

2003-01-01

Full Text Available The paper describes a dynamic variant of the traditional ABC storage policy. The variant is to be used in manual order picking warehouses where SKUs experience a rather unstable demand. Its objective is to reduce the order picking time. It mainly consists in shifting items between the storage areas A, B and C according to the way their daily number of order lines changes. A few case studies based on computer simulations have shown that this variant can yield interesting time savings if its parameters are chosen with care. One of those case studies is presented in this paper. Because of the pioneering nature of this variant, some ideas for further research are also sketched.

Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

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Muhammad Tahir Khalily

2011-10-01

Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

Directory of Open Access Journals (Sweden)

Muhammad Tahir Khalily

2011-10-01

Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector.Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy.Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

Musculoskeletal health and work ability in physically demanding occupations: study protocol for a prospective field study on construction and health care workers.

Science.gov (United States)

Lunde, Lars-Kristian; Koch, Markus; Knardahl, Stein; Wærsted, Morten; Mathiassen, Svend Erik; Forsman, Mikael; Holtermann, Andreas; Veiersted, Kaj Bo

2014-10-16

Musculoskeletal disorders have a profound impact on individual health, sickness absence and early retirement, particularly in physically demanding occupations. Demographics are changing in the developed countries, towards increasing proportions of senior workers. These senior workers may have particular difficulties coping with physically demanding occupations while maintaining good health. Previous studies investigating the relationship between physical work demands and musculoskeletal disorders are mainly based on self-reported exposures and lack a prospective design. The aim of this paper is to describe the background and methods and discuss challenges for a field study examining physical demands in construction and health care work and their prospective associations with musculoskeletal disorders, work ability and sickness absence. This protocol describes a prospective cohort study on 1200 construction and health care workers. Participants will answer a baseline questionnaire concerning musculoskeletal complaints, general health, psychosocial and organizational factors at work, work demands, work ability and physical activity during leisure. A shorter questionnaire will be answered every 6th months for a total of two years, together with continuous sickness absence monitoring during this period. Analysis will prospectively consider associations between self-reported physical demands and musculoskeletal disorders, work ability and sickness absence. To obtain objective data on physical exposures, technical measurements will be collected from two subgroups of N = 300 (Group A) and N = 160 (Group B) during work and leisure. Both group A and B will be given a physical health examination, be tested for physical capacity and physical activity will be measured for four days. Additionally, muscle activity, ground reaction force, body positions and physical activity will be examined during one workday for Group B. Analysis of associations between objectively measured

[A case study on duty of care in professional nursing].

Science.gov (United States)

Huang, Hui-Man; Liao, Chi-Chun

2013-08-01

Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

Dynamic Analysis of Money Demand Function: Case of Turkey*

OpenAIRE

doğru, bülent

2013-01-01

In this paper, the dynamic determinants of money demand function and the long-run and short-run relationships between money demand, income and nominal interest rates are examined in Turkey for the time period 1980-2012. In particular we estimate a dynamic specification of a log money demand function based on Keynesian liquidity preference theory to ascertain the relevant elasticity of money demand. The empirical results of the study show that in Turkey inflation, exchange rate and money deman...

Case study of forecasting uranium supply and demand

International Nuclear Information System (INIS)

Noritake, Kazumitsu

1992-01-01

PNC collects and analyzes information about uranium market trend, world uranium supply and demand, and world uranium resources potential in order to establish the strategy of uranium exploration. This paper outlines the results obtained to forecast uranium supply and demand. Our forecast indicates that 8,500 tU, accounting for one-sixth of the demand in the year 2001, must be met by uranium produced by mines to be newly developed. After 2019, demand cannot be met by the 123 mines currently in operation or expected to have gone into production by this year. The projected shortage must therefore be covered by uranium to be newly discovered. To preclude this occurrence, uranium exploration will have to be steadily continued in order to ensure future new uranium resources, to alleviate anxiety about future supply, and to prevent sharp price hikes. (author)

From end of life to chronic care: the provision of community home-based care for HIV and the adaptation to new health care demands in Zambia.

Science.gov (United States)

Aantjes, Carolien J; Simbaya, Joseph; Quinlan, Tim K C; Bunders, Joske F G

2016-11-01

Aim We present the evolution of primary-level HIV and AIDS services, shifting from end of life to chronic care, and draw attention to the opportunities and threats for the future of Zambia's nascent chronic care system. Although African governments struggled to provide primary health care services in the context of a global economic crisis, civil society organisations (CSO) started mobilising settlement residents to respond to another crisis: the HIV and AIDS pandemic. These initiatives actively engaged patients, families and settlement residents to provide home-based care to HIV-infected patients. After 30 years, CHBC programmes continue to be appropriate in the context of changing health care needs in the population. The study took place in 2011 and 2012 and was part of a multi-country study. It used a mixed method approach involving semi-structured interviews, focus group discussions, structured interviews, service observations and a questionnaire survey. Findings Our research revealed long-standing presence of extensive mutual support amongst residents in many settlements, the invocation of cultural values that emphasise social relationships and organisation of people by CSO in care and support programmes. This laid the foundation for a locally conceived model of chronic care capable of addressing the new care demands arising from the country's changing burden of disease. However, this capacity has come under threat as the reduction in donor funding to community home-based care programmes and donor and government interventions, which have changed the nature of these programmes in the country. Zambia's health system risks losing valuable capacity for fulfilling its vision 'to bring health care as close to the family as possible' if government strategies do not acknowledge the need for transformational approaches to community participation and continuation of the brokering role by CSO in primary health care.

Case-mix and quality indicators in Chinese elder care homes: are there differences between government-owned and private-sector facilities?

Science.gov (United States)

Liu, Chang; Feng, Zhanlian; Mor, Vincent

2014-02-01

To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Prevention and nursing care in the first case of Ebola virus disease contracted outside Africa.

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Cerón-Serrano, Alicia; Jiménez-Castellano, Rafael; Gómez-Campos, Ana María

After the evacuation from Africa to Western hospitals of several international workers with the Ebola virus disease, the first case of contagion outside Africa occurred in Madrid, Spain. A nursing care assistant who had attended a missionary repatriated from Sierra Leone contracted the disease. On October 7 th 2014, the patient arrived at the University Hospital La Paz-Carlos III in Madrid. She remained in the hospital for 30 days, 25 of which were in strict isolation in a negative pressure room with air lock anteroom; personal protective equipment was required. During the last five days, the patient was moved to a standard room. Protection measures were used in accordance with the Hospital Occupational Health Department. According to its evolution, we differentiate three phases with specific care demands which were conditioned by the risk of transmission, forcing extreme measures of prevention. The largest numbers of direct interventions fall within the realm of the nursing profession. It is essential that specialized units with regular training be created for highly contagious diseases. In addition, this and other cases should be analyzed from the point of view of nursing, to allow standardized care. We also recognize the importance of managing communication to prevent social unrest and stigmatization of staff. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Resistance Elasticity of Antibiotic Demand in Intensive Care.

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Heister, Thomas; Hagist, Christian; Kaier, Klaus

2017-07-01

The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. In intensive care units (ICUs), first-line antibiotic therapy is highly standardized and widely empiric while treatment failure because of AMR often has severe consequences. Simultaneously, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first-line therapy. This paper explores the implications of resistance-induced substitution effects in ICUs. The extent of such substitution effects is shown in a dynamic fixed effect regression analysis using a panel of 66 German ICUs with monthly antibiotic use and resistance data between 2001 and 2012. Our findings support the hypothesis that demand for reserve antibiotics substantially increases when resistance towards first-line agents rises. For some analyses the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. The available information about resistance rates allows physicians to efficiently balance the trade-off between exacerbating resistance and ensuring treatment success. However, resistance-induced substitution effects are not free of charge. These effects should be considered an indirect burden of AMR. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Predicting nurse burnout from demands and resources in three acute care hospitals under different forms of ownership: a cross-sectional questionnaire survey.

Science.gov (United States)

Hansen, Niklas; Sverke, Magnus; Näswall, Katharina

2009-01-01

Health care organizations have changed dramatically over the last decades, with hospitals undergoing restructurings and privatizations. The aim of this study is to enhance the understanding of the origin and prevalence of burnout in health care by investigating factors in the psychosocial work environment and comparing three Swedish emergency hospitals with different types of ownership. A cross-sectional design was used. We selected a total sample of 1800 registered nurses from three acute care hospitals, one private for-profit, one private non-profit and one publicly administered. A total of 1102 questionnaires were included in the analyses. The examined ownership types were a private for-profit, a private non-profit and a traditional publicly administered hospital. All were situated in the Stockholm region, Sweden. Data were collected by questionnaires using validated instruments, in accordance with the Job Demands-Resources Model and Maslach's Burnout Inventory. Descriptive statistics, correlation analyses, multivariate covariance analyses and multiple regression analyses were conducted. The results showed that the burnout levels were the highest at the private for-profit hospital and lowest at the publicly administered hospital. However, in contrast to expectations the demands were not higher overall at the for-profit organization or lowest at the public administration unit, and overall, resources were not better in the private for-profit or worse at the publicly administered hospital. Multiple regression analyses showed that several of the demands included were related to higher burnout levels. Job resources were linked to lower burnout levels, but not for all variables. Profit orientation in health care seems to result in higher burnout levels for registered nurses compared to a publicly administered hospital. In general, demands were more predictive of burnout than resources, and there were only marginal differences in the pattern of predictors across

Case-mix payment for nursing home care: lessons from Maryland.

Science.gov (United States)

Feder, J; Scanlon, W

1989-01-01

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

Effect of policy-based bioenergy demand on southern timber markets: A case study of North Carolina

International Nuclear Information System (INIS)

Abt, Robert C.; Abt, Karen L.; Cubbage, Frederick W.; Henderson, Jesse D.

2010-01-01

Key factors driving renewable energy demand are state and federal policies requiring the use of renewable feedstocks to produce energy (renewable portfolio standards) and liquid fuels (renewable fuel standards). However, over the next decade, the infrastructure for renewable energy supplies is unlikely to develop as fast as both policy- and market-motivated renewable energy demands. This will favor the use of existing wood as a feedstock in the first wave of bioenergy production. The ability to supply wood over the next decade is a function of the residual utilization, age class structure, and competition from traditional wood users. Using the North Carolina Renewable Portfolio Standard as a case study, combined with assumptions regarding energy efficiency, logging residual utilization, and traditional wood demands over time, we simulate the impacts of increased woody biomass demand on timber markets. We focus on the dynamics resulting from the interaction of short-run demand changes and long-term supply responses. We conclude that logging residuals alone may be unable to meet bioenergy demands from North Carolina's Renewable Portfolio Standard. Thus, small roundwood (pulpwood) may be used to meet remaining bioenergy demands, resulting in increased timber prices and removals; displacement of traditional products; higher forest landowner incomes; and changes in the structure of the forest resource. (author)

Managing Disasters Using Pressure Dependent Demand Analysis – Case Study of Shirpur Town

Directory of Open Access Journals (Sweden)

Madhuri Mulay

2016-12-01

Full Text Available Water is the most essential component for sustaining lives of humans and other living creatures. Supplying potable water with adequate residual pressure is a fundamental responsibility of city administration, which they do during normal conditions. But sometimes, abnormal conditions are formed resulting pressure deficient conditions during the daily operations of water distribution networks. These are caused due to common occurrences such as pump failure, pipe bursts, and isolation of major pipes from the system for planned maintenance work and excessive firefighting demands. Total water stop conditions may arise, when the major source supplying water to the city fails in natural disaster such as floods, Tsunami, earthquake or manmade disaster such as terrorist attack. Unlike the pipe failure, longer time is required for restoring water in case of source failure condition. In such situations, the quantity of water is generally decreased and the water distribution systems (WDS may not be able to satisfy all consumers’ demands. In this context, the assumption that all demands are fully satisfied regardless of the pressure in the system becomes unreasonable. A realistic behavior of the network performance can only be attained by considering demands to be pressure dependent. This paper aims to describe how pressure dependent demand analysis is useful for the simulation of disaster scenario due to source failure of the Shirpur town. The simulation of failure scenario is carried out using WaterGEMs software. The paper also aims to prepare the action plans for the recovery of water supply in such crisis conditions.

Validating the accuracy of GIS-based accessibility analysis in determining public primary health care demand in metropolitan areas: conference presentation

CSIR Research Space (South Africa)

Mokgalaka, H

2014-07-01

Full Text Available selected for the analysis are mainly those that offered public primary health care services and acted as first point of contact with the health service delivery system. Attached to the facility data are attribute data indicating the capacity...-Based Accessibility Analysis in Determining Public Primary Health Care Demand in Metropolitan Areas Hunadi Mokgalaka July 2014 Contents • Service access planning • GIS-based accessibility analysis • Key challenges to application • Methodology...

New issues in attendance demand: the case of the English football league

OpenAIRE

D Forrest; R Simmons

2005-01-01

This paper uses an attendance demand model with panel data on over 4,000 games to examine economic problems of fixture congestion in English Football League schedules. We find that televised midweek Champions League matches involving English Premier League clubs have substantial adverse impacts on lower division Football League gate attendance. This suggests that affected clubs may have a case for compensation from the Premier League for loss of gate revenue from this source. Scheduling of ho...

OA2 Chinese migrant peasant workers and the contradictory demands of filial piety in neo-liberal chinese society: a case study of filial end-of-life care in langzhong city.

Science.gov (United States)

He, Longtao

2015-04-01

Many scholars claim that recent changes to Chinese society since economic reform have challenged longstanding forms of informal social care, such as filial piety. For instance there is a societal tension at work in contemporary Chinese society today. On the one hand decreasing co-residence in multi-generational households caused by rural-urban migration, population ageing, the fall in fertility and 'One-Child Policy', and women's increasing participation in the labour market, emphasises an individualised, wage earning centred society. On the other hand, the Chinese government has sought to enforce a form of institutionalised filial piety through policies that legally require younger generations fulfil the full responsibility of care as there is no institutionalised equivalent of the welfare state to provide e.g. home help or personal care to the elderly whose relatives live and work at some distance. This places many younger generations in the contradiction of having to comply with neo-liberal labour market demands while also fulfilling state enforced filial piety. This research is to look at how Chinese migrant worker experience perceived filial responsibilities in relation to End-of-Life care for parents diagnosed with cancer in the current Chinese context. My PhD, based on interviews with migrant peasant workers caught in this dilemma by the demands of having a terminally ill parent, examines how Chinese migrant peasant workers negotiate and conduct their filial practices. The preliminary analysis of the interviews suggests that 'Filial Piety' is getting reconstructed in multifaceted ways as they negotiate the care dilemmas they face. The way they engage with the concept of filial piety enables and constrains how they can think about and practically organise their parents' care. The result would shed a light on evaluation of and suggestions for governmental policy-makings, such as the newly implemented Parent-Visiting law in China, in terms of better reinforcing

Operational resilience of reservoirs to climate change, agricultural demand, and tourism: A case study from Sardinia.

Science.gov (United States)

Mereu, Simone; Sušnik, Janez; Trabucco, Antonio; Daccache, Andre; Vamvakeridou-Lyroudia, Lydia; Renoldi, Stefano; Virdis, Andrea; Savić, Dragan; Assimacopoulos, Dionysis

2016-02-01

Many (semi-) arid locations globally, and particularly islands, rely heavily on reservoirs for water supply. Some reservoirs are particularly vulnerable to climate and development changes (e.g. population change, tourist growth, hydropower demands). Irregularities and uncertainties in the fluvial regime associated with climate change and the continuous increase in water demand by different sectors will add new challenges to the management and to the resilience of these reservoirs. The resilience of vulnerable reservoirs must be studied in detail to prepare for and mitigate potential impacts of these changes. In this paper, a reservoir balance model is developed and presented for the Pedra e' Othoni reservoir in Sardinia, Italy, to assess resilience to climate and development changes. The model was first calibrated and validated, then forced with extensive ensemble climate data for representative concentration pathways (RCPs) 4.5 and 8.5, agricultural data, and with four socio-economic development scenarios. Future projections show a reduction in annual reservoir inflow and an increase in demand, mainly in the agricultural sector. Under no scenario is reservoir resilience significantly affected, the reservoir always achieves refill. However, this occurs at the partial expenses of hydropower production with implications for the production of renewable energy. There is also the possibility of conflict between the agricultural sector and hydropower sector for diminishing water supply. Pedra e' Othoni reservoir shows good resilience to future change mostly because of the disproportionately large basin feeding it. However this is not the case of other Sardinian reservoirs and hence a detailed resilience assessment of all reservoirs is needed, where development plans should carefully account for the trade-offs and potential conflicts among sectors. For Sardinia, the option of physical connection between reservoirs is available, as are alternative water supply measures

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan.

Science.gov (United States)

Nishino, Tatsuya

2017-12-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan

Science.gov (United States)

Nishino, Tatsuya

2017-01-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly’s care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan’s Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize ‘Ageing in Place’. When considering households’ tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia. PMID:29194405

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

Science.gov (United States)

Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

Science.gov (United States)

Phillips, Charles D

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

Directory of Open Access Journals (Sweden)

Charles D. Phillips

2015-01-01

Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD).

Science.gov (United States)

Heidenreich, Kaja; Bremer, Anders; Materstvedt, Lars Johan; Tidefelt, Ulf; Svantesson, Mia

2017-12-14

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.

Emotional job demands and the role of matching job resources: a cross-sectional survey study among health care workers

NARCIS (Netherlands)

Jonge, de J.; Blanc, Le P.M.; Peeters, M.C.W.; Noordam, H.

2008-01-01

Background Research on emotional labour in health care work has not yet revealed under what conditions emotional job demands have an impact on employee health and well-being. There is a need for more theory to unveil the black box of emotional labour processes. Objectives To test the moderating role

Students experienced help from preservative care. A reflective case study of two nursing students caring from a nursing framework on good care for older people

Directory of Open Access Journals (Sweden)

Jan S. Jukema

2015-11-01

Full Text Available Background: The practice of nursing is shaped partly by nurses’ professional perspective of good care, guided by a nursing framework. An example is the framework of preservative care, which defines good nursing care for vulnerable older people in nursing homes. Currently we lack an understanding of how this framework could help nurses in training; it may be a useful developmental aid for undergraduate nursing students but so far there are no empirical data to support this. Aim: The purpose of this study is to explore how helpful a particular framework can be in the learning journey of two undergraduate nursing students. The study draws on narrative and reflective accounts, guided by the question: ‘How does preservative care as a framework of good care help two undergraduate nursing students develop their caring for older people?’ Methods: This was a reflective case study, in which two students – experienced registered nurses (non-graduates following a part-time education programme – reflected on their practices, using preservative care as a framework for taking care of older people. They kept reflective journals and received constructive feedback from the author of the preservative care framework (the first author. Their data were analysed in three steps. Findings: Both students reported gaining profound help from the framework in their evaluations of daily practices, although they rated the help differently in terms of demanding and rewarding experiences. The framework was particularly helpful in developing qualities in three domains: person-centredness, professional role and specific nursing competencies. Conclusions: The results of our study indicate how using a particular nursing framework made a difference to the practice of two undergraduate nursing students. Exploring the meaning and place of particular nursing frameworks in nursing education is necessary to establish their potential benefits for students. Implications for

Changes in case-mix and outcomes of critically ill patients in an Australian tertiary intensive care unit.

Science.gov (United States)

Williams, T A; Ho, K M; Dobb, G J; Finn, J C; Knuiman, M W; Webb, S A R

2010-07-01

Critical care service is expensive and the demand for such service is increasing in many developed countries. This study aimed to assess the changes in characteristics of critically ill patients and their effect on long-term outcome. This cohort study utilised linked data between the intensive care unit database and state-wide morbidity and mortality databases. Logistic and Cox regression was used to examine hospital survival and five-year survival of 22,298 intensive care unit patients, respectively. There was a significant increase in age, severity of illness and Charlson Comorbidity Index of the patients over a 16-year study period. Although hospital mortality and median length of intensive care unit and hospital stay remained unchanged, one- and five-year survival had significantly improved with time, after adjusting for age, gender; severity of illness, organ failure, comorbidity, 'new' cancer and diagnostic group. Stratified analyses showed that the improvement in five-year survival was particularly strong among patients admitted after cardiac surgery (P = 0.001). In conclusion, although critical care service is increasingly being provided to patients with a higher severity of acute and chronic illnesses, long-term survival outcome has improved with time suggesting that critical care service may still be cost-effectiveness despite the changes in case-mix.

The impact of case mix on timely access to appointments in a primary care group practice.

Science.gov (United States)

Ozen, Asli; Balasubramanian, Hari

2013-06-01

At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician's appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions.

Labour supply in the home care industry: A case study in a Dutch region.

Science.gov (United States)

Breedveld, Elly J; Meijboom, Bert R; de Roo, Aad A

2006-04-01

Health organizations have started to become more market-driven. Therefore, it is important for health organizations to analyse the competitive dynamics of their industrial structure. However, relevant theories and models have mainly been developed for organizations acting in the profit sector. In this paper, we adapt Porter's 'five forces model' to the home care industry. In particular, we modify the (determinants of the) bargaining power of labour suppliers. We then apply the modified Porter-model to the home care industry in the Netherlands for the period of 1987-1997 with special attention for labour supply. The new instrument clarifies the complexity of the supply chains and value systems of the home care industry. As can be illustrated by developments in the home care industry in the province of North Brabant during the 1990s, competition between home care providers has influenced labour market relations, but so do other factors as well. Between 1987 and 1997, the bargaining power of labour suppliers was relatively limited. After 1997, however, the demand for home care personnel has increased strongly. In spite of the present economic recession, scarcity on this labour market seems to prevail in the longer term due to a growing demand for home care services.

Differential effects of decision latitude and control on the job demands-strain relationship: a cross-sectional survey study among elderly care nursing staff.

Science.gov (United States)

Schmidt, Klaus-Helmut; Diestel, Stefan

2011-03-01

According to the influential Job Demands-Control (JD-C) model developed by Karasek (1979; Karasek and Theorell, 1990), job strain is expected to result from high job demands and low job control as well as an interaction between both job characteristics. Previous research, however, has found such an interaction only rarely or inconsistently.It has been suggested that the conceptualization of the control variable (formerly referred to as decision latitude) may be particularly responsible for the lack of supportive findings. The present study aimed at clarifying this issue by contrasting a focused measure of control with a traditional measure of decision latitude in their relations to job strain of health care workers. The measure of decision latitude encompassed a wide range of job characteristics including control, task variety, and learning opportunities. A cross-sectional questionnaire survey was conducted with job satisfaction, psychosomatic complaints and emotional exhaustion as criterion measures of job strain. A supra-regional organization for residential elderly care with 11 nursing homes located in a federal state in Germany. Questionnaires were distributed to the whole nursing staff, of which 379 filled in the questionnaire during normal working hours (68% participation rate). In addition to confirmatory factor analyses, descriptive statistics, and bivariate correlations, hierarchical multiple regression analyses were performed for testing the corresponding interaction effects. Findings confirmed the assumption that the focused measure of control and the traditional measure of decision latitude represent distinct, yet correlated factors. Furthermore, findings revealed a significant interaction effect between job demands and control on all outcomes considered. By way of contrast, there was no equivalent interaction effect between job demands and decision latitude. In line with the JD-C model, the adverse influence of increasing demands on job satisfaction

Ten Demands of Improved Usability in eHealth and Some Progress - Co-Creation by Health and Social Care Professionals.

Science.gov (United States)

Scandurra, Isabella; Liljequist, David

2016-01-01

Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.

Modeling of Residential Water Demand Using Random Effect Model,Case Study: Arak City

Directory of Open Access Journals (Sweden)

Seyed Hossein Sajadifar

2011-10-01

Full Text Available The present study tries to apply the “Partial Adjustment Model” and “Random Effect Model” techniques to the Stone-Greay’s linear expenditure system, in order to estimate the "Residential Seasonal Demand" for water in Arak city. Per capita water consumption of family residences is regressed on marginal price, per capita income, price of other goods, average temperature and average rainfall. Panel data approaches based on a sample of 152 observations from Arak city referred to 1993-2003. From the estimation of the Elasticity-price of the residential water demand, we want to know how a policy of responsive pricing can lead to more efficient household water consumption inArakcity. Results also indicated that summer price elasticity was twice the winter and price and income elasticity was less than 1 in all cases.

[Strengthening primary health care: a strategy to maximize coordination of care].

Science.gov (United States)

de Almeida, Patty Fidelis; Fausto, Márcia Cristina Rodrigues; Giovanella, Lígia

2011-02-01

To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

Inventory control in case of unknown demand and control parameters

NARCIS (Netherlands)

Janssen, E.

2010-01-01

This thesis deals with unknown demand and control parameters in inventory control. Inventory control involves decisions on what to order when and in what quantity. These decisions are based on information about the demand. Models are constructed using complete demand information; these models ensure

Protecting workers in the home care industry: workers' experienced job demands, resource gaps, and benefits following a socially supportive intervention.

Science.gov (United States)

Mabry, Linda; Parker, Kelsey N; Thompson, Sharon V; Bettencourt, Katrina M; Haque, Afsara; Luther Rhoten, Kristy; Wright, Rob R; Hess, Jennifer A; Olson, Ryan

2018-05-02

The Community of Practice and Safety Support (COMPASS) program is a peer-led group intervention for home care workers. In a randomized controlled trial, COMPASS significantly improved workers' professional support networks and safety and health behaviors. However, quantitative findings failed to capture workers' complex emotional, physical, and social experiences with job demands, resource limitations, and the intervention itself. Therefore, we conducted qualitative follow-up interviews with a sample of participants (n = 28) in the program. Results provided examples of unique physical and psychological demands, revealed stressful resource limitations (e.g., safety equipment access), and elucidated COMPASS's role as a valuable resource.

Forecasting Ontario's blood supply and demand.

Science.gov (United States)

Drackley, Adam; Newbold, K Bruce; Paez, Antonio; Heddle, Nancy

2012-02-01

Given an aging population that requires increased medical care, an increasing number of deferrals from the donor pool, and a growing immigrant population that typically has lower donation rates, the purpose of this article is to forecast Ontario's blood supply and demand. We calculate age- and sex-specific donation and demand rates for blood supply based on 2008 data and project demand between 2008 and 2036 based on these rates and using population data from the Ontario Ministry of Finance. Results indicate that blood demand will outpace supply as early as 2012. For instance, while the total number of donations made by older cohorts is expected to increase in the coming years, the number of red blood cell (RBC) transfusions in the 70+ age group is forecasted grow from approximately 53% of all RBC transfusions in 2008 (209,515) in 2008 to 68% (546,996) by 2036. A series of alternate scenarios, including projections based on a 2% increase in supply per year and increased use of apheresis technology, delays supply shortfalls, but does not eliminate them without active management and/or multiple methods to increase supply and decrease demand. Predictions show that demand for blood products will outpace supply in the near future given current age- and sex-specific supply and demand rates. However, we note that the careful management of the blood supply by Canadian Blood Services, along with new medical techniques and the recruitment of new donors to the system, will remove future concerns. © 2012 American Association of Blood Banks.

Taking care of Care

NARCIS (Netherlands)

Evelien Eggink; Debbie Oudijk; Isolde Woittiez

2010-01-01

Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

Cost-efficient demand-pull policies for multi-purpose technologies – The case of stationary electricity storage

International Nuclear Information System (INIS)

Battke, Benedikt; Schmidt, Tobias S.

2015-01-01

Highlights: • A definition of multi-purpose technologies (MPTs) is proposed. • Opportunities for a cost-efficient demand-pull policy strategy for MPTs are derived. • The multi-purpose character of stationary electricity storage (SES) is shown. • An exemplary profitability assessment of one SES technology supports the argument. - Abstract: Stationary electricity storage technologies (SES) allow to increase the shares of intermittent renewable energy technologies in electricity networks. As SES currently exhibit high costs, policy makers have started introducing demand-pull policies in order to foster their diffusion and drive these technologies further down the learning curve. However, as observed in the case of renewable energy technologies, demand-pull policies for technologies can come at high costs in cases where the profitability gap that needs to be covered by the policy support is large. Yet, SES can create value in multiple distinct applications in the power system – making it a “multi-purpose technology”. We argue that policy makers can make use of the multi-purpose character of SES to limit costs of demand-pull policies. We propose a policy strategy which grants support based on the profitability gap in the different applications, thereby moving down the learning curve efficiently. To support our argumentation, we firstly conduct a comprehensive literature review of SES applications exemplifying the multi-purpose character of these technologies. Second, we assess the profitability of one SES technology (vanadium redox flow battery) in five SES applications, highlighting a strong variation of the profitability gap across these applications

Autotransplantation of Odontoma-Associated Impacted Teeth-A Treatment Strategy for Satisfying Immediate Esthetic Demands: A Case Report.

Science.gov (United States)

Hwang, Lisa Alice; Kuo, Chih-Yin; Yang, Jung-Wu; Chiang, Wei-Fan

2017-09-01

Compound odontomas are common odontogenic tumors associated with permanent tooth impaction in the premaxilla. This report describes the case of a 14-year-old girl with an odontoma-associated impaction over the premaxilla that was treated using autotransplantation to satisfy an immediate esthetic demand. At postoperative follow-up conducted in the 14th month, a satisfactory cosmetic appearance with a healthy periodontal status was observed. In addition, the authors discuss the possible complications of autotransplantation and different treatment strategies for odontoma-associated impaction and for correcting bone defects in this case report. Autotransplantation for treating odontoma-associated impaction can be an alternative solution for satisfying an immediate cosmetic demand and providing a favorable outcome. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.

Science.gov (United States)

Burn, Anne-Marie; Fleming, Jane; Brayne, Carol; Fox, Chris; Bunn, Frances

2018-03-17

In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care

Job demands and job strain as risk factors for employee wellbeing in elderly care: an instrumental-variables analysis.

Science.gov (United States)

Elovainio, Marko; Heponiemi, Tarja; Kuusio, Hannamaria; Jokela, Markus; Aalto, Anna-Mari; Pekkarinen, Laura; Noro, Anja; Finne-Soveri, Harriet; Kivimäki, Mika; Sinervo, Timo

2015-02-01

The association between psychosocial work environment and employee wellbeing has repeatedly been shown. However, as environmental evaluations have typically been self-reported, the observed associations may be attributable to reporting bias. Applying instrumental-variable regression, we used staffing level (the ratio of staff to residents) as an unconfounded instrument for self-reported job demands and job strain to predict various indicators of wellbeing (perceived stress, psychological distress and sleeping problems) among 1525 registered nurses, practical nurses and nursing assistants working in elderly care wards. In ordinary regression, higher self-reported job demands and job strain were associated with increased risk of perceived stress, psychological distress and sleeping problems. The effect estimates for the associations of these psychosocial factors with perceived stress and psychological distress were greater, but less precisely estimated, in an instrumental-variables analysis which took into account only the variation in self-reported job demands and job strain that was explained by staffing level. No association between psychosocial factors and sleeping problems was observed with the instrumental-variable analysis. These results support a causal interpretation of high self-reported job demands and job strain being risk factors for employee wellbeing. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Measuring case-mix complexity of tertiary care hospitals using DRGs.

Science.gov (United States)

Park, Hayoung; Shin, Youngsoo

2004-02-01

The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

Work demands and health consequences of organizational and technological measures introduced to enhance the quality of home care services--A subgroup analysis.

Science.gov (United States)

Andersen, Gunn Robstad; Bendal, Synne; Westgaard, Rolf H

2015-11-01

This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into 'high', 'moderate' and 'low' strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

Directory of Open Access Journals (Sweden)

Meaney Christopher

2011-08-01

investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. Results The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4% and females (49.6%. The majority (86.2% were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%, with mid-high household incomes (92.2% and well-educated, receiving at least a high-school diploma (84.1%. Many participants reported no chronic disease (51.9%, fell into a small number (0-5 of ambulatory diagnostic groups (62.3%, and perceived their health status as good/excellent (88.1%; however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%. These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75 and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66 in low severity cases. Conclusion Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations

Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

Science.gov (United States)

Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

2011-08-19

department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department

Active Social Media Management: The Case of Health Care

OpenAIRE

Miller, Amalia R.; Tucker, Catherine Elizabeth

2012-01-01

Given the demand for authentic personal interactions over social media, it is unclear how much firms should actively manage their social media presence. We study this question empirically in a health care setting. We show that active social media management drives more user-generated content. However, we find that this is due to an incremental increase in user postings from an organization's employees rather than from its clients. This result holds when we explore exogenous variation in socia...

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2016-04-01

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

Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands

DEFF Research Database (Denmark)

Holtermann, Andreas; Jørgensen, Marie B; Gram, Bibi

2010-01-01

) characterized by high physical work demands, musculoskeletal disorders, poor work ability and sickness absence. METHODS/DESIGN: A novel approach of the FINALE programme is that the interventions, i.e. 3 randomized controlled trials (RCT) and 1 exploratory case-control study are tailored to the physical work......BACKGROUND: A mismatch between individual physical capacities and physical work demands enhance the risk for musculoskeletal disorders, poor work ability and sickness absence, termed physical deterioration. However, effective intervention strategies for preventing physical deterioration in job...... groups with high physical demands remains to be established. This paper describes the background, design and conceptual model of the FINALE programme, a framework for health promoting interventions at 4 Danish job groups (i.e. cleaners, health-care workers, construction workers and industrial workers...

Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

Science.gov (United States)

Sears, Nancy A

2002-01-01

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

OpenAIRE

Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

Meeting increased demand.

Science.gov (United States)

Blair, Andrew

2004-07-01

of people affected by arthritis will increase by nearly 50%. A huge increase in numbers affected with musculoskeletal conditions will require significant increases in health care resources, including hospital beds and facilities, orthopaedic surgeons and other health care professionals. New Zealand has been slow to acknowledge and plan for the increased demand for health services which is looming. Growing New Zealand's economy will help, but alone will not be enough. It is more than just finding the financial resources to better meet the demand. The enormous demands on the availability of treatment resources including hospital facilities and trained health care professionals must be addressed. There are major workforce issues to be faced. The change in population distribution between young and old will have an impact and it will be necessary to ensure that there are sufficient numbers of properly trained health care professionals available at all levels. It is hoped that improvements in preventative care programmes and new technologies and treatment techniques may reduce the rate of demand. As the health of our population is improved through targeted programmes dealing with obesity, diabetes, smoking and accident prevention, it may be possible to reallocate or change the focus of resources within the health and hospital sectors. Many countries are developing national strategies for their aging population. Clearly the New Zealand Government needs to move swiftly to develop a plan to manage the increased burden that is developing as a result of the aging population. That plan must create an environment which facilitates, encourages and supports greater private investment in healthcare facilities and healthcare delivery. Incentives must be created to motivate individuals to take greater responsibility for their healthcare needs and the funding of it. The development of a long term strategy to meet the challenges of the aging population is a priority.

Estimation of demand function on natural gas and study of demand analysis

Energy Technology Data Exchange (ETDEWEB)

Kim, Y.D. [Korea Energy Economics Institute, Euiwang (Korea, Republic of)

1998-04-01

Demand Function is estimated with several methods about the demand on natural gas, and analyzed per usage. Since the demand on natural gas, which has big share of heating use, has a close relationship with temperature, the inter-season trend of price and income elasticity is estimated considering temperature and economic formation. Per usage response of natural gas demand on the changes of price and income is also estimated. It was estimated that the response of gas demand on the changes of price and income occurs by the change of number of users in long term. In case of the response of unit consumption, only industrial use shows long-term response to price. Since gas price barely responds to the change of exchange rate, it seems to express the price-making mechanism that does not reflect timely the import condition such as exchange rate, etc. 16 refs., 12 figs., 13 tabs.

Production practices affecting worker task demands in concrete operations: A case study.

Science.gov (United States)

Memarian, Babak; Mitropoulos, Panagiotis

2015-01-01

Construction work involves significant physical, mental, and temporal task demands. Excessive task demands can have negative consequences for safety, errors and production. This exploratory study investigates the magnitude and sources of task demands on a concrete operation, and examines the effect of the production practices on the workers' task demands. The NASA Task Load Index was used to measure the perceived task demands of two work crews. The operation involved the construction of a cast-in-place concrete building under high schedule pressures. Interviews with each crew member were used to identify the main sources of the perceived demands. Extensive field observations and interviews with the supervisors and crews identified the production practices. The workers perceived different level of task demands depending on their role. The production practices influenced the task demands in two ways: (1) practices related to work organization, task design, resource management, and crew management mitigated the task demands; and (2) other practices related to work planning and crew management increased the crew's ability to cope with and adapt to high task demands. The findings identify production practices that regulate the workers' task demands. The effect of task demands on performance is mitigated by the ability to cope with high demands.

Practical multimodal care for cancer cachexia.

Science.gov (United States)

Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C H

2016-12-01

Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

[Ethical case discussions in the intensive care unit : from testing to routine].

Science.gov (United States)

Meyer-Zehnder, B; Barandun Schäfer, U; Albisser Schleger, H; Reiter-Theil, S; Pargger, H

2014-06-01

The daily work of many healthcare professionals has become more complex and demanding in recent years. Apart from purely medical issues, ethical questions and problems arise quite often. Managing these problems requires ethical knowledge. Questions about the usefulness of a therapy and treatment occur especially at the end of life. So-called medical futility, a useless futile therapy, is often perceived by nurses and physicians in intensive care units who themselves often develop symptoms of depression or burnout. The clinical ethical model METAP (acronym from module, ethics, therapy decision, allocation and process) provides methods and criteria that allow the clinical team to treat and solve ethical issues according to a solution-oriented approach. The ethical decision-making of this model addresses these issues according to a series of sequential stages in the form of a so-called escalation model. When it is not possible to tackle and solve an ethical problem or dilemma in one stage, one moves to the next. The implementation of this approach in everyday practice requires the commitment of all team members in addition to certain basic conditions. In a surgical intensive care unit a fixed date in the schedule is reserved for ethical case discussions (level 3 of the escalation model). At this level a team member who has been specified according to a quarterly plan is responsible for the organization and performance of the discussion. All protocols of the 44 ethical case discussions in 41 patients between January 2011 and July 2012 were collected and summarized. A short questionnaire to all participants recorded their assessment of the benefits for the patient and the team as well as their perception of personal stress reduction. Also queried was the impact of this method on the collaboration between nurses and physicians and the ethical competence. Ethical case discussions among the care team took place regularly (44 case discussions between January 2011 and June

Women's participation in rural credit programmes in Bangladesh and their demand for formal health care: is there a positive impact?

Science.gov (United States)

Nanda, P

1999-08-01

Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.

Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

Science.gov (United States)

Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee

2006-01-01

The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

Does subsidy work? Price elasticity of demand for influenza vaccination among the elderly in Japan.

Science.gov (United States)

Kondo, Masahide; Hoshi, Shu-ling; Okubo, Ichiro

2009-08-01

Subsidy for influenza vaccination is often provided to the elderly in order to encourage them to receive a flu shot in developed countries. However, its effect on uptake rate, i.e., price elasticity of demand, has not been well studied. Japan's decentralised vaccination programme allows observation of various pairs in price and uptake rate of flu shots among the elderly by the municipality from 2001/2002 to 2004/2005 season. We combine our sample survey data (n=281), which monitor price, subsidy and uptake rate, with published data on local characteristics in order to estimate price elasticity of demand with panel model. We find price elasticity of demand for influenza vaccine: nearly zero in nationwide, nearly zero in urban area, and -1.07 in rural area. The results question the rationale for subsidy, especially in urban area. There are cases where maintaining or increasing the level of subsidy is not an efficient allocation of finite health care resources. When organising a vaccination programme, health manager should be careful about the balance between subsidy and other efforts in order to encourage the elderly to receive shots with price elasticity in mind.

Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries.

Science.gov (United States)

Vassall, Anna; Mangham-Jefferies, Lindsay; Gomez, Gabriela B; Pitt, Catherine; Foster, Nicola

2016-02-01

Global guidelines for new technologies are based on cost and efficacy data from a limited number of trial locations. Country-level decision makers need to consider whether cost-effectiveness analysis used to inform global guidelines are sufficient for their situation or whether to use models that adjust cost-effectiveness results taking into account setting-specific epidemiological and cost heterogeneity. However, demand and supply constraints will also impact cost-effectiveness by influencing the standard of care and the use and implementation of any new technology. These constraints may also vary substantially by setting. We present two case studies of economic evaluations of the introduction of new diagnostics for malaria and tuberculosis control. These case studies are used to analyse how the scope of economic evaluations of each technology expanded to account for and then address demand and supply constraints over time. We use these case studies to inform a conceptual framework that can be used to explore the characteristics of intervention complexity and the influence of demand and supply constraints. Finally, we describe a number of feasible steps that researchers who wish to apply our framework in cost-effectiveness analyses. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

'Demand pull' government policies to support Product-Service System activity: The case of Energy Service Companies in the UK

OpenAIRE

Hannon, MJ; Foxon, TJ; Gale, WF

2015-01-01

Product-Service Systems (PSSs) constitute a family of service-based business models designed to satisfy our societal needs in an economically and environmentally sustainable manner. To date however PSS application has remained niche due to a variety of critical barriers. This paper explores how ‘demand pull’ national government policies could support PSS activity by addressing these barriers and cultivating market demand. Lessons are drawn from a case study of how regulatory, economic incenti...

Information Technology Framework for Pharmaceutical Supply Chain Demand Management: a Brazilian Case Study

Directory of Open Access Journals (Sweden)

Pedro Domingos Antoniolli

2016-01-01

Full Text Available The paper aims at proposing an information technology framework for demand management within a dyad on the supply chain pharmaceutical industry. The paper adopts the exploratory study as research method, involving a producer of generic drugs and its main distributor. Data was collected by semi - structured interviews. In pharmaceu tical supply chain, sharing information boosted by information technology translates into greater flexibility and reliability, lower costs, obtained through more reliable forecasting, and lower inventory requirements. There are few initiatives involving In formation Technology (IT applied to demand management in pharmaceutical supply chains available in the literature. It was found that the IT framework proposed in this research is adherent to the demand management of the focused pharmaceutical dyad. Other assumption was that, if partners processes integration exist, better supply chain performance is achieved. It was found that, by means of proposed tools and solutions, such as RFID and involved partners applications integration, this goal could be achieved . Because of the chosen research approach, results may be restricted to these specific dyadic processes. Further application of the proposed IT framework have to be tested. The paper identifies demand management strategic and operational processes that can reach a better performance by using the proposed IT framework. Based on the literature, were identified which IT requirements should be met to demand management processes optimization. Additionally, were applied questionnaires and interviews to the focuse d dyad personnel, to corroborate the data identified in the literature. Answers found in the case study link literature elements with those stated by respondents. Finally, based on this, was conceived an IT framework composed of three elements: 1. One spec ific for infrastructure, to enable data and systems interoperability among SC participants, considering a

Evaluation of climate change impacts on energy demand

DEFF Research Database (Denmark)

Taseska, Verica; Markovska, Natasa; Callaway, John M.

2012-01-01

change and the energy demand in Macedonia. The analyses are conducted using the MARKAL (MARKet ALlocation)-Macedonia model, with a focus on energy demand in commercial and residential sectors (mainly for heating and cooling). Three different cases are developed: 1) Base Case, which gives the optimal...... electricity production mix, taking into account country’s development plans (without climate change); 2) Climate Change Damage Case, which introduces the climate changes by adjusting the heating and cooling degree days inputs, consistent with the existing national climate scenarios; and 3) Climate Change...... Adaptation Case, in which the optimal electricity generation mix is determined by allowing for endogenous capacity adjustments in the model. This modeling exercise will identify the changes in the energy demand and in electricity generation mix in the Adaptation Case, as well as climate change damages...

Informal care givers’ experiences with support in primary palliative care when a case manager is involved: a descriptive study in the Netherlands.

NARCIS (Netherlands)

Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.

2017-01-01

Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and

Price elasticity matrix of demand in power system considering demand response programs

Science.gov (United States)

Qu, Xinyao; Hui, Hongxun; Yang, Shengchun; Li, Yaping; Ding, Yi

2018-02-01

The increasing renewable energy power generations have brought more intermittency and volatility to the electric power system. Demand-side resources can improve the consumption of renewable energy by demand response (DR), which becomes one of the important means to improve the reliability of power system. In price-based DR, the sensitivity analysis of customer’s power demand to the changing electricity prices is pivotal for setting reasonable prices and forecasting loads of power system. This paper studies the price elasticity matrix of demand (PEMD). An improved PEMD model is proposed based on elasticity effect weight, which can unify the rigid loads and flexible loads. Moreover, the structure of PEMD, which is decided by price policies and load types, and the calculation method of PEMD are also proposed. Several cases are studied to prove the effectiveness of this method.

Data model for Demand Side Management

Directory of Open Access Journals (Sweden)

Simona-Vasilica OPREA

2017-08-01

Full Text Available Demand Side Management (DSM is a portfolio of measures to improve the energy system mainly at the consumption level. In this paper we propose a data model for DSM stating from the optimization methods approach in SMARTRADE project from different perspectives of several entities that include: Transmission System Operator (TSO/Distribution System Operators (DSOs perspectives in case of security/reliability concerns: minimum amount of load (or generation shedding; aggregators perspective in case of demand or generation shedding request: Which demand (or generators should be shed?; consumers perspective: load shifting (time-of-use (ToU tariffs and optimum contract strategies with the aggregators (also known as balancing responsible parties- BRP for load shedding.

A prospective study on the characteristics and subjects of pediatric palliative care case management provided by a hospital based palliative care team

NARCIS (Netherlands)

Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.

2017-01-01

Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case

[Anesthetic Care of Patient With Heroin Addiction: A Case Report].

Science.gov (United States)

Lee, Wen-Yi; Kuo, Shu-Yu

2018-04-01

The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.

Analyses of demand response in Denmark

International Nuclear Information System (INIS)

Moeller Andersen, F.; Grenaa Jensen, S.; Larsen, Helge V.; Meibom, P.; Ravn, H.; Skytte, K.; Togeby, M.

2006-10-01

Due to characteristics of the power system, costs of producing electricity vary considerably over short time intervals. Yet, many consumers do not experience corresponding variations in the price they pay for consuming electricity. The topic of this report is: are consumers willing and able to respond to short-term variations in electricity prices, and if so, what is the social benefit of consumers doing so? Taking Denmark and the Nord Pool market as a case, the report focuses on what is known as short-term consumer flexibility or demand response in the electricity market. With focus on market efficiency, efficient allocation of resources and security of supply, the report describes demand response from a micro-economic perspective and provides empirical observations and case studies. The report aims at evaluating benefits from demand response. However, only elements contributing to an overall value are presented. In addition, the analyses are limited to benefits for society, and costs of obtaining demand response are not considered. (au)

Guidelines for forecasting energy demand

International Nuclear Information System (INIS)

Sonino, T.

1976-11-01

Four methodologies for forecasting energy demand are reviewed here after considering the role of energy in the economy and the analysis of energy use in different economic sectors. The special case of Israel is considered throughout, and some forecasts for energy demands in the year 2000 are presented. An energy supply mix that may be considered feasible is proposed. (author)

Demand for healthcare in India

Directory of Open Access Journals (Sweden)

Brijesh C. Purohit

2013-03-01

Full Text Available In a developing country like India, allocation of scarce fiscal resources has to be based on a clear understanding of how investments in the heath sector are going to affect demand. Three aspects like overall healthcare demand, consumer decisions to use public and/or private care and role of price/quality influencing poor/rich consumer’s decisions are critical to assessing the equity implications of alternative policies. Our paper addresses these aspects through examining the pattern of healthcare demand in India. Data from the National Family Health Survey are used to model the healthcare choices that individuals make. We consider what these behavioral characteristics imply for public policy. This analysis aims to study disparities between rural and urban areas from all throughout India to five Indian states representing three levels of per capita incomes (all-India average, rich and poor. Results evidence that healthcare demand both in rural and urban areas is a commodity emerging as an essential need. Choices between public or private provider are guided by income and quality variables mainly with regard to public healthcare denoting thus a situation of very limited alternatives in terms of availing private providers. These results emphasize that existing public healthcare facilities do not serve the objective of providing care to the poor in a satisfactory manner in rural areas. Thus, any financing strategy to improve health system and reduce disparities across rich-poor states and rural-urban areas should also take into account not only overcoming inadequacy but also inefficiency in allocation and utilization of healthcare inputs.

Demand response in energy markets

International Nuclear Information System (INIS)

Skytte, K.; Birk Mortensen, J.

2004-11-01

Improving the ability of energy demand to respond to wholesale prices during critical periods of the spot market can reduce the total costs of reliably meeting demand, and the level and volatility of the prices. This fact has lead to a growing interest in the short-run demand response. There has especially been a growing interest in the electricity market where peak-load periods with high spot prices and occasional local blackouts have recently been seen. Market concentration at the supply side can result in even higher peak-load prices. Demand response by shifting demand from peak to base-load periods can counteract the market power in the peak-load. However, demand response has so far been modest since the current short-term price elasticity seems to be small. This is also the case for related markets, for example, green certificates where the demand is determined as a percentage of the power demand, or for heat and natural gas markets. This raises a number of interesting research issues: 1) Demand response in different energy markets, 2) Estimation of price elasticity and flexibility, 3) Stimulation of demand response, 4) Regulation, policy and modelling aspects, 5) Demand response and market power at the supply side, 6) Energy security of supply, 7) Demand response in forward, spot, ancillary service, balance and capacity markets, 8) Demand response in deviated markets, e.g., emission, futures, and green certificate markets, 9) Value of increased demand response, 10) Flexible households. (BA)

Have out-of-pocket health care payments risen under free health care policy? The case of Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha; Grimm, Michael

2018-04-26

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out-of-pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income-induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink. Copyright © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

Technology-dependent children and the demand for pharmaceutical care.

Science.gov (United States)

Okido, Aline Cristiane Cavicchioli; Cunha, Suelen Teles da; Neves, Eliane Tatsch; Dupas, Giselle; Lima, Regina Aparecida Garcia de

2016-01-01

to understand the experience of mothers of technology-dependent children as regards pharmaceutical care. this was a qualitative, descriptive-exploratory study developed based on open interviews using a structured characterization tool, and applied during home visits to 12 mothers caring for technology-dependent children. The data was submitted to inductive content analysis. this study is split into two themes: (i) maternal overload during pharmaceutical care, demonstrating the need to administer drugs continuously and the repercussions of this exhaustive care on the caregivers; (ii) the ease or difficulty of access to the medicines required, showing informal strategies and support networks. pharmaceutical care is a daily challenge expressed in maternal overload and difficulty accessing the drugs, made worse by failures in the care network and coordinated care.

How to implement process-oriented care: a case study on the implementation of process-oriented in-hospital stroke care.

NARCIS (Netherlands)

Vos, L.; Oostenbrugge, R.J. van; Limburg, M.; Merode, G.G. van; Groothuis, S.

2009-01-01

Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study

Synthesizing Econometric Evidence: The Case of Demand Elasticity Estimates.

Science.gov (United States)

DeCicca, Philip; Kenkel, Don

2015-06-01

Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important. © 2015 Society for Risk Analysis.

Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

Science.gov (United States)

Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G

2010-11-01

Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review

Science.gov (United States)

2016-03-23

This research study combines qualitative and quantitative methodology in reflectively exploring positive case studies to ascertain strategies that...enabled patients to engage in self-management. Moreover, this study seeks to better understand how applying the ADA Standards of Care in a military

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons.

Science.gov (United States)

Lee, Jung Jeung; Park, Nam Hee; Lee, Kun Sei; Chee, Hyun Keun; Sim, Sung Bo; Kim, Myo Jeong; Choi, Ji Suk; Kim, Myunghwa; Park, Choon Seon

2016-12-01

While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors

Food safety information and food demand

DEFF Research Database (Denmark)

Smed, Sinne; Jensen, Jørgen Dejgård

2005-01-01

Purpose – The purpose of this paper is to analyze how news about food-related health risks affects consumers’ demands for safe food products. Design/methodology/approach – By identifying structural breaks in an econometrically estimated demand model, news with permanent impact on demand...... induces a permanent increase in the demand for pasteurized eggs, while more moderate negative news influences demand temporarily and to a lesser extent. There is, however, considerable variation in the response to food safety news across socio-demographic groups of consumers. Research limitations...... is distinguished from news with temporary impact. The Danish demand for pasteurized versus shell eggs is used as an illustrative case. Findings – Negative safety news about one product variety can provide significant stimulation to the demand for safe varieties. Severe negative news about the safety of shell eggs...

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Science.gov (United States)

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Beyond bankable dollars: establishing a business case for improving health care.

Science.gov (United States)

Bailit, Michael; Dyer, Mary Beth

2004-09-01

To address widespread deficiencies in the quality of health care, the authors argue that health care organizations need to be able to make a "business case" for improving quality--a compelling rationale for financial investment in quality improvement programs. The authors' framework for such a business case is organized around three broad areas: direct financial considerations, strategic considerations, and internal organizational considerations. Within these categories, they offer a total of 10 specific business case arguments, with examples, for investing in quality improvement.

Essential competencies for the education of nursing assistants and care helpers in elderly care

NARCIS (Netherlands)

Oeseburg, Barth; Hilberts, Rudi; Roodbol, Petrie F

2015-01-01

BACKGROUND: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains

Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

Science.gov (United States)

Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

2018-01-01

Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

A Novel Hierarchical Model to Locate Health Care Facilities with Fuzzy Demand Solved by Harmony Search Algorithm

Directory of Open Access Journals (Sweden)

Mehdi Alinaghian

2014-08-01

Full Text Available In the field of health losses resulting from failure to establish the facilities in a suitable location and the required number, beyond the cost and quality of service will result in an increase in mortality and the spread of diseases. So the facility location models have special importance in this area. In this paper, a successively inclusive hierarchical model for location of health centers in term of the transfer of patients from a lower level to a higher level of health centers has been developed. Since determination the exact number of demand for health care in the future is difficult and in order to make the model close to the real conditions of demand uncertainty, a fuzzy programming model based on credibility theory is considered. To evaluate the proposed model, several numerical examples are solved in small size. In order to solve large scale problems, a meta-heuristic algorithm based on harmony search algorithm was developed in conjunction with the GAMS software which indicants the performance of the proposed algorithm.

WATER DEMAND PREDICTION USING ARTIFICIAL NEURAL ...

African Journals Online (AJOL)

This paper presents Hourly water demand prediction at the demand nodes of a water distribution network using NeuNet Pro 2.3 neural network software and the monitoring and control of water distribution using supervisory control. The case study is the Laminga Water Treatment Plant and its water distribution network, Jos.

Exploring interprofessional, interagency multimorbidity care: case study based observational research

Science.gov (United States)

McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

2017-01-01

Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

Questioning the sustainable palm oil demand: case study from French-Indonesia supply chain

Science.gov (United States)

Chalil, D.; Barus, R.

2018-02-01

Sustainable palm oil has been widely debated. Consuming countries insist certified sustainable produces palm oil, but in fact the absorption of the certified palm oil is still less than 60%. This raise questions about the sustainable palm oil demand. In this study, such a condition will be analysed in French-Indonesia supply chain case. Using monthly and quarterly data from 2010 to 2016 with Autoregressive Distributed Lag (ARDL) approach and Error Correction Model, demand influencing factors and price integration in each market of the supply chain is estimated. Two scenarios namely re-export and direct export models are considered in the Error Correction Model. The results show that France Gross Domestic Product, prices of France palm oil import from Indonesia, Malaysia, and Germany, and price of France groundnut import significantly influence the France palm oil import volume from Indonesia. Prices in each market along palm oil re-export France-Indonesia supply chain are co-integrated and converge towards long-run equilibrium, but not in the direct export supply chain. This leads to a conclusion that France market preferences in specific and EU market preferences in general need to be considered by Indonesian palm oil decision makers.

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

Science.gov (United States)

Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

2015-09-01

The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

Designing a Care Pathway Model - A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway.

Science.gov (United States)

Oosterholt, Robin I; Simonse, Lianne Wl; Boess, Stella U; Vehmeijer, Stephan Bw

2017-03-09

Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. The design addressed existing problems and is an optimisation of the case hospital's pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

Application of Demand Analysis in Marketing Continuing Education.

Science.gov (United States)

Waters, Elzberry, Jr.

This study investigated the feasibility of applying economic demand analysis (especially elasticity of demand) in marketing George Washington University off-campus degree programs. In the case under study, a supplemental budget request had to be submitted to meet expenses incurred by an unforeseen increase in demand for graduate and undergraduate…

Job stress and job satisfaction: home care workers in a consumer-directed model of care.

Science.gov (United States)

Delp, Linda; Wallace, Steven P; Geiger-Brown, Jeanne; Muntaner, Carles

2010-08-01

To investigate determinants of job satisfaction among home care workers in a consumer-directed model. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work-health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer-directed models of care and efforts to retain long-term care workers.

Managing the growing energy demand - The case of Egypt

Energy Technology Data Exchange (ETDEWEB)

El-Kholy, Hosni; Faried, Ragy

2010-09-15

The electric energy consumption rate in Egypt has an average increase of 7% per year through the last three decades. In order to satisfy the ever increasing energy demand, several actions were, and have to be taken. These actions have to be carried out in parallel. The one having the greatest effect is the measures carried out for energy conservation and loss reduction. Diversifying the energy source such as utilization of Renewable Energy technologies can contribute to satisfying the demand and extending the hydro-carbon reserves life. Regional integration of electrical networks will save expenditures used to build additional power plants.

A Solution Approach from an Analytic Model to Heuristic Algorithm for Special Case of Vehicle Routing Problem with Stochastic Demands

Directory of Open Access Journals (Sweden)

2009-03-01

Full Text Available We define a special case for the vehicle routing problem with stochastic demands (SC-VRPSD where customer demands are normally distributed. We propose a new linear model for computing the expected length of a tour in SC-VRPSD. The proposed model is based on the integration of the “Traveling Salesman Problem” (TSP and the Assignment Problem. For large-scale problems, we also use an Iterated Local Search (ILS algorithm in order to reach an effective solution.

Ebola cases and health system demand in Liberia.

Directory of Open Access Journals (Sweden)

John M Drake

2015-01-01

Full Text Available In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the

Future butanes supply/demand

International Nuclear Information System (INIS)

Whitley, S.C.

1992-01-01

This paper graphically depicts, through in-depth supply/demand analysis, how environmental regulations can be both bad and good for an industry. In the case of n-butane, the Environmental Protection Agency (EPA) summertime gasoline volatility regulations are a culprit - threatening to ultimately destroy refinery demand for the product as a gasoline blendstock. Waiting in the wings are environmental regulations that should eventually prove to be n-butane's savior. The regulations referred to here are the Clean Air Act (CAA) of 1990's mandate for motor fuel oxygenates. The negative impact of gasoline volatility regulations on U.S. n-butane demand and the positive impact that should come from the use of n-butane as a MTBE precursor are covered. Many variables exist which make studying the effects of these environmental regulations very difficult. Over the past three years RPC Group has conducted numerous studies on n-butane supply/demand, as impacted by both EPA gasoline volatility and fuel oxygenate regulations

Long-term uranium supply-demand analyses

International Nuclear Information System (INIS)

1986-12-01

It is the intention of this study to investigate the long-term uranium supply demand situation using a number of supply and demand related assumptions. For supply, these assumptions as used in the Resources and Production Projection (RAPP) model include country economic development status, and consequent lead times for exploration and development, uranium development status, country infrastructure, and uranium resources including the Reasonably Assured (RAR), Estimated Additional, Categories I and II, (EAR-I and II) and Speculative Resource categories. The demand assumptions were based on the ''pure'' reactor strategies developed by the NEA Working Party on Nuclear Fuel Cycle Requirements for the 1986 OECD (NEA)/IAEA reports ''Nuclear Energy and its Fuel Cycle: Prospects to 2025''. In addition for this study, a mixed strategy case was computed using the averages of the Plutonium (Pu) burning LWR high, and the improved LWR low cases. It is understandable that such a long-term analysis cannot present hard facts, but it can show which variables may in fact influence the long-term supply-demand situation. It is hoped that results of this study will provide valuable information for planners in the uranium supply and demand fields. Periodical re-analyses with updated data bases will be needed from time to time

The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

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Sina Waibel

2015-07-01

Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

[Continuity of care from the acute care hospital: Results].

Science.gov (United States)

Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

2015-01-01

To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Implications of case managers' perceptions and attitude on safety of home-delivered care.

Science.gov (United States)

Jones, Sarahjane

2015-12-01

Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.

China's medical savings accounts: an analysis of the price elasticity of demand for health care.

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Yu, Hao

2017-07-01

Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis.

Interaction between demand-control and social support in the occurrence of common mental disorders

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Amália Ivine Santana Mattos

Full Text Available ABSTRACT OBJECTIVE To analyze the interaction between the psychosocial aspects of work and the occurrence of common mental disorders among health workers. METHODS This is a cross-sectional study conducted with a representative sample of workers of the primary health care of five municipalities of the State of Bahia, Brazil, in 2012. The variable of outcome were the common mental disorders evaluated by the SRQ-20, and the variables of exposure were high demand (high psychological demand and low control over the work and low social support in the workplace. Interaction was checked by the deviation of the additivity of the effects for the factors studied from the calculation of excess risk from interaction, proportion of cases attributed to interaction, and the synergy index. RESULTS The global prevalence of common mental disorders was 21%. The group of combined exposure has shown higher magnitude (high demand and low social support, reaching 28% when compared to the 17% in the situation of no exposure (low demand and high social support. CONCLUSIONS The results strengthen the hypothesis of interaction between the factors investigated, directing to the synergy of the effects.

An Optimization of (Q,r Inventory Policy Based on Health Care Apparel Products with Compound Poisson Demands

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An Pan

2014-01-01

Full Text Available Addressing the problems of a health care center which produces tailor-made clothes for specific people, the paper proposes a single product continuous review model and establishes an optimal policy for the center based on (Q,r control policy to minimize expected average cost on an order cycle. A generic mathematical model to compute cost on real-time inventory level is developed to generate optimal order quantity under stochastic stock variation. The customer demands are described as compound Poisson process. Comparisons on cost between optimization method and experience-based decision on Q are made through numerical studies conducted for the inventory system of the center.

[Job demands and work-family conflict in a health care staff. The role of work shifts].

Science.gov (United States)

Zito, Margherita; Colombo, Lara; Mura, Gabriella

2013-01-01

Work-family conflict (wfc), that originates from an incompatibility between the job and the family demands, is a very relevant topic in health care context, as suggested by NEXT study. Work overload and schedule organization are dimensions that can affect wfc, and particularly, studies indicate work shifts as one of its main determinants, as they limit the work-family balance and represent one of the prime risk factors for workers' health. The aim of this study was to detect the role of some job demands (both general and specific) and of schedule organization in determining the wfc experience, with particular attention to work shifts. Respondents to our questionnaire are 207 nurses of a north Italian public health organization. They are mostly women (92.8%) and their average age is 42. Data analysis shows that wfc is mostly influenced by work shifts, but also by work overload, cognitive load and by on-call availability. Staff working on shifts and on-call availability perceive a higher wfc than their colleagues without work shifts and on-call availability. The central role of work shifts in determining wfc suggests the need to act on schedule organization and on training programs for supervisors and workers.

New estimates of elasticity of demand for healthcare in rural China.

Science.gov (United States)

Zhou, Zhongliang; Su, Yanfang; Gao, Jianmin; Xu, Ling; Zhang, Yaoguang

2011-12-01

Only limited empirical studies reported own-price elasticity of demand for health care in rural China. Neither research on income elasticity of demand for health care nor cross-price elasticity of demand for inpatient versus outpatient services in rural China has been reported. However, elasticity of demand is informative to evaluate current policy and to guide further policy making. Our study contributes to the literature by estimating three elasticities (i.e., own-price elasticity, cross-price elasticity, and income elasticity of demand for health care based on nationwide-representative data. We aim to answer three empirical questions with regard to health expenditure in rural China: (1) Which service is more sensitive to price change, outpatient or inpatient service? (2) Is outpatient service a substitute or complement to inpatient service? and (3) Does demand for inpatient services grow faster than demand for outpatient services with income growth? Based on data from a National Health Services Survey, a Probit regression model with probability of outpatient visit and probability of inpatient visit as dependent variables and a zero-truncated negative binomial regression model with outpatient visits as dependent variable were constructed to isolate the effects of price and income on demand for health care. Both pooled and separated regressions for 2003 and 2008 were conducted with tests of robustness. Own-price elasticities of demand for first outpatient visit, outpatient visits among users and first inpatient visit are -0.519 [95% confidence interval (-0.703, -0.336)], -0.547 [95% confidence interval (-0.747, -0.347)] and -0.372 [95% confidence interval (-0.517, -0.226)], respectively. Cross-price elasticities of demand for first outpatient visit, outpatient visits among users and first inpatient visit are 0.073 [95% confidence interval (-0.176, 0.322)], 0.308 [95% confidence interval (0.087, 0.528)], and 0.059 [95% confidence interval (-0.085, 0

Applying operations management in client-oriented and cost-efficient provision of care, welfare and housing services

Science.gov (United States)

de Blok, Carolien; Meijboom, Bert; Luijkx, Katrien; Schols, Jos

2008-01-01

Purpose In all Western countries, ageing populations cause the demand for elderly care services to increase dramatically. In addition, elderly clients are getting more demanding about the services they require to fulfil their widely varying and multiple needs. Besides, cost reductions have been the focus of governmental policies and organisational practices for many years. Health care providers increasingly see operations management as a promising approach to align both client-orientation and cost-efficiency in their day-to-day practices. Theory The paper starts from operations management literature on front office—back office design and modular production. Organisations have several options for deciding which activities need to be performed by FO, BO, or the client himself, and in deciding which employees need to perform these activities. By applying modular production, organisations can differentiate care and related services to a high degree without major cost increases. Method A literature review will be presented leading to a theoretical framework. This formed the basis for explorative case studies in the elderly care sector. Results and conclusions It will be argued how insights provided with the framework may enhance a client-orientation in integrated care delivery without major cost increases. Although case studies need to be interpreted with caution, interesting implications for organisational structures and inter-organisational cooperation can be seen. We will discuss how combined supply of care services can be made transparent to enhance choice options in service products, and what is required at the level of professionals for providing care and service packages based on client demand.

Real-Time Demand Side Management Algorithm Using Stochastic Optimization

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Moses Amoasi Acquah

2018-05-01

Full Text Available A demand side management technique is deployed along with battery energy-storage systems (BESS to lower the electricity cost by mitigating the peak load of a building. Most of the existing methods rely on manual operation of the BESS, or even an elaborate building energy-management system resorting to a deterministic method that is susceptible to unforeseen growth in demand. In this study, we propose a real-time optimal operating strategy for BESS based on density demand forecast and stochastic optimization. This method takes into consideration uncertainties in demand when accounting for an optimal BESS schedule, making it robust compared to the deterministic case. The proposed method is verified and tested against existing algorithms. Data obtained from a real site in South Korea is used for verification and testing. The results show that the proposed method is effective, even for the cases where the forecasted demand deviates from the observed demand.

When constitutional justice has the last word on health care: the case of Chile.

Science.gov (United States)

Zúñiga Fajuri, Alejandra

2014-01-01

The Chilean health care system is in crisis. Since the recent ruling of the Constitutional Court that declared the risk rating (actuarial insurance) of private health insurers unconstitutional, all of the social actors related to health care have tried to agree on a legislative reform that would overcome the existing highly segmented and inequitable system, which is a legacy of Pinochet's dictatorship. Here we demonstrate how the social and political demands for legislative reform in the health care sector have been supported by the decisions of the courts. To achieve its goals of reducing equity gaps in health and ending the judicialization of health care (claims for protection represent almost 70% of total resources of the courts), the National Congress of Chile is trying to create a new national health insurance system that guarantees the right to a minimum level of health care. Part of this effort involves obtaining the constitutional approval of the courts. In Chile, justice has the final word on health care.

Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

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Robin I. Oosterholt

2017-03-01

Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

Accumulative job demands and support for strength use: Fine-tuning the job demands-resources model using conservation of resources theory.

Science.gov (United States)

van Woerkom, Marianne; Bakker, Arnold B; Nishii, Lisa H

2016-01-01

Absenteeism associated with accumulated job demands is a ubiquitous problem. We build on prior research on the benefits of counteracting job demands with resources by focusing on a still untapped resource for buffering job demands-that of strengths use. We test the idea that employees who are actively encouraged to utilize their personal strengths on the job are better positioned to cope with job demands. Based on conservation of resources (COR) theory, we hypothesized that job demands can accumulate and together have an exacerbating effect on company registered absenteeism. In addition, using job demands-resources theory, we hypothesized that perceived organizational support for strengths use can buffer the impact of separate and combined job demands (workload and emotional demands) on absenteeism. Our sample consisted of 832 employees from 96 departments (response rate = 40.3%) of a Dutch mental health care organization. Results of multilevel analyses indicated that high levels of workload strengthen the positive relationship between emotional demands and absenteeism and that support for strength use interacted with workload and emotional job demands in the predicted way. Moreover, workload, emotional job demands, and strengths use interacted to predict absenteeism. Strengths use support reduced the level of absenteeism of employees who experienced both high workload and high emotional demands. We conclude that providing strengths use support to employees offers organizations a tool to reduce absenteeism, even when it is difficult to redesign job demands. (c) 2016 APA, all rights reserved).

Strategies for Demand Response in Commercial Buildings

Energy Technology Data Exchange (ETDEWEB)

Watson, David S.; Kiliccote, Sila; Motegi, Naoya; Piette, Mary Ann

2006-06-20

This paper describes strategies that can be used in commercial buildings to temporarily reduce electric load in response to electric grid emergencies in which supplies are limited or in response to high prices that would be incurred if these strategies were not employed. The demand response strategies discussed herein are based on the results of three years of automated demand response field tests in which 28 commercial facilities with an occupied area totaling over 11 million ft{sup 2} were tested. Although the demand response events in the field tests were initiated remotely and performed automatically, the strategies used could also be initiated by on-site building operators and performed manually, if desired. While energy efficiency measures can be used during normal building operations, demand response measures are transient; they are employed to produce a temporary reduction in demand. Demand response strategies achieve reductions in electric demand by temporarily reducing the level of service in facilities. Heating ventilating and air conditioning (HVAC) and lighting are the systems most commonly adjusted for demand response in commercial buildings. The goal of demand response strategies is to meet the electric shed savings targets while minimizing any negative impacts on the occupants of the buildings or the processes that they perform. Occupant complaints were minimal in the field tests. In some cases, ''reductions'' in service level actually improved occupant comfort or productivity. In other cases, permanent improvements in efficiency were discovered through the planning and implementation of ''temporary'' demand response strategies. The DR strategies that are available to a given facility are based on factors such as the type of HVAC, lighting and energy management and control systems (EMCS) installed at the site.

Money-in-the-Utility-Function: Model Simulations and Money Demand Estimation in the Case of the Republic of Macedonia

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Ivanov Mile

2015-03-01

Full Text Available This paper aims to reassess and analyze the dynamic interactions between money, prices and economic activity in the case of the Republic of Macedonia. The first part of the paper simulates the property of the superneutrality of money, based on Sidrauski’s (1967 framework. The second part presents the money demand estimations on the monetary aggregate M2 for the period from 2002 to 2012, using the cointegration approach. Following Cziráky and Gillman (2006, we examine the validity of the Fisher equation in the case of Macedonia. The Fisher equation does not hold in the case of Macedonia, so the inflation rate must be included in the money demand specification. The estimated cointegration equation is in line with economic theory. The cointegration equation shows income elasticity less than unity (0,81, small and negative interest rate semi-elasticity (-0.17 and negative elasticity with respect to inflation. The short-run dynamics reveal that only 2,70% of the disequilibrium is corrected in a single quarter. The properties of stability imply that the M2 aggregate may serve as a proper policy indicator.

Forecasting need and demand for home health care: a selective review.

Science.gov (United States)

Sharma, R K

1980-01-01

THREE MODELS FOR FORECASTING HOME HEALTH CARE (HHC) NEEDS ARE ANALYZED: HSA/SP model (Health Systems Agency of Southwestern Pennsylvania); Florida model (Florida State Department of Health and Rehabilitative Services); and Rhode Island model (Rhode Island Department of Community Affairs). A utilization approach to forecasting is also presented.In the HSA/SP and Florida models, need for HHC is based on a certain proportion of (a) hospital admissions and (b) patients entering HHC from other sources. The major advantage of these models is that they are relatively easy to use and explain; their major weaknesses are an imprecise definition of need and an incomplete model specification.The Rhode Island approach defines need for HHC in terms of the health status of the population as measured by chronic activity limitations. The major strengths of this approach are its explicit assumptions and its emphasis on consumer needs. The major drawback is that it requires considerable local area data.The utilization approach is based on extrapolation from observed utilization experience of the target population. Its main limitation is that it is based on current market imperfections; its major advantage is that it exposes existing deficiencies in HHC.The author concludes that each approach should be tested empirically in order to refine it, and that need and demand approaches be used jointly in the planning process.

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

Science.gov (United States)

Motlagh, Soraya Nouraei; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Ghaderi, Hossein

2015-01-01

Introduction: In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance. Method: In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran. Results: In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance. Conclusion: Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their

An electricity generation planning model incorporating demand response

International Nuclear Information System (INIS)

Choi, Dong Gu; Thomas, Valerie M.

2012-01-01

Energy policies that aim to reduce carbon emissions and change the mix of electricity generation sources, such as carbon cap-and-trade systems and renewable electricity standards, can affect not only the source of electricity generation, but also the price of electricity and, consequently, demand. We develop an optimization model to determine the lowest cost investment and operation plan for the generating capacity of an electric power system. The model incorporates demand response to price change. In a case study for a U.S. state, we show the price, demand, and generation mix implications of a renewable electricity standard, and of a carbon cap-and-trade policy with and without initial free allocation of carbon allowances. This study shows that both the demand moderating effects and the generation mix changing effects of the policies can be the sources of carbon emissions reductions, and also shows that the share of the sources could differ with different policy designs. The case study provides different results when demand elasticity is excluded, underscoring the importance of incorporating demand response in the evaluation of electricity generation policies. - Highlights: ► We develop an electric power system optimization model including demand elasticity. ► Both renewable electricity and carbon cap-and-trade policies can moderate demand. ► Both policies affect the generation mix, price, and demand for electricity. ► Moderated demand can be a significant source of carbon emission reduction. ► For cap-and-trade policies, initial free allowances change outcomes significantly.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

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Jung Jeung Lee

2016-12-01

Full Text Available Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time

Exploring the Demands on Nurses Working in Health Care Facilities During a Large-Scale Natural Disaster

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Gillian C. Scrymgeour

2016-06-01

Full Text Available Nurses are pivotal to an effective societal response to a range of critical events, including disasters. This presents nurses with many significant and complex challenges that require them to function effectively under highly challenging and stressful circumstances and often for prolonged periods of time. The exponential growth in the number of disasters means that knowledge of disaster preparedness and how this knowledge can be implemented to facilitate the development of resilient and adaptive nurses and health care organizations represents an important adjunct to nurse education, policy development, and research considerations. Although this topic has and continues to attract attention in the literature, a lack of systematic understanding of the contingencies makes it difficult to clearly differentiate what is known and what gaps remain in this literature. Providing a sound footing for future research can be facilitated by first systematically reviewing the relevant literature. Focused themes were identified and analyzed using an ecological and interactive systems framework. Ten of the 12 retained studies included evacuation, revealing that evacuation is more likely to occur in an aged care facility than a hospital. The unpredictability of an event also highlighted organizational, functional, and competency issues in regard to the complexity of decision making and overall preparedness. The integrative review also identified that the unique roles, competencies, and demands on nurses working in hospitals and residential health care facilities during a natural disaster appear invisible within the highly visible event.

Care in Family Relations : The Case of Surrogacy Leave

OpenAIRE

Burri, Susanne

2015-01-01

The advance of reproductive technologies, like surrogacy arrangements, confronts courts with new demands and dilemmas. This contribution analyses the potential of EU law towards a better and more balanced reconciliation of work, private and family life when no national law applies. In two recent cases of the Court of Justice of the EU on leave for surrogacy mothers, the Advocates General Kokott and Wahl published diverging opinions on similar prejudicial questions of national courts. These op...

New information on world uranium resource, production, supply and demand

International Nuclear Information System (INIS)

Zhang Jianguo; Meng Jin

2006-01-01

New information on world uranium resource, production, supply and demand is introduced. Up to now, explored uranium resources at production cost < USD 40/kg U has 2523257 t uranium; production cost < USD 80/kg U has 5911514 t uranium; production cost < USD130/kg U has 11280488 t uranium; and cost range unassigned has 3102000 t uranium. At moment, the demand uranium of each year is about 67000 t U. After 2020, world uranium demand will rise well above 100000 t per annum with sharp revival of nuclear power plants. With three kinds of economic growth the cumulative requirement of the uranium in low demand case, middle demand case and high demand case from 2000 to 2050 is 3390000, 5394100 and 7577300 t respectively. In the world market uranium price rises from 20 years lowest 18.2 USD/kg U to 75.4 USD/kg U. In 2003, global uranium product is about 35385 t U, and 2004, global uranium product is about 40475 t U. In 2004's world uranium production underground mining, open pit, in situ, by product, and combination account for 39%, 27%, 19%, 11% and 4% respectively. (authors)

Substances of abuse - demand for their determinations in the Western Cape

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Pieter van der Bijl

2004-04-01

Full Text Available Background. Drug abuse is as relevant today as ever. Management of such cases on a primary health care level may be challenging, particularly when laboratory facilities are unavailable. Furthermore, substance abuse and its sequelae place a significant burden on the already overstretched primary health care resources in the country, as well as on other ser- vices and society in general. Objectives. The current study surveyed the trends in demand for laboratory determination of amphetamines, opiates, methaqualone, cannabis, cocaine and ethanol for the period 1991 - 2002, in the Western Cape. The survey was conducted by extracting the relevant data from the records of the Pharmacology/Toxicology Laboratory of the University of Stellenbosch and Tygerberg Academic Hospital. This facility processes the largest number of specimens by a single laboratory in the Western Cape. Results. From the data obtained a seasonal pattern emerged for all substances except ethanol, with a trough appearing in early winter. Demand for ethanol analysis was fairly constant throughout the year, with a peak in the last quarter. Ethanol level was the most frequently requested analysis between 1991 and 1997. This concurs with its status as the main substance of abuse in South Africa and the rest of the world. There was an increased demand for analysis of ampheta- mines, opiates, methaqualone, cannabis and cocaine between 1991 and 2002. Generally dominating, next to ethanol, were requests for cannabis and methaqualone analysis. Interesting to note was the increase in demand for opiate analysis, following the trend observed in certain other regions of the world. Conclusion. The analysis trends observed in this study demon- strate global patterns of drug abuse emerging in the Western Cape. The medical and social effects of drug abuse impose a grave responsibility on policymakers to ensure that adequate funding is available for analytical laboratories. Only in such a way can

The Physical Demands and Ergonomics of Working with Young Children.

Science.gov (United States)

Gratz, Rene R.; Claffey, Anne; King, Phyllis; Scheuer, Gina

2002-01-01

Examines the physical demands and ergonomic concerns within child care settings. Discusses problem areas and ergonomic recommendations for room design and staff training. Presents important implications for writing job descriptions, determining essential job functions, orienting and training staff, and committing to improving the child care work…

Climate-related electricity demand-side management in oil-exporting countries--the case of the United Arab Emirates

International Nuclear Information System (INIS)

Al-Iriani, Mahmoud A.

2005-01-01

The oil crisis of the 1970s has increased the concern about the continuity of oil imports flow to major oil-importing developed countries. Numerous policy measures including electricity demand-side management (DSM) programs have been adopted in such countries. These measures aim at reducing the growing need for electricity power that increases the dependency on imported foreign oil and damages the environment. On the other hand, the perception that energy can be obtained at very low cost in oil-rich countries led to less attention being paid to the potential of DSM policies in these countries. This paper discusses such potential using the case of the United Arab Emirates (UAE). Since air conditioning is a major source of electric energy consumption, the relationship between climate conditions and electric energy consumption is considered. An electricity demand model is constructed using time series techniques. The fitted model seems to represent these relationships rather well. Forecasts for electricity consumption using the estimated model indicate that a small reduction in cooling degrees requirement might induce a significant reduction in electric energy demand. Hence, a DSM program is proposed with policy actions to include, among others, measures to reduce cooling degrees requirement

Care of radiation accidents

International Nuclear Information System (INIS)

Renz, K.

1983-01-01

The small probability of a serious radiation accident happening dispenses neither the plants where radiation exposure occurs nor the employers' liability insurance associations from their obligation to make provision for such cases. On the other hand, the efforts involved in such preventive measures must be kept within reasonable limits. As a result of these considerations a concept for taking care of radiation accidents was developed that is based on already existing institutions. The most attention was demanded by questions of organization, logistics, communication and information. The syndrome appearing after acute whole-body irradiation is known. This syndrome in its different stages and the relative therapeutic measures form the basis for the organization of the care of radiation accidents. (orig./MG) [de

DeMand: A tool for evaluating and comparing device-level demand and supply forecast models

DEFF Research Database (Denmark)

Neupane, Bijay; Siksnys, Laurynas; Pedersen, Torben Bach

2016-01-01

Fine-grained device-level predictions of both shiftable and non-shiftable energy demand and supply is vital in order to take advantage of Demand Response (DR) for efficient utilization of Renewable Energy Sources. The selection of an effective device-level load forecast model is a challenging task......, mainly due to the diversity of the models and the lack of proper tools and datasets that can be used to validate them. In this paper, we introduce the DeMand system for fine-tuning, analyzing, and validating the device-level forecast models. The system offers several built-in device-level measurement...... datasets, forecast models, features, and errors measures, thus semi-automating most of the steps of the forecast model selection and validation process. This paper presents the architecture and data model of the DeMand system; and provides a use-case example on how one particular forecast model...

Variations in levels of care between nursing home patients in a public health care system.

Science.gov (United States)

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2014-03-05

Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States.

Science.gov (United States)

Cunha-Cruz, Joana; Milgrom, Peter; Huebner, Colleen E; Scott, JoAnna; Ludwig, Sharity; Dysert, Jeanne; Mitchell, Melissa; Allen, Gary; Shirtcliff, R Mike

2017-12-20

Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment. A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy. Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company's mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0

[Moral case deliberation: time for ethical reflection in the daily practice of mental health care].

Science.gov (United States)

Vellinga, A; van Melle-Baaijens, E A H

2016-01-01

Nowadays, reflecting on ethics, which we choose to call moral case deliberation, is occurring more and more frequently in psychiatric institutions. We have personal experience of organising and supervising moral case deliberation in a large psychiatric institute and we can confirm the positive effects of moral case deliberation which have been reported in the literature. To describe a structured method for moral case deliberation which enables care-givers in health care and/or addiction care to reflect on moral dilemmas. We refer to the main findings in relevant literature and describe how we developed a structured method for implementing moral case deliberation. Our studies of the literature indicate that systematic reflection about ethical dilemmas can improve the quality of care and make care-givers more satisfied with their work. This is why we have developed our own method which is applicable particularly to psychiatric and/or addition care and which can be used systematically in discussions of moral dilemmas. Our method for discussing ethical issues works well in clinical practice, particularly when it is embedded in a multidisciplinary context. Of course, to ensure the continuity of the system, deliberation about moral and ethical issues needs to be financially safeguarded and embedded in the organisation. Discussion of moral issues improves the quality of care and increases care-givers' satisfaction with their work.

Demand response in liberalized electricity markets - the Nordic case

International Nuclear Information System (INIS)

Bjoerndal, Mette; Lund, Arne-Christian; Rud, Linda

2005-01-01

The liberalization of the Nordic electricity markets started with the deregulation of the Norwegian market, and the later inclusion of Sweden, Denmark and Finland in The Nord Pool area has provided a truly international marketplace, where prices are quoted for all the Nordic countries except Iceland. The structure of the Norwegian supply side was a favorable starting point for the liberalization process with many independent (hydropower) producers and, following the Energy Act of 1991, the vertical separation of competitive production on the one hand and regulated transmission / distribution one the other hand (implemented as a requirement of separation of financial accounts). Moreover, since the mid 1990s (unregulated) retail competition has provided market based price-signals to customers, even to individual households. In this paper we will focus on the potential benefits of demand flexibility in order to enhance the performance of the electricity market in attaining optimal operation and development of the electricity system. These benefits will depend on the price elasticity of the demand. However, whether it is possible to act on price changes also depends on the information provided to and from the customers. Especially for short run flexibility, this may require two way communication devises for larger customer groups, which raises questions like who is to pay for the investments needed, and who will benefit from them. Demand response also depends on the marginal signals resulting from the different contracts offered to the customers. Today this includes ''variable'' price, spot price (based on Nord Pool Elspot) and fixed price contracts. Customer flexibility depends on the possibility of substitution for instance to other fuels / alternative energy provisions. Finally, flexibility will differ between customer classes, for instance households, industry, power intensive industry etc. In this paper we investigate demand response and customer flexibility in

The impact of demand management strategies on parents’ decision-making for out-of-hours primary care: findings from a survey in The Netherlands

OpenAIRE

Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

2017-01-01

Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, ove...

Social support, flexible resources, and health care navigation.

Science.gov (United States)

Gage-Bouchard, Elizabeth A

2017-10-01

Recent research has focused attention on the role of patients' and clinicians' cultural skills and values in generating inequalities in health care experiences. Yet, examination of how social structural factors shape people's abilities to build, refine, and leverage strategies for navigating the health care system have received less attention. In this paper I place focus on one such social structural factor, social support, and examine how social support operates as a flexible resource that helps people navigate the health care system. Using the case of families navigating pediatric cancer care this study combines in-depth interviews with parents of pediatric cancer patients (N = 80), direct observation of clinical interactions between families and physicians (N = 73), and in-depth interviews with pediatric oncologists (N = 8). Findings show that physicians assess parental visibility in the hospital, medical vigilance, and adherence to their child's treatment and use these judgments to shape clinical decision-making. Parents who had help from their personal networks had more agility in balancing competing demands, and this allowed parents to more effectively meet institutional expectations for appropriate parental involvement in the child's health care. In this way, social support served as a flexible resource for some families that allowed parents to more quickly adapt to the demands of caring for a child with cancer, foster productive interpersonal relationships with health care providers, and play a more active role in their child's health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving client-centred care and services: the role of front/back-office configurations.

Science.gov (United States)

Broekhuis, Manda; de Blok, Carolien; Meijboom, Bert

2009-05-01

This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

Case Study: South Texas Veterans Health Care System’s Communication Center

Science.gov (United States)

2008-07-14

appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

The impact of future energy demand on renewable energy production – Case of Norway

International Nuclear Information System (INIS)

Rosenberg, Eva; Lind, Arne; Espegren, Kari Aamodt

2013-01-01

Projections of energy demand are an important part of analyses of policies to promote conservation, efficiency, technology implementation and renewable energy production. The development of energy demand is a key driver of the future energy system. This paper presents long-term projections of the Norwegian energy demand as a two-step methodology of first using activities and intensities to calculate a demand of energy services, and secondly use this as input to the energy system model TIMES-Norway to optimize the Norwegian energy system. Long-term energy demand projections are uncertain and the purpose of this paper is to illustrate the impact of different projections on the energy system. The results of the analyses show that decreased energy demand results in a higher renewable fraction compared to an increased demand, and the renewable energy production increases with increased energy demand. The most profitable solution to cover increased demand is to increase the use of bio energy and to implement energy efficiency measures. To increase the wind power production, an increased renewable target or higher electricity export prices have to be fulfilled, in combination with more electricity export. - Highlights: • Projections to 2050 of Norwegian energy demand services, carriers and technologies. • Energy demand services calculated based on intensities and activities. • Energy carriers and technologies analysed by TIMES-Norway. • High renewable target results in more wind power production and electricity export. • Increased energy efficiency is important for a high renewable fraction

Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity.

Science.gov (United States)

Boehmer, Kasey R; Shippee, Nathan D; Beebe, Timothy J; Montori, Victor M

2016-06-01

Chronic conditions burden patients with illness and treatments. We know little about the disruption of life by the work of dialysis in relation to the resources patients can mobilize, that is, their capacity, to deal with such demands. We sought to determine the disruption of life by dialysis and its relation to patient capacity to cope. We administered a survey to 137 patients on dialysis at an academic medical center. We captured disruption from illness and treatment, and physical, mental, personal, social, financial, and environmental aspects of patient capacity using validated scales. Covariates included number of prescriptions, hours spent on health care, existence of dependents, age, sex, and income level. On average, patients reported levels of capacity and disruption comparable to published levels. In multivariate regression models, limited physical, financial, and mental capacity were significantly associated with greater disruption. Patients in the top quartile of disruption had lower-than-expected physical, financial, and mental capacity. Our sample generally had capacity comparable to other populations and may be able to meet the demands imposed by treatment. Those with reduced physical, financial, and mental capacity reported higher disruption and represent a vulnerable group that may benefit from innovations in minimally disruptive medicine. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Intercity Travel Demand Analysis Model

Directory of Open Access Journals (Sweden)

Ming Lu

2014-01-01

Full Text Available It is well known that intercity travel is an important component of travel demand which belongs to short distance corridor travel. The conventional four-step method is no longer suitable for short distance corridor travel demand analysis for the time spent on urban traffic has a great impact on traveler's main mode choice. To solve this problem, the author studied the existing intercity travel demand analysis model, then improved it based on the study, and finally established a combined model of main mode choice and access mode choice. At last, an integrated multilevel nested logit model structure system was built. The model system includes trip generation, destination choice, and mode-route choice based on multinomial logit model, and it achieved linkage and feedback of each part through logsum variable. This model was applied in Shenzhen intercity railway passenger demand forecast in 2010 as a case study. As a result, the forecast results were consistent with the actuality. The model's correctness and feasibility were verified.

Interprofessional collaboration regarding patients' care plans in primary care : a focus group study into influential factors

NARCIS (Netherlands)

Stephanie Anna Lenzen; Trudy van der Weijden; Anna Beurskens; Marloes Amantia van Bokhoven; Ramon Daniëls; Jerôme Jean Jacques van Dongen

2016-01-01

Background: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors

NARCIS (Netherlands)

Dongen, J.J. van; Lenzen, S.A.; Bokhoven, M.A. van; Daniels, R.; Weijden, T.T. van der; Beurskens, A.

2016-01-01

BACKGROUND: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

Analyses of demand response in Denmark[Electricity market

Energy Technology Data Exchange (ETDEWEB)

Moeller Andersen, F.; Grenaa Jensen, S.; Larsen, Helge V.; Meibom, P.; Ravn, H.; Skytte, K.; Togeby, M.

2006-10-15

Due to characteristics of the power system, costs of producing electricity vary considerably over short time intervals. Yet, many consumers do not experience corresponding variations in the price they pay for consuming electricity. The topic of this report is: are consumers willing and able to respond to short-term variations in electricity prices, and if so, what is the social benefit of consumers doing so? Taking Denmark and the Nord Pool market as a case, the report focuses on what is known as short-term consumer flexibility or demand response in the electricity market. With focus on market efficiency, efficient allocation of resources and security of supply, the report describes demand response from a micro-economic perspective and provides empirical observations and case studies. The report aims at evaluating benefits from demand response. However, only elements contributing to an overall value are presented. In addition, the analyses are limited to benefits for society, and costs of obtaining demand response are not considered. (au)

Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

Directory of Open Access Journals (Sweden)

Richards Judy-Lynn

2010-06-01

of the established system of care were taken, often out of necessity. Three kinds of circumventions were identified from the data: (1 interventions to shift the system (e.g., the role of advocacy; (2 service innovations (e.g., educational initiatives; and (3 new alternative structures (e.g., the establishment of independent hospice organizations. Overall, the evolution of HPC across the case study provinces has been markedly slow, but steady and continuous. Conclusions HPC in Canada remains at the margins of the health care system. Its integration into the primary health care system may ensure dedicated and ongoing funding, enhanced access, quality and service responsiveness. Though demographics are expected to influence HPC demand in Canada, our study confirms that concerned citizens, advocacy organizations and local champions will continue to be the agents of change that make the necessary and lasting impacts on HPC in Canada.

Tracking the evolution of hospice palliative care in Canada: a comparative case study analysis of seven provinces.

Science.gov (United States)

Williams, Allison M; Crooks, Valorie A; Whitfield, Kyle; Kelley, Mary-Lou; Richards, Judy-Lynn; DeMiglio, Lily; Dykeman, Sarah

2010-06-01

, often out of necessity. Three kinds of circumventions were identified from the data: (1) interventions to shift the system (e.g., the role of advocacy); (2) service innovations (e.g., educational initiatives); and (3) new alternative structures (e.g., the establishment of independent hospice organizations). Overall, the evolution of HPC across the case study provinces has been markedly slow, but steady and continuous. HPC in Canada remains at the margins of the health care system. Its integration into the primary health care system may ensure dedicated and ongoing funding, enhanced access, quality and service responsiveness. Though demographics are expected to influence HPC demand in Canada, our study confirms that concerned citizens, advocacy organizations and local champions will continue to be the agents of change that make the necessary and lasting impacts on HPC in Canada.

The worst case scenario: Locomotor and collision demands of the longest periods of gameplay in professional rugby union.

Directory of Open Access Journals (Sweden)

Cillian Reardon

Full Text Available A number of studies have used global positioning systems (GPS to report on positional differences in the physical game demands of rugby union both on an average and singular bout basis. However, the ability of these studies to report quantitative data is limited by a lack of validation of certain aspects of measurement by GPS micro-technology. Furthermore no study has analyzed the positional physical demands of the longest bouts of ball-in-play time in rugby union. The aim of the present study is to compare the demands of the single longest period of ball-in-play, termed "worst case scenario" (WCS between positional groups, which have previously been reported to have distinguishable game demands. The results of this study indicate that WCS periods follow a similar sporadic pattern as average demands but are played at a far higher pace than previously reported for average game demands with average meters per minute of 116.8 m. The positional differences in running and collision activity previously reported are perpetuated within WCS periods. Backs covered greater total distances than forwards (318 m vs 289 m, carried out more high-speed running (11.1 m·min-1 vs 5.5 m·min-1 and achieved higher maximum velocities (MaxVel. Outside Backs achieved the highest MaxVel values (6.84 m·sec-1. Tight Five and Back Row forwards underwent significantly more collisions than Inside Back and Outside Backs (0.73 & 0.89 collisions·min-1 vs 0.28 & 0.41 collisions·min-1 respectively. The results of the present study provide information on the positional physical requirements of performance in prolonged periods involving multiple high intensity bursts of effort. Although the current state of GPS micro-technology as a measurement tool does not permit reporting of collision intensity or acceleration data, the combined use of video and GPS provides valuable information to the practitioner. This can be used to match and replicate game demands in training.

The worst case scenario: Locomotor and collision demands of the longest periods of gameplay in professional rugby union

Science.gov (United States)

Reardon, Cillian; Tobin, Daniel P.; Tierney, Peter; Delahunt, Eamonn

2017-01-01

A number of studies have used global positioning systems (GPS) to report on positional differences in the physical game demands of rugby union both on an average and singular bout basis. However, the ability of these studies to report quantitative data is limited by a lack of validation of certain aspects of measurement by GPS micro-technology. Furthermore no study has analyzed the positional physical demands of the longest bouts of ball-in-play time in rugby union. The aim of the present study is to compare the demands of the single longest period of ball-in-play, termed “worst case scenario” (WCS) between positional groups, which have previously been reported to have distinguishable game demands. The results of this study indicate that WCS periods follow a similar sporadic pattern as average demands but are played at a far higher pace than previously reported for average game demands with average meters per minute of 116.8 m. The positional differences in running and collision activity previously reported are perpetuated within WCS periods. Backs covered greater total distances than forwards (318 m vs 289 m), carried out more high-speed running (11.1 m·min-1 vs 5.5 m·min-1) and achieved higher maximum velocities (MaxVel). Outside Backs achieved the highest MaxVel values (6.84 m·sec-1). Tight Five and Back Row forwards underwent significantly more collisions than Inside Back and Outside Backs (0.73 & 0.89 collisions·min-1 vs 0.28 & 0.41 collisions·min-1 respectively). The results of the present study provide information on the positional physical requirements of performance in prolonged periods involving multiple high intensity bursts of effort. Although the current state of GPS micro-technology as a measurement tool does not permit reporting of collision intensity or acceleration data, the combined use of video and GPS provides valuable information to the practitioner. This can be used to match and replicate game demands in training. PMID:28510582

A summary of demand response in electricity markets

International Nuclear Information System (INIS)

Albadi, M.H.; El-Saadany, E.F.

2008-01-01

This paper presents a summary of demand response (DR) in deregulated electricity markets. The definition and the classification of DR as well as potential benefits and associated cost components are presented. In addition, the most common indices used for DR measurement and evaluation are highlighted, and some utilities' experiences with different demand response programs are discussed. Finally, the effect of demand response in electricity prices is highlighted using a simulated case study. (author)

Case report physiotherapy care of a patient diagnosed with polyarthritis with early rheumatoid arthritis

OpenAIRE

Michálková, Kateřina

2013-01-01

Title of bachelor's thesis: Case report physiotherapy care of a patient diagnosed with polyarthritis with early rheumatoid arthritis. Summary: The bachelor thesis deals with polyarthritis disease with early rheumatoid arthritis and its physiotherapy care. It consists of two parts. The general part contains a general joint anatomy, deals with the major problems of disease and polyarthritis rheumatoid arthritis, its diagnosis, treatment and physiotherapy care. Special part includes a case repor...

A Column Generation Approach to the Capacitated Vehicle Routing Problem with Stochastic Demands

DEFF Research Database (Denmark)

Christiansen, Christian Holk; Lysgaard, Jens

. The CVRPSD can be formulated as a Set Partitioning Problem. We show that, under the above assumptions on demands, the associated column generation subproblem can be solved using a dynamic programming scheme which is similar to that used in the case of deterministic demands. To evaluate the potential of our......In this article we introduce a new exact solution approach to the Capacitated Vehicle Routing Problem with Stochastic Demands (CVRPSD). In particular, we consider the case where all customer demands are distributed independently and where each customer's demand follows a Poisson distribution...

Leadership development and succession planning in case management.

Science.gov (United States)

Miodonski, Kathleen; Hines, Patricia

2013-01-01

The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

[Dutch Health Care Inspectorate (IGZ) abuses its inspection authority in patient files].

Science.gov (United States)

van Lessen Kloeke, Koosje

2014-01-01

For its investigation regarding the transfer of data after discharge of vulnerable elderly patients from hospital to nursing homes, care homes or home care, the Dutch Health Care Inspectorate (IGZ) demands access to patients' files, without their explicit consent. Doctors who do not cooperate run the risk of penalty payments. Since it concerns a limited number of patients per practice, it would not be unreasonably onerous for the Inspectorate to allow doctors to ask their patients' consent. Other reasons mentioned by the Inspectorate, such as possible "inappropriate correction" of data and the capability of vulnerable elderly patients to give their consent seem improper grounds to breach patients' right to privacy and to demand that doctors breach professional confidentiality. The legality of the Inspectorate's actions could be addressed in a test case and should be discussed more widely in light of the Inspectorate's work plan for 2014.

Market design for rapid demand response

DEFF Research Database (Denmark)

Nielsen, Kurt; Tamirat, Tseganesh Wubale

We suggest a market design for rapid demand response in electricity markets. The solution consists of remotely controlled switches, meters, forecasting models as well as a flexible auction market to set prices and select endusers job by job. The auction market motivates truth-telling and makes...... it simple to involve the endusers in advance and to activate demand response immediately. The collective solution is analyzed and economic simulations are conducted for the case of Kenya. Kenya has been su ering from unreliable electricity supply for many years and companies and households have learned...... to adjust by investments in backup generators. We focus on turning the many private backup generators into a demand response system. The economic simulation focuses on possible distortion introduced by various ways of splitting the generated surplus from the demand response system. An auction run instantly...

Influence of workplace demands on nurses' perception of patient safety.

Science.gov (United States)

Ramanujam, Rangaraj; Abrahamson, Kathleen; Anderson, James G

2008-06-01

Patient safety is an ongoing challenge in the design and delivery of health-care services. As registered nurses play an integral role in patient safety, further examination of the link between nursing work and patient safety is warranted. The present study examines the relationship between nurses' perceptions of job demands and nurses' perceptions of patient safety. Structural equation modeling is used to analyze the data collected from a survey of 430 registered nurses at two community hospitals in the USA. As hypothesized, nurses' perception of patient safety decreases as the job demands increase. The level of personal control over practice directly affects nurses' perception of the ability to assure patient well-being. Nurses who work full-time and are highly educated have a decreased perception of patient safety, as well. The significant relationship between job demands and patient safety confirms that nurses make a connection between their working conditions and the ability to deliver safe care.

Building nursing capacity for palliative care at a Jesuit Catholic University: A model program

Directory of Open Access Journals (Sweden)

Eileen R. O’Shea

2017-01-01

Full Text Available The average life span is increasing, due to vast advancements in social conditions, public health, and medical care. Globally, those living with chronic and serious medical conditions can benefit from palliative care services. Yet, the workforce is insufficient to support the demand. This case study describes efforts made by one Jesuit Catholic University to build nursing capacity and to promote access to high quality, compassionate palliative healthcare.

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

Science.gov (United States)

Brown, Kevin A; Jones, Makoto; Daneman, Nick; Adler, Frederick R; Stevens, Vanessa; Nechodom, Kevin E; Goetz, Matthew B; Samore, Matthew H; Mayer, Jeanmarie

2016-06-21

Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings. To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence. Multilevel longitudinal nested case-control study. Veterans Health Administration health care regions, from 2006 through 2012. Long-term care residents. Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks. 6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R2 = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]). Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non-Veterans Health Administration acute care sources was not considered. Only 25% of the variation in regional C difficile incidence in long

Developing the DESCARTE Model: The Design of Case Study Research in Health Care.

Science.gov (United States)

Carolan, Clare M; Forbat, Liz; Smith, Annetta

2016-04-01

Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered. © The Author(s) 2015.

Product Quality and the Demand for Food: The Case of Urban China

OpenAIRE

Dong, Diansheng; Gould, Brian W.

2007-01-01

A Quadratic Almost Ideal Demand System is used to examine the structure of food demand for a sample of urban Chinese households. The dual choice of product quality and quantity is accounted for in the econometric model via the inclusion of simultaneously estimated unit-value equations.

Demand-Side Financing--A Focus on Vouchers in Post-Compulsory Education and Training: Discussion Paper and Case Studies. CEDEFOP Dossier.

Science.gov (United States)

West, Anne; Sparkes, Jo; Balabanov, Todor

The use of demand-side financing mechanisms and vouchers for postcompulsory secondary-level education was examined through case studies of funding practices in the following countries: Austria; France; the United Kingdom; the United States; and Wallonia (the French community of Belgium). Different models of voucher use were identified in the…

Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

Directory of Open Access Journals (Sweden)

Martin Roland

2012-07-01

Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

The impact of predicted demand on energy production

Science.gov (United States)

El kafazi, I.; Bannari, R.; Aboutafail, My. O.

2018-05-01

Energy is crucial for human life, a secure and accessible supply of power is essential for the sustainability of societies. Economic development and demographic progression increase energy demand, prompting countries to conduct research and studies on energy demand and production. Although, increasing in energy demand in the future requires a correct determination of the amount of energy supplied. Our article studies the impact of demand on energy production to find the relationship between the two latter and managing properly the production between the different energy sources. Historical data of demand and energy production since 2000 are used. The data are processed by the regression model to study the impact of demand on production. The obtained results indicate that demand has a positive and significant impact on production (high impact). Production is also increasing but at a slower pace. In this work, Morocco is considered as a case study.

Global Supply and Demand of Opioids for Pain Management.

Science.gov (United States)

Kunnumpurath, Sreekumar; Julien, Natasha; Kodumudi, Gopal; Kunnumpurath, Anamika; Kodumudi, Vijay; Vadivelu, Nalini

2018-04-04

The goal of this review is to evaluate the global supply and demand of opioids used for pain management and discuss how it relates to the utilization of opioids around the world. The purpose of the review is also to determine the factors that contribute to inappropriate pain management. The total global production of opium for opioid manufacturing is enough to supply the growing global demands. However, licit opioids are only consumed by 20% of the world population. Most people throughout the world had no access to opioid analgesics for pain relief in case of need. Opioid misuse and abuse is not only a phenomena plague by the USA but globally across many countries. Many countries have a lack of availability of opioids, contributing factors being strict government regulations limiting access, lack of knowledge of the efficacy of opioid analgesics in treating acute and chronic pain and palliative care, and the stigma that opioids are highly addictive. For the countries in which opioids are readily available and prescribed heavily, diversion, misuse, abuse, and the resurgence of heroin have become problems leading to morbidity and mortality. It is pertinent to find a balance between having opioids accessible to patients in need, with ensuring that opioids are regulated along with other illicit drugs to decrease abuse potential.

The development of an acute care case manager orientation.

Science.gov (United States)

Strzelecki, S; Brobst, R

1997-01-01

The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.

Enhancing the contribution of research to health care policy-making: a case study of the Dutch Health Care Performance Report.

Science.gov (United States)

Hegger, Ingrid; Marks, Lisanne K; Janssen, Susan W J; Schuit, Albertine J; van Oers, Hans A M

2016-01-01

The Dutch Health Care Performance Report, issued by the National Institute of Public Health and the Environment, aims to monitor health care performance in The Netherlands. Both the National Institute and the Ministry of Health wish to increase the contribution of the Report to health care policy-making. Our aim was to identify ways to achieve that. We used contribution mapping as a theoretical framework that recognizes alignment of research as crucial to managing contributions to policy-making. To investigate which areas need alignment efforts by researchers and/or policy-makers, we interviewed National Institute researchers and policy-makers from the Ministry of Health and assessed the process for developing the 2010 Report. We identified six areas where alignment is specifically relevant for enhancing the contributions of future versions of the Dutch Health Care Performance Report: well-balanced information for different ministerial directorates; backstage work; double role actors; reports of other knowledge institutes; data collection/generation and presentation forms. The contribution of health care performance reporting to policy-making is complex and requires continuous alignment efforts between researchers and policy-makers. These efforts should form an inseparable part of health care performance reporting and although this demands considerable resources, it is worth considering since it may pay back in better contributions to policy-making. © The Author(s) 2015.

Utility Sector Impacts of Reduced Electricity Demand

Energy Technology Data Exchange (ETDEWEB)

Coughlin, Katie

2014-12-01

This report presents a new approach to estimating the marginal utility sector impacts associated with electricity demand reductions. The method uses publicly available data and provides results in the form of time series of impact factors. The input data are taken from the Energy Information Agency's Annual Energy Outlook (AEO) projections of how the electric system might evolve in the reference case, and in a number of side cases that incorporate different effciency and other policy assumptions. The data published with the AEO are used to define quantitative relationships between demand-side electricity reductions by end use and supply-side changes to capacity by plant type, generation by fuel type and emissions of CO2, Hg, NOx and SO2. The impact factors define the change in each of these quantities per unit reduction in site electricity demand. We find that the relative variation in these impacts by end use is small, but the time variation can be significant.

Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia.

Science.gov (United States)

Ormond, Meghann

2015-01-01

Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and

Brain-oriented care in the NICU: a case study.

Science.gov (United States)

Bader, Lisa

2014-01-01

With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside.

Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand.

Science.gov (United States)

Ladabaum, Uri; Song, Kenneth

2005-10-01

Colorectal cancer (CRC) screening is effective and cost-effective, but the potential national impact of widespread screening is uncertain. It is controversial whether screening colonoscopy can be offered widely and how emerging tests may impact health services demand. Our aim was to produce integrated, comprehensive estimates of the impact of widespread screening on national clinical and economic outcomes and health services demand. We used a Markov model and census data to estimate the national consequences of screening 75% of the US population with conventional and emerging strategies. Screening decreased CRC incidence by 17%-54% to as few as 66,000 cases per year and CRC mortality by 28%-60% to as few as 23,000 deaths per year. With no screening, total annual national CRC-related expenditures were 8.4 US billion dollars. With screening, expenditures for CRC care decreased by 1.5-4.4 US billion dollars but total expenditures increased to 9.2-15.4 US billion dollars. Screening colonoscopy every 10 years required 8.1 million colonoscopies per year including surveillance, with other strategies requiring 17%-58% as many colonoscopies. With improved screening uptake, total colonoscopy demand increased in general, even assuming substantial use of virtual colonoscopy. Despite savings in CRC care, widespread screening is unlikely to be cost saving and may increase national expenditures by 0.8-2.8 US billion dollars per year with conventional tests. The current national endoscopic capacity, as recently estimated, may be adequate to support widespread use of screening colonoscopy in the steady state. The impact of emerging tests on colonoscopy demand will depend on the extent to which they replace screening colonoscopy or increase screening uptake in the population.

Smart Buildings and Demand Response

Science.gov (United States)

Kiliccote, Sila; Piette, Mary Ann; Ghatikar, Girish

2011-11-01

Advances in communications and control technology, the strengthening of the Internet, and the growing appreciation of the urgency to reduce demand side energy use are motivating the development of improvements in both energy efficiency and demand response (DR) systems in buildings. This paper provides a framework linking continuous energy management and continuous communications for automated demand response (Auto-DR) in various times scales. We provide a set of concepts for monitoring and controls linked to standards and procedures such as Open Automation Demand Response Communication Standards (OpenADR). Basic building energy science and control issues in this approach begin with key building components, systems, end-uses and whole building energy performance metrics. The paper presents a framework about when energy is used, levels of services by energy using systems, granularity of control, and speed of telemetry. DR, when defined as a discrete event, requires a different set of building service levels than daily operations. We provide examples of lessons from DR case studies and links to energy efficiency.

New methods for solving a vertex p-center problem with uncertain demand-weighted distance: A real case study

Directory of Open Access Journals (Sweden)

Javad Nematian

2015-04-01

Full Text Available Vertex and p-center problems are two well-known types of the center problem. In this paper, a p-center problem with uncertain demand-weighted distance will be introduced in which the demands are considered as fuzzy random variables (FRVs and the objective of the problem is to minimize the maximum distance between a node and its nearest facility. Then, by introducing new methods, the proposed problem is converted to deterministic integer programming (IP problems where these methods will be obtained through the implementation of the possibility theory and fuzzy random chance-constrained programming (FRCCP. Finally, the proposed methods are applied for locating bicycle stations in the city of Tabriz in Iran as a real case study. The computational results of our study show that these methods can be implemented for the center problem with uncertain frameworks.

Money Demand and Inflation in Dollarized Economies; The Case of Russia

OpenAIRE

Franziska L Ohnsorge; Nienke Oomes

2005-01-01

Money demand in dollarized economies often appears to be highly unstable, making it difficult to forecast and control inflation. In this paper, we show that a stable money demand function for Russia can be found for "effective broad money," which includes an estimate of foreign cash holdings. Moreover, we find that an excess supply of effective broad money is inflationary, while other excess money measures are not, and that effective broad money growth has the strongest and most persistent ef...

Resource Demand Scenarios for the Major Metals.

Science.gov (United States)

Elshkaki, Ayman; Graedel, T E; Ciacci, Luca; Reck, Barbara K

2018-03-06

The growth in metal use in the past few decades raises concern that supplies may be insufficient to meet demands in the future. From the perspective of historical and current use data for seven major metals-iron, manganese, aluminum, copper, nickel, zinc, and lead-we have generated several scenarios of potential metal demand from 2010 to 2050 under alternative patterns of global development. We have also compared those demands with various assessments of potential supply to midcentury. Five conclusions emerge: (1) The calculated demand for each of the seven metals doubles or triples relative to 2010 levels by midcentury; (2) The largest demand increases relate to a scenario in which increasingly equitable values and institutions prevail throughout the world; (3) The metal recycling flows in the scenarios meet only a modest fraction of future metals demand for the next few decades; (4) In the case of copper, zinc, and perhaps lead, supply may be unlikely to meet demand by about midcentury under the current use patterns of the respective metals; (5) Increased rates of demand for metals imply substantial new energy provisioning, leading to increases in overall global energy demand of 21-37%. These results imply that extensive technological transformations and governmental initiatives could be needed over the next several decades in order that regional and global development and associated metal demand are not to be constrained by limited metal supply.

The Sudan Demand for International Reserve: A Case of a Labour-Exporting Country.

OpenAIRE

Elbadawi, Ibrahim A

1990-01-01

An empirical analysis of the demand for international reserves in the Sudan is presented, based on the error-correction model. This model is parametrically rich enough to allow the division of the effects into long-run influences, short-term adjustments, and proportional equilibrium impacts. Beside addressing conventional issues in reserve demand literature, the model explicitly incorporates the impact on reserve demand of remittances transferred by Sudanese nationals working abroad and the i...

Dietetics supply and demand: 2010-2020.

Science.gov (United States)

Hooker, Roderick S; Williams, James H; Papneja, Jesleen; Sen, Namrata; Hogan, Paul

2012-03-01

The Academy of Nutrition and Dietetics, in conjunction with the Commission on Dietetic Registration (CDR), invited The Lewin Group to undertake an analysis of the dietetics workforce. The purpose of the workforce study was to develop a model that can project the supply and demand for both registered dietitians (RDs) and dietetic technicians, registered (DTRs) (collectively referred to as CDR-credentialed dietetics practitioners) as the result of various key drivers of change. The research team was asked to quantify key market factors where possible and to project likely paths for the evolution of workforce supply and demand, as well as to assess the implications of the findings. This article drew on the survey research conducted by Readex Research and futurist organizations such as Signature i and Trend Spot Consulting. Furthermore, members of the Dietetics Workforce Demand Task Force were a source of institutional and clinical information relevant to the credentialed dietetics workforce--including their opinions and judgment of the current state of the health care market for dietetic services, its future state, and factors affecting it, which were useful and were integrated with the objective sources of data. The model is flexible and accommodates the variation in how RDs and DTRs function in diverse practice areas. For purposes of this study and model, the dietetics workforce is composed of RDs and DTRs. This report presents the results of this workforce study and the methodology used to calculate the projected dietetics workforce supply and demand. The projections are based on historical trends and estimated future changes. Key findings of the study included the following: • The average age of all CDR-credentialed dietetics practitioners in baseline supply (2010) is 44 years; approximately 96% are women. • Approximately 55% of CDR-credentialed dietetics practitioners work in clinical dietetics. • The annual growth rate of supply of CDR

Emissions associated with meeting the future global wheat demand: A case study of UK production under climate change constraints

International Nuclear Information System (INIS)

Röder, Mirjam; Thornley, Patricia; Campbell, Grant; Bows-Larkin, Alice

2014-01-01

Highlights: • Conflicts between adapting to climate change, food security and reducing emissions. • Climate change likely to limit wheat production in the southern hemisphere. • Climate change yield benefits marginally increase emissions per unit of product. • Improved yield will result in higher total production emissions. • Production-based inventories discourage an increase in production. - Abstract: Climate change, population growth and socio-structural changes will make meeting future food demands extremely challenging. As wheat is a globally traded food commodity central to the food security of many nations, this paper uses it as an example to explore the impact of climate change on global food supply and quantify the resulting greenhouse gas emissions. Published data on projected wheat production is used to analyse how global production can be increased to match projected demand. The results show that the largest projected wheat demand increases are in areas most likely to suffer severe climate change impacts, but that global demand could be met if northern hemisphere producers exploit climate change benefits to increase production and narrow their yield gaps. Life cycle assessment of different climate change scenarios shows that in the case of one of the most important wheat producers (the UK) it may be possible to improve yields with an increase of only 0.6% in the emission intensity per unit of wheat produced in a 2 °C scenario. However, UK production would need to rise substantially, increasing total UK wheat production emissions by 26%. This demonstrates how national emission inventories and associated targets do not incentivise minimisation of global greenhouse gas emissions while meeting increased food demands, highlighting a triad of challenges: meeting the rising demand for food, adapting to climate change and reducing emissions

Attending Unintended Transformations of Health Care Infrastructure

DEFF Research Database (Denmark)

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theor......Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background...

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults.

Science.gov (United States)

Shiu, Chengshi; Muraco, Anna; Fredriksen-Goldsen, Karen

2016-01-01

Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver-care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships.

Confronting the fear factor: the coverage/access disparity in universal health care.

Science.gov (United States)

Litow, Mark E

2007-01-01

Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.

Customer service: the key to remaining competitive in managed care.

Science.gov (United States)

Howard, J E

2000-01-01

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.

Identifying patients suitable for palliative care - a descriptive analysis of enquiries using a Case Management Process Model approach

Directory of Open Access Journals (Sweden)

Kuhn Ulrike

2012-11-01

Full Text Available Abstract Background In Germany, case management in a palliative care unit was first implemented in 2005 at the Department of Palliative Medicine at the University Hospital Cologne. One of the purposes of this case management is to deal with enquiries from patients and their relatives as well as medical professionals. Using the Case Management Process Model of the Case Management Society of America as a reference, this study analysed (a how this case management was used by different enquiring groups and (b how patients were identified for case management and for palliative care services. The first thousand enquiries were analysed considering patient variables, properties of the enquiring persons and the content of the consultations. Results Most enquiries to the case management were made by telephone. The majority of requests regarded patients with oncological disease (84.3 %. The largest enquiring group was composed of patients and relatives (40.8 %, followed by internal professionals of the hospital (36.1 %. Most of the enquiring persons asked for a patient’s admission to the palliative care ward (46.4 %. The second most frequent request was for consultation and advice (30.9 %, followed by requests for the palliative home care service (13.3 %. Frequent reasons for actual admissions were the need for the treatment of pain, the presence of symptoms and the need for nursing care. More than half of the enquiries concerning admission to the palliative care ward were followed by an admission. Conclusions Case management has been made public among the relevant target groups. Case management as described by the Case Management Process Model helps to identify patients likely to benefit from case management and palliative care services. In addition, with the help of case management palliative patients may be allocated to particular health care services.

Demand Response as a System Reliability Resource

Energy Technology Data Exchange (ETDEWEB)

Eto, Joseph H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Lewis, Nancy Jo [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Watson, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Kiliccote, Sila [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Auslander, David [Univ. of California, Berkeley, CA (United States); Paprotny, Igor [Univ. of California, Berkeley, CA (United States); Makarov, Yuri [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2012-12-31

The Demand Response as a System Reliability Resource project consists of six technical tasks: • Task 2.1. Test Plan and Conduct Tests: Contingency Reserves Demand Response (DR) Demonstration—a pioneering demonstration of how existing utility load-management assets can provide an important electricity system reliability resource known as contingency reserve. • Task 2.2. Participation in Electric Power Research Institute (EPRI) IntelliGrid—technical assistance to the EPRI IntelliGrid team in developing use cases and other high-level requirements for the architecture. • Task 2.3. Research, Development, and Demonstration (RD&D) Planning for Demand Response Technology Development—technical support to the Public Interest Energy Research (PIER) Program on five topics: Sub-task 1. PIER Smart Grid RD&D Planning Document; Sub-task 2. System Dynamics of Programmable Controllable Thermostats; Sub-task 3. California Independent System Operator (California ISO) DR Use Cases; Sub-task 4. California ISO Telemetry Requirements; and Sub-task 5. Design of a Building Load Data Storage Platform. • Task 2.4. Time Value of Demand Response—research that will enable California ISO to take better account of the speed of the resources that it deploys to ensure compliance with reliability rules for frequency control. • Task 2.5. System Integration and Market Research: Southern California Edison (SCE)—research and technical support for efforts led by SCE to conduct demand response pilot demonstrations to provide a contingency reserve service (known as non-spinning reserve) through a targeted sub-population of aggregated residential and small commercial customers enrolled in SCE’s traditional air conditioning (AC) load cycling program, the Summer Discount Plan. • Task 2.6. Demonstrate Demand Response Technologies: Pacific Gas and Electric (PG&E)—research and technical support for efforts led by PG&E to conduct a demand response pilot demonstration to provide non

Supply and demand analysis of the current and future US neurology workforce.

Science.gov (United States)

Dall, Timothy M; Storm, Michael V; Chakrabarti, Ritashree; Drogan, Oksana; Keran, Christopher M; Donofrio, Peter D; Henderson, Victor W; Kaminski, Henry J; Stevens, James C; Vidic, Thomas R

2013-07-30

This study estimates current and projects future neurologist supply and demand under alternative scenarios nationally and by state from 2012 through 2025. A microsimulation supply model simulates likely career choices of individual neurologists, taking into account the number of new neurologists trained each year and changing demographics of the neurology workforce. A microsimulation demand model simulates utilization of neurology services for each individual in a representative sample of the population in each state and for the United States as a whole. Demand projections reflect increased prevalence of neurologic conditions associated with population growth and aging, and expanded coverage under health care reform. The estimated active supply of 16,366 neurologists in 2012 is projected to increase to 18,060 by 2025. Long wait times for patients to see a neurologist, difficulty hiring new neurologists, and large numbers of neurologists who do not accept new Medicaid patients are consistent with a current national shortfall of neurologists. Demand for neurologists is projected to increase from ∼18,180 in 2012 (11% shortfall) to 21,440 by 2025 (19% shortfall). This includes an increased demand of 520 full-time equivalent neurologists starting in 2014 from expanded medical insurance coverage associated with the Patient Protection and Affordable Care Act. In the absence of efforts to increase the number of neurology professionals and retain the existing workforce, current national and geographic shortfalls of neurologists are likely to worsen, exacerbating long wait times and reducing access to care for Medicaid beneficiaries. Current geographic differences in adequacy of supply likely will persist into the future.

Governance on home care in Europe.

NARCIS (Netherlands)

Genet, N.; Boerma, W.; Hutchinson, A.; Garms-Homolova, V.; Naiditch, M.; Lamura, G.; Chlabicz, S.; Ersek, K.; Laszlo, G.; Fagerstrom, C.; Bolibar, B.

2010-01-01

Introduction: Demand for health and social care services in the community will grow as a result of the ageing of populations across Europe. At present, however, very little is known about the preparedness of national home care systems for changing demand, which is not just quantitative but also

A mismatch between supply and demand of social support in dementia care: a qualitative study on the perspectives of spousal caregivers and their social network members.

Science.gov (United States)

Dam, Alieske E H; Boots, Lizzy M M; van Boxtel, Martin P J; Verhey, Frans R J; de Vugt, Marjolein E

2017-06-13

Access to social support contributes to feelings of independence and better social health. This qualitative study aims to investigate multi-informant perspectives on informal social support in dementia care networks. Ten spousal caregivers of people with dementia (PwD) completed an ecogram, a social network card and a semi-structured interview. The ecogram aimed to trigger subjective experiences regarding social support. Subsequently, 17 network members were interviewed. The qualitative analyses identified codes, categories, and themes. Sixth themes emerged: (1) barriers to ask for support; (2) facilitators to ask for support; (3) barriers to offer support; (4) facilitators to offer support; (5) a mismatch between supply and demand of social support; and (6) openness in communication to repair the imbalance. Integrating social network perspectives resulted in a novel model identifying a mismatch between the supply and demand of social support, strengthened by a cognitive bias: caregivers reported to think for other social network members and vice versa. Openness in communication in formal and informal care systems might repair this mismatch.

Health federalism: the role of health care professionals in Nepal.

Science.gov (United States)

Dulal, R K

2009-01-01

Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.

New Real-Time Market Facilitating Demand-Side Resources for System Balancing

DEFF Research Database (Denmark)

Feng, Donghan; Nyeng, Preben; Xie, Jun

2011-01-01

Many demand side resources have the potential to provide fast and low cost balancing services. Switching these devices on and off can be executed in seconds and have limited consequences for the customers if the duration is not long. With carefully designed market rules, tens of thousands...... the participation of demand-side resources. In light of the future environment of increasing intermittent renewable power and distributed energy/storage resources, stochastic time-series and Monte-Carlo simulation are used to analyze the relationship between balancing requirement and generation/demand uncertainties...

[Refusal of care faced by case manager from elderly persons in complex situation: cross perspectives].

Science.gov (United States)

Corvol, A; Balard, F; Moutel, G; Somme, D

2014-01-01

Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Dental case manager encounters: the association with retention in dental care and treatment plan completion.

Science.gov (United States)

Lemay, Celeste A; Tobias, Carol; Umez-Eronini, Amarachi A; Brown, Carolyn; McCluskey, Amanda; Fox, Jane E; Bednarsh, Helene; Cabral, Howard J

2013-01-01

Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy.

Science.gov (United States)

Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda

2017-05-01

Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of

From demand side management (DSM) to energy efficiency services: A Finnish case study

International Nuclear Information System (INIS)

Apajalahti, Eeva-Lotta; Lovio, Raimo; Heiskanen, Eva

2015-01-01

Energy conservation is expected to contribute significantly to climate change mitigation and energy security. Traditionally, energy companies have had strong role in providing Demand Side Management (DSM) measures. However, after energy market liberalization in Europe, energy companies' DSM activities declined. In response, the EU issued Directive (2006/32/EC) on energy end-use efficiency and energy services (ESD) to motivate energy companies to promote energy efficiency and conservation, closely followed by Directive (2012/27/EU) on energy efficiency (EED), requiring the setting up energy efficiency obligation schemes. Despite strong political and economic motivation, energy companies struggle to develop energy efficiency services in liberalised energy markets due to conflicting institutional demands, which arise from contradicting policy requirements and customer relations. The main challenges in developing new innovative energy efficiency services, evidenced by an in-depth case study, were (1) the unbundling of energy company operations, which makes it difficult to develop services when the contribution of several business units is required and (2) the distrust among energy end-users, which renders the business logic of energy saving contract models self-contradictory. On the basis of the research, avenues out of these dilemmas are suggested. -- Highlights: •Energy companies struggle to become energy service provides •We explore the development of new energy saving business solutions •Dispersed organisational structure leaves energy saving business as isolated function •Strong consumer scepticism towards energy companies as providers of energy saving •More emphasis on the changing company-customer relationship is needed

Electrical network capacity support from demand side response: Techno-economic assessment of potential business cases for small commercial and residential end-users

International Nuclear Information System (INIS)

Martínez Ceseña, Eduardo A.; Good, Nicholas; Mancarella, Pierluigi

2015-01-01

Demand Side Response (DSR) is recognised for its potential to bring economic benefits to various electricity sector actors, such as energy retailers, Transmission System Operators (TSOs) and Distribution Network Operators (DNOs). However, most DSR is provided by large industrial and commercial consumers, and little research has been directed to the quantification of the value that small (below 100 kW) commercial and residential end-users could accrue by providing DSR services. In particular, suitable models and studies are needed to quantify potential business cases for DSR from small commercial and residential end-users. Such models and studies should consider the technical and physical characteristics of the power system and demand resources, together with the economic conditions of the power market. In addition, the majority of research focuses on provision of energy arbitrage or ancillary services, with very little attention to DSR services for network capacity support. Accordingly, this paper presents comprehensive techno-economic methodologies for the quantification of three capacity-based business cases for DSR from small commercial and residential end-users. Case study results applied to a UK context indicate that, if the appropriate regulatory framework is put in place, services for capacity support to both DNOs and TSOs can result into potentially attractive business cases for DSR from small end-users with minimum impact on their comfort level. -- Highlights: •We present three business cases for DSR from domestic and commercial end-users. •A comprehensive techno-economic methodology is proposed for the quantification of each DSR business cases. •The regulatory implications associated with each business case are discussed

A Growing Demand for Monitoring and Evaluation in Africa

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Stephen Porter

2013-09-01

Full Text Available When decision-makers want to use evidence from monitoring and evaluation (M&E systems to assist them in making choices, there is a demand for M&E. When there is great capacity to supply M&E information, but low capacity to demand quality evidence, there is a mismatch between supply and demand. In this context, as Picciotto (2009 observed, ‘monitoring masquerades as evaluation’. This article applies this observation, using six case studies of African M&E systems, by asking: What evidence is there that African governments are developing stronger endogenous demand for evidence generated from M&E systems? The argument presented here is that demand for evidence is increasing, leading to further development of M&E systems, with monitoring being dominant. As part of this dominance there are attempts to align monitoring systems to emerging local demand, whilst donor demands are still important in several countries. There is also evidence of increasing demand through government-led evaluation systems in South Africa, Uganda and Benin. One of the main issues that this article notes is that the M&E systems are not yet conceptualised within a reform effort to introduce a comprehensive results-based orientation to the public services of these countries. Results concepts are not yet consistently applied throughout the M&E systems in the case countries. In addition, the results-based notions that are applied appear to be generating perverse incentives that reinforce upward compliance and contrôle to the detriment of more developmental uses of M&E evidence.

Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

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Jonathan Stokes

Full Text Available An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis.We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group. Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately, and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14. A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36 and long-term (0.35, 0.04 to 0.66. Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care.This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and

Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

2015-01-01

An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care. This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the

Self-care practice of patients with arterial hypertension in primary health care

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Cláudia Rayanna Silva Mendes

2016-02-01

Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.

Leveraging tuberculosis case relative locations to enhance case detection and linkage to care in Swaziland.

Science.gov (United States)

Brunetti, Marie; Rajasekharan, Sathyanath; Ustero, Piluca; Ngo, Katherine; Sikhondze, Welile; Mzileni, Buli; Mandalakas, Anna; Kay, Alexander W

2018-01-01

In Swaziland, as in many high HIV/TB burden settings, there is not information available regarding the household location of TB cases for identifying areas of increased TB incidence, limiting the development of targeted interventions. Data from "Butimba", a TB REACH active case finding project, was re-analyzed to provide insight into the location of TB cases surrounding Mbabane, Swaziland. The project aimed to identify geographical areas with high TB burdens to inform active case finding efforts. Butimba implemented household contact tracing; obtaining landmark based, informal directions, to index case homes, defined here as relative locations. The relative locations were matched to census enumeration areas (known location reference areas) using the Microsoft Excel Fuzzy Lookup function. Of 403 relative locations, an enumeration area reference was detected in 388 (96%). TB cases in each census enumeration area and the active case finders in each Tinkhundla, a local governmental region, were mapped using the geographic information system, QGIS 2.16. Urban Tinkhundla predictably accounted for most cases; however, after adjusting for population, the highest density of cases was found in rural Tinkhundla. There was no correlation between the number of active case finders currently assigned to the 7 Tinkhundla surrounding Mbabane and the total number of TB cases (Spearman rho = -0.57, p  = 0.17) or the population adjusted TB cases (Spearman rho = 0.14, p  = 0.75) per Tinkhundla. Reducing TB incidence in high-burden settings demands novel analytic approaches to study TB case locations. We demonstrated the feasibility of linking relative locations to more precise geographical areas, enabling data-driven guidance for National Tuberculosis Programs' resource allocation. In collaboration with the Swazi National Tuberculosis Control Program, this analysis highlighted opportunities to better align the active case finding national strategy with the TB disease

Millennium bim managing growing demand

OpenAIRE

Lopes, Francisca Barbosa Malpique de Paiva

2014-01-01

Millennium bim, the Mozambican operation of Millennium bcp group, was the Company selected to serve as background for the development of a teaching case in Marketing. This case is followed by a teaching note, and is intended to be used as a pedagogical tool in undergraduate and/or graduate programs. Even though Mozambique is still characterized by high financial exclusion, the number of people entering within the banking industry has been growing at a fast pace. Actually, the demand for fi...

Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.

Science.gov (United States)

van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D

2015-01-01

Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

Science.gov (United States)

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of

Power Generation Expansion Optimization Model Considering Multi-Scenario Electricity Demand Constraints: A Case Study of Zhejiang Province, China

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Peng Wang

2018-06-01

Full Text Available Reasonable and effective power planning contributes a lot to energy efficiency improvement, as well as the formulation of future economic and energy policies for a region. Since only a few provinces in China have nuclear power plants so far, nuclear power plants were not considered in many provincial-level power planning models. As an extremely important source of power generation in the future, the role of nuclear power plants can never be overlooked. In this paper, a comprehensive and detailed optimization model of provincial-level power generation expansion considering biomass and nuclear power plants is established from the perspective of electricity demand uncertainty. This model has been successfully applied to the case study of Zhejiang Province. The findings suggest that the nuclear power plants will contribute 9.56% of the total installed capacity, and it will become the second stable electricity source. The lowest total discounted cost is 1033.28 billion RMB and the fuel cost accounts for a large part of the total cost (about 69%. Different key performance indicators (KPI differentiate electricity demand in scenarios that are used to test the model. Low electricity demand in the development mode of the comprehensive adjustment scenario (COML produces the optimal power development path, as it provides the lowest discounted cost.

Effect of Physician Gender on Demand for Pap Tests

OpenAIRE

Lin, Tsui-Fang; Chen, Jennjou

2014-01-01

People’s demand for preventive medical care is one type of investment in health. The aim of this paper is to examine women’s demand for secondary prevention in Taiwan, focusing on the role a physician’s gender plays in women’s inclination to undergo Pap tests. Our estimation results show that regional ratio of female doctors has a positive and significant effect on utilization of Pap tests for the full sample and for women aged below 30. In addition, doctor’s gender matters only in utilizatio...

[The German DRG system 2003-2010 from the perspective of intensive care medicine].

Science.gov (United States)

Franz, Dominik; Bunzemeier, Holger; Roeder, Norbert; Reinecke, Holger

2010-01-01

Intensive care medicine is extremely heterogeneous, expensive and can only be partially planned and controlled. A correct and fair representation of intensive care medicine in the G-DRG system is an essential requirement for the use as a pricing system. From the perspective of intensive care medicine, pertinent changes of the DRG structure and differentiation of relevant parameters have been established within the G-DRG systems 2003-2010. Analysis of relevant diagnoses, medical procedures, co-payment structures and G-DRGs in the versions 2003-2010 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Since the first G-DRG system version 2003, numerous measures improved quality of case allocation of intensive care medicine. Highly relevant to the system version 2010 are duration of mechanical ventilation, the intensive care treatment complex and complicating constellations. The number of G-DRGs relevant to intensive medical care increased from n = 3 (2003) to n = 58 (2010). For standard cases, quality of case allocation and G-DRG reimbursement are adequate in 2010. The G-DRG system gained complexity again. High demands are made on correct and complete coding of complex cases. Nevertheless, further adjustments of the G-DRG system especially for cases with extremely high costs are necessary. Where the G-DRG system is unable to cover extremely high-cost cases, reimbursement solutions beyond the G-DRG structure should be taken into account.

Bacterial transmission from lens storage cases to contact lenses - Effects of lens care solutions and silver impregnation of cases

NARCIS (Netherlands)

Vermeltfoort, Pit B. J.; Hooymans, Johanna M. M.; Busscher, Henk J.; van der Mei, Henny C.

2008-01-01

The killing efficacies of multipurpose lens care solutions on planktonic and biofilm bacteria grown in polypropylene contact lens storage cases with and without silver impregnation and effects on bacterial transmission from storage cases to silicone hydrogel contact lenses were investigated. For

Stochastic model of forecasting spare parts demand

Directory of Open Access Journals (Sweden)

Ivan S. Milojević

2012-01-01

Full Text Available If demand is known for the whole planning period (complete information, then this type of demand or a supply system is deterministic. In the simplest cases, the demand per time unit is constant. If demand levels change over time following a precisely determined and pre-known principle, this type of demand is also classified as deterministic. This quality of demand is very rare. In most cases demand is the product of a process, for example TMS maintenance, whose progression cannot be predicted due to a number of factors influencing the process and causing random demand changes. In this case, a supply system must function according to the complete information and with a certain degree of uncertainty. In cases when demand may be defined by some of the laws of the probability theory, we are talking about stochastic demand and a stochastic supply system. Demand can be described by mathematical expectation, mathematical expectation and standard deviation, probability distribution or as a random process. However, there is usually a need for the most complex description, i.e. the complex random process because both intensity of demand and the probability distribution change during the observed intervals. The level of temporal (dynamic series is traditionally considered as a complex phenomenon consisting of four components: - basic tendency of phenomenon development - cyclical impact (long-term, 'ancient' - seasonal effects - random fluctuations. The basic tendency of phenomenon development means a long-term evolution of phenomena. A function that expresses the trajectory of changes of the basic tendency of a phenomenon development in the form of the equation is called a trend. Often, the trend involves time regression; i.e. the coefficients of the proposed functions are often determined by the least squares method. To roughly determine the coefficients of the proposed function, the sum of three and three-point methods are also used. After checking the

Simulation-based Strategies for Smart Demand Response

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Ines Leobner

2018-03-01

Full Text Available Demand Response can be seen as one effective way to harmonize demand and supply in order to achieve high self-coverage of energy consumption by means of renewable energy sources. This paper presents two different simulation-based concepts to integrate demand-response strategies into energy management systems in the customer domain of the Smart Grid. The first approach is a Model Predictive Control of the heating and cooling system of a low-energy office building. The second concept aims at industrial Demand Side Management by integrating energy use optimization into industrial automation systems. Both approaches are targeted at day-ahead planning. Furthermore, insights gained into the implications of the concepts onto the design of the model, simulation and optimization will be discussed. While both approaches share a similar architecture, different modelling and simulation approaches were required by the use cases.

Organizing and delivering case management services: lessons from the National Long Term Care Channeling Demonstration.

Science.gov (United States)

Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B

1988-01-01

This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.

Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town.

Science.gov (United States)

Smit, Ida; Zemlin, Annalise E; Erasmus, Rajiv T

2015-07-01

Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £ 25,387. The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols

DEFF Research Database (Denmark)

Soegaard, Rikke; Christensen, Finn B; Lauerberg, Ida

2006-01-01

Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patie...... service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program.......Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient......-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral...

Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

Science.gov (United States)

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

2016-01-01

To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

Science.gov (United States)

Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

2011-11-01

It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

Energy Demand Modeling Methodology of Key State Transitions of Turning Processes

Directory of Open Access Journals (Sweden)

Shun Jia

2017-04-01

Full Text Available Energy demand modeling of machining processes is the foundation of energy optimization. Energy demand of machining state transition is integral to the energy requirements of the machining process. However, research focus on energy modeling of state transition is scarce. To fill this gap, an energy demand modeling methodology of key state transitions of the turning process is proposed. The establishment of an energy demand model of state transition could improve the accuracy of the energy model of the machining process, which also provides an accurate model and reliable data for energy optimization of the machining process. Finally, case studies were conducted on a CK6153i CNC lathe, the results demonstrating that predictive accuracy with the proposed method is generally above 90% for the state transition cases.

The Evolution of End-of-Life Care: Ethical Implications for Case Management.

Science.gov (United States)

Fink-Samnick, Ellen

2016-01-01

This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

Background on Establishing a Working Group to Create Home Clinical Cases for Education.

Science.gov (United States)

Yoshitake, Taketo

2017-01-01

In Japan there are concerns that there will be a surge in social insurance costs such as medical and nursing care expenses as a result of the baby boom generation reaching the late stages of old age (75 years old and beyond) around 2025 ("The 2025 Problem"). In 2012, the "Outline on Social Insurance and Tax Reform" was approved by the Japanese cabinet and government, including "construction of regional comprehensive care". To promote participation in home medical care by pharmacists, this article presents the roles demanded of pharmacists in regional comprehensive care from the standpoint of physicians, and the discussion of case studies bridging the gap from knowledge learned in lectures to practical applications. In the field of medical education, "The 2023 Problem", regarding standards of education on a global level, caused medical schools across Japan to scramble for curriculum reform, specifically in the demand for increased time spent in clinical training and the expansion of community-based medical education. The current state of community-based medical education will be reviewed. In light of these developments, "the working group to create home clinical cases for education" was developed by clinical pharmacists in the field and university faculty members at Daiichi University of Pharmacy.

Migrants' decision-process shaping work destination choice: the case of long-term care work in the United Kingdom and Norway.

Science.gov (United States)

Christensen, Karen; Hussein, Shereen; Ismail, Mohamed

2017-09-01

Escalating demands for formal long-term care (LTC) result in the reliance on migrant workers in many developed countries. Within Europe, this is currently framed by progressive European immigration policies favouring inter-European mobility. Using the UK and Norway as case studies, this article has two main aims: (1) to document changes in the contribution of European Union (EU) migrants to the LTC sectors in Western Europe, and (2) to gain further understanding of migrants' decision-processes relating to destination and work choices. The UK and Norway provide examples of two European countries with different immigration histories, welfare regimes, labour market characteristics and cultural values, offering a rich comparison platform. The analysis utilizes national workforce datasets and data obtained from migrants working in the LTC sector in the UK and Norway ( n  = 248) and other stakeholders ( n  = 136). The analysis establishes a significant increase in the contribution of EU migrants (particularly from Eastern Europe) to the LTC sector in both the UK and Norway despite their different welfare regimes. The findings also highlight how migrant care workers develop rational decision-processes influenced by subjective perspectives of investments and returns within a context of wider structural migration barriers. The latter includes welfare and social care policies framing the conditions for migrants' individual actions.

Influence of the demand information quality on planning process accuracy in supply chain. Case studies

OpenAIRE

Natalia Szozda; Sylwia Werbińska-Wojciechowska

2013-01-01

Background: Identification and analysis of factors that affect the accuracy of demand planning process across the supply chain is one of the most important problems which influence the effectiveness of its material and information flows. Material and methods: On the basis of demand planning process investigation authors define the main elements affecting the right supply chain performance level and investigate the possible connections between demand information quality and demand plannin...

Integration home care in the care chain: results from the EURHOMAP study.

NARCIS (Netherlands)

Genet, N.; Boerma, W.

2010-01-01

Background: Demand for home care is expected to rise sharply across Europe as a result of trends of reduced institutional care and the ageing of populations. The increased volume and complexity in home care will challenge the coordination of services delivered in the home situation and the

The demand for environmental quality in driving transitions to low-polluting energy sources

International Nuclear Information System (INIS)

Fouquet, Roger

2012-01-01

The purpose of this paper is to understand the long run demand for energy-related environmental quality, its influence on legislation and on transitions to low polluting energy sources. It presents a series of episodes in British history where a demand for improvements in energy-related environmental quality existed. These episodes helped to identify a few cases where markets partially drove transitions to low polluting energy sources, in specific economic conditions. More generally, they showed that, when pushed, governments will introduce environmental legislation, although it tends to be weak and poorly enforced. In the case of air pollution, strong and binding legislation occurred roughly one hundred years later than was socially optimal. Based on this evidence, for a transition to a low carbon economy, governments will probably need to introduce focussed and binding legislation, and this cannot be expected without strong and sustained demand for climate stability. This demand will need to be spearheaded by pressure groups to introduce legislation, to enforce it and to avoid it being over-turned by future governments. - Highlights: ► Reviews demand for improvements in environmental quality in British history. ► In special cases, demand may drive transitions through markets. ► Demand will probably have to drive transitions to low polluting energy through legislation. ► Need for strong and sustained demand spearheaded through pressure groups.

Preventive home care of frail older people: a review of recent case management studies.

Science.gov (United States)

Hallberg, Ingalill Rahm; Kristensson, Jimmie

2004-09-01

Preventive actions targeting community-dwelling frail older people will be increasingly important with the growing number of very old and thereby also frail older people. This study aimed to explore and summarize the empirical literature on recent studies of case/care management interventions for community-dwelling frail older people and especially with regard to the content of the interventions and the nurse's role and outcome of it. Very few of the interventions took either a preventive or a rehabilitative approach using psycho-educative interventions focusing, for instance, on self-care activities, risk prevention, health complaints management or how to preserve or strengthen social activities, community involvement and functional ability. Moreover, it was striking that very few included a family-oriented approach also including support and education for informal caregivers. Thus it seems that the content of case/care management needs to be expanded and more influenced by a salutogenic health care perspective. Targeting frail older people seemed to benefit from a standardized two-stage strategy for inclusion and for planning the interventions. A comprehensive geriatric assessment seemed useful as a base. Nurses, preferably trained in gerontological practice, have a key role in case/care management for frail older people. This approach calls for developing the content of case/care management so that it involves a more salutogenic, rehabilitative and family-oriented approach. To this end it may be useful for nurses to strengthen their psychosocial skills or develop close collaboration with social workers. The outcome measures examined in this study represented one of three perspectives: the consumer's perspective, the perspective of health care consumption or the recipient's health and functional ability. Perhaps effects would be expected in all three areas and thus these should be included in evaluative studies in addition to measures for family and/or informal

Electricity demand analysis using cointegration and ARIMA modelling: A case study of Turkey

International Nuclear Information System (INIS)

Erdogdu, Erkan

2007-01-01

In the early 2000s, the Republic of Turkey has initiated an ambitious reform program in her electricity market, which requires privatization, liberalization as well as a radical restructuring. The most controversial reason behind, or justification for, recent reforms has been the rapid electricity demand growth; that is to say, the whole reform process has been a part of the endeavors to avoid the so-called 'energy crisis'. Using cointegration analysis and autoregressive integrated moving average (ARIMA) modelling, the present article focuses on this issue by both providing an electricity demand estimation and forecast, and comparing the results with official projections. The study concludes, first, that consumers' respond to price and income changes is quite limited and therefore there is a need for economic regulation in Turkish electricity market; and second, that the current official electricity demand projections highly overestimate the electricity demand, which may endanger the development of both a coherent energy policy in general and a healthy electricity market in particular

Professional groups driving change toward patient-centred care

DEFF Research Database (Denmark)

Burau, Viola; Carstensen, Kathrine; Lou, Stina

2017-01-01

BACKGROUND: Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim...... was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. METHODS: A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day......-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. RESULTS: Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation...

An analysis of short haul air passenger demand, volume 2

Science.gov (United States)

Blumer, T. P.; Swan, W. M.

1978-01-01

Several demand models for short haul air travel are proposed and calibrated on pooled data. The models are designed to predict demand and analyze some of the motivating phenomena behind demand generation. In particular, an attempt is made to include the effects of competing modes and of alternate destinations. The results support three conclusions: (1) the auto mode is the air mode's major competitor; (2) trip time is an overriding factor in intermodal competition, with air fare at its present level appearing unimportant to the typical short haul air traveler; and (3) distance appears to underly several demand generating phenomena, and therefore, must be considered very carefully to any intercity demand model. It may be the cause of the wide range of fare elasticities reported by researchers over the past 15 years. A behavioral demand model is proposed and calibrated. It combines the travel generating effects of income and population, the effects of modal split, the sensitivity of travel to price and time, and the effect of alternative destinations satisfying the trip purpose.

Demand and access to mental health services: a qualitative formative study in Nepal.

Science.gov (United States)

Brenman, Natassia F; Luitel, Nagendra P; Mall, Sumaya; Jordans, Mark J D

2014-08-02

Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach

The impact of health information technology and e-health on the future demand for physician services.

Science.gov (United States)

Weiner, Jonathan P; Yeh, Susan; Blumenthal, David

2013-11-01

Arguably, few factors will change the future face of the American health care workforce as widely and dramatically as health information technology (IT) and electronic health (e-health) applications. We explore how such applications designed for providers and patients will affect the future demand for physicians. We performed what we believe to be the most comprehensive review of the literature to date, including previously published systematic reviews and relevant individual studies. We estimate that if health IT were fully implemented in 30 percent of community-based physicians' offices, the demand for physicians would be reduced by about 4-9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4-7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2-5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings. Future predictions of physician supply adequacy should take these likely changes into account.

Integrated Comprehensive Care - A Case Study in Nursing Leadership and System Transformation.

Science.gov (United States)

Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin

2017-01-01

Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.

Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

Directory of Open Access Journals (Sweden)

Hsiu-Hung Wang

2012-09-01

Full Text Available The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.

Care on demand in nursing homes: a queueing theoretic approach

NARCIS (Netherlands)

Van Eeden, K.; Moeke, D.; Bekker, R.

2014-01-01

Nursing homes face ever-tightening healthcare budgets and are searching for ways to increase the efficiency of their healthcare processes without losing sight of the needs of their residents. Optimizing the allocation of care workers plays a key role in this search as care workers are responsible

Getting Help From Others: The Effects of Demand and Supply

Science.gov (United States)

2014-01-01

Objectives. This article investigates whether the help with care needs that is received from others depends on the potential supply of family helpers. Methods. Data from the first round of survey data collected in the National Health and Aging Trends Study are used to create measures of whether help is received, the number of helpers, and the hours of help received. Regression analysis is used to relate these outcomes to indicators of the demand for and supply of helpers. Results. Analyses suggest limited evidence that the receipt of help is a supply-driven phenomenon. Although the measures of child–caregiver supply are not associated with a binary indicator of help received, caregiver-supply factors are associated with the number of helpers and the total hours of help received. Discussion. Findings on the total number of helpers and total hours of care have implications for the division of care labor within families and between families and nonfamily members. Foreseeable trends in the demand for and the supply of help suggest further evolution in patterns of elders’ receipt of help with care needs. Even if those with needs for care continue to have their needs addressed by one or more helpers, the number of helpers, and the aggregate amount of help they provide, is likely to undergo adjustment in response to changing family patterns. PMID:25342824

Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

Science.gov (United States)

Sellars, Marcus; Detering, Karen M; Silvester, William

2015-04-23

Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

Future Capacity Procurements Under Unknown Demand and Increasing Costs

OpenAIRE

Apostolos Burnetas; Stephen Gilbert

2001-01-01

In this paper we study a situation in which a broker must manage the procurement of a short-life-cycle product. As the broker observes demand for the item, she learns about the demand process. However, as is often the case in practice, it becomes either more difficult or more expensive to procure the item as the selling season advances. Thus, the broker must trade off higher procurement costs against the benefit of making ordering decisions with better information about demand. Problems of th...

Demand Forecasting in the Fashion Industry: A Review

Directory of Open Access Journals (Sweden)

Maria Elena Nenni

2013-08-01

Full Text Available Forecasting demand is a crucial issue for driving efficient operations management plans. This is especially the case in the fashion industry, where demand uncertainty, lack of historical data and seasonal trends usually coexist. Many approaches to this issue have been proposed in the literature over the past few decades. In this paper, forecasting methods are compared with the aim of linking approaches to the market features.

Accessing patient-centered care using the advanced access model.

Science.gov (United States)

Tantau, Catherine

2009-01-01

Waits and delays for healthcare are legendary. These delays are not only frustrating and potentially hazardous for patients and providers but also represent significant cost to office practices. The traditional medical model that defines urgent care versus routine care is a vain and futile attempt to sort demand. This approach is at constant odds with patients' definition of urgency. Trusting patients to determine when and how they want to access care makes sense from a customer service perspective. If approached systematically using the principles of Advanced Access, patient demand patterns can be tracked to forecast demand. These demand patterns become the template for deploying the resources necessary to meet patients' needs. Although not a simple journey, the transformation to Advanced Access provides an entree to patient-centered care where patients can say, "I get exactly the care I want and need, when I want and need it."

A stable demand for money despite financial crisis: The case of Venezuela

OpenAIRE

Bjørnland, Hilde C.

2003-01-01

This paper investigates the demand for broad money in Venezuela, over a period of financial crisis and substantial exchange rate fluctuations. The analysis shows that there exist a long run relationship between real money, real income, inflation, the exchange rate and the domestic interest rate, that remains stable over major policy changes and large shocks. The long run properties emphasize that both inflation and exchange rate depreciations have negative effects on real money demand. The lo...

The case for conserving oil resources: the fundamentals of supply and demand

International Nuclear Information System (INIS)

Reynolds, D.B.

2000-01-01

This article summarises the evidence for an oil price shock and argues that oil producers, both OPEC and non-OPEC, need to cut back oil production more, in order to conserve oil for the future and to avert sudden extreme movements in oil prices in the next five-to-ten years. Four physical fundamentals determine long-run changes in oil prices: supply, demand, technology and substitutes. We show that supply, technology and substitutes are limited and demand is growing strongly. As demand pushes against supply, prices will rise rapidly. It would be better to conserve oil now, in order to have a smoother transition to higher-priced oil in the future. In addition, oil is such a valuable resource for the worlds economies in general, that we should conserve it for future generations. The world, in its haste for economic growth, should support OPEC conservation efforts. (author)

Modeling of gas demand using degree-day concept: case study for Ankara

International Nuclear Information System (INIS)

Gumrah, F.; Katircioglu, D.; Aykan, Y.; Okumus, S.; Kilincer, N.

2001-01-01

The demand for natural gas is rapidly increasing in Turkey, as it is in the rest of the world. However, natural gas reserves and production are rather limited in Turkey.The bulk of the Turkish gas demand is met by imports. Russia currently accounts for 69% of Turkey's gas supplies. Physical shortages might occur; supplies for industrial production and household consumption could temporarily run short. Also, fluctuations in consumption might occur due to climatic reasons or peak daily industrial energy demand. Underground gas storage is a necessity in order to regulate these seasonal, daily, and hourly fluctuations. In order to effectively design and utilize underground gas storage, it is necessary to identify the market requirements. In this study, Ankara was chosen as a pilot region due to its strategical importance of being the capital city of Turkey, and a wide range of marketing surveys for the last seven years was performed. All of the factors influencing the gas consumption and the relationships between these factors were analyzed. How does gas demand behave in extremely cold weather? How does the industrial part of the city act in the consumption behavior? What are the plans of the Municipality of Ankara, responsible for the execution of the natural gas distribution project in Ankara? A model was developed based on degree-day (DD) concept, including the annual number of customers, average DDs, and the usage per customer. A history matching study was performed to verify the results of the model with the measured consumption data for the last seven years. Comparisons showed that the calculated consumption by DD model and measured daily consumption were in good agreement. Finally, by using the developed approach, the gas demand was forecasted for Ankara up to 2005. The results of this study can be used to design underground gas storage facility near Ankara. (author)

Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis.

Science.gov (United States)

Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

2015-01-01

To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. All seven programmes involved bottom-up innovation driven by local needs and included: (1) a single point of entry, (2) holistic care assessments, (3) comprehensive care planning, (4) care co-ordination and (5) a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the 'business case' for integrated health and social care and to ensure successful generalization of local successes.

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam

Directory of Open Access Journals (Sweden)

Fujita Masami

2012-12-01

Full Text Available Abstract Background The global initiative ‘Treatment 2.0’ calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. Methods We developed a new analytical framework of the continuum of prevention and care (COPC. Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Results Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in

An integrated approach to health care costs: the case of American Can.

Science.gov (United States)

Silvers, J B; Haslinger, J

1984-01-01

Faced with numerous health care options, corporations are searching for plans which provide necessary benefits while containing costs. This article examines the case of the American Can Company where, since 1978, a new approach has produced mutual economic gains and employee satisfaction. American Can's efforts involved differential pricing and encouraged responsible selection by employees. The company was one of several studied by the Health Systems Management Center at Case Western Reserve University under contract with the Business Roundtable Health Initiatives Task Force. Such studies provide insight for other companies seeking ways to attack burgeoning corporate health care costs. This article is one of a series reporting the results of these studies.

What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

Science.gov (United States)

Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

2017-01-01

Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

Servant leadership: a case study of a Canadian health care innovator

Directory of Open Access Journals (Sweden)

Vanderpyl TH

2012-02-01

Full Text Available Tim H VanderpylSchool of Global Leadership, Regent University, Virginia Beach, VA, USAAbstract: Both servant leadership and innovation are easier to theorize than to actually implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael's Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into strategic alliances. Under his leadership, St Michael's Health Centre went from being one of the most underperforming health care organizations in Canada, to one of the most innovative. This article describes some of Cowan's strategies and argues that a servant leadership approach has a direct impact on an organization's ability to innovate. As far as the author is aware, this is the first published article on this specific change effort, which presents a unique perspective on the topics of servant leadership and innovation.Keywords: servant leadership, innovation, Canada, health care, case study

Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

NARCIS (Netherlands)

Vos, L.; Dückers, M.L.A.; Wagner, C.; Merode, G.G. van

2010-01-01

Objectives: Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix

Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study

Directory of Open Access Journals (Sweden)

Schellevis François G

2009-09-01

Full Text Available Abstract Background The pathophysiology of upper gastrointestinal (GI symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use. Methods Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001. Cases (adults visiting their primary care physician (PCP with upper GI symptoms and controls (individuals not having any of these complaints, matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psychopharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis. Results Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year. Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs ranging from 1.37 to 3.45. Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90, including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or

Epidemiological profile of tuberculosis cases reported among health care workers at the University Hospital in Vitoria, Brazil.

Science.gov (United States)

do Prado, Thiago Nascimento; Galavote, Heleticia Scabelo; Brioshi, Ana Paula; Lacerda, Thamy; Fregona, Geisa; Detoni, Valdério do Valle; Lima, Rita de Cássia Duarte; Dietze, Reynaldo; Maciel, Ethel Leonor Noia

2008-08-01

To describe the epidemiological profile of tuberculosis cases reported among health care workers in the Tuberculosis Control Program of the Cassiano Antonio of Moraes University Hospital in Vitoria, Brazil. A retrospective descriptive study of secondary data was conducted between 2002 and 2006. Twenty-five cases of health care workers with tuberculosis were reported: 8 in nursing technicians (32%); 4 in doctors (16%); 3 in nurses (12%); 2 in radiology technicians (8%) and 8 in professionals from other categories (32%). Of those 25 health care workers, 14 (56%) were male and 11 (44%) were female. The incidence of the disease was highest among those from 35 to 39 years of age. The predominant clinical presentation was extrapulmonary (12 cases, 48%), followed by pulmonary (11 cases, 44%) and a combination of the two (2 cases, 8%). Regarding comorbidities, AIDS, alcoholism and smoking, respectively, were present in 33.3% of the study population. Outcomes were as follows: 22 cases of cure (88%); 2 transfers (8%); and 1 death (4%). The proportion of health care workers diagnosed with tuberculosis in the period studied was 2.53%. The results show the need for heath care workers who work in the tuberculosis control program to fill out the field "professional occupation" on the tuberculosis case registry database reporting forms. In addition, this situation draws attention to the need to implement an occupational tuberculosis control program.

Decision-making process in elderly care : an explorative study

NARCIS (Netherlands)

Visser, Leenke; de Jong, Dirk Johan

2015-01-01

Current many changes are taking place in the elderly care: care is changing from supply-oriented to demand driven, problems have to be more serious than previously to get a placement in a nursing home, furthermore the demand for heavier care will increase due to ageing. The aim of this study is to

Water demand forecasting: review of soft computing methods.

Science.gov (United States)

Ghalehkhondabi, Iman; Ardjmand, Ehsan; Young, William A; Weckman, Gary R

2017-07-01

Demand forecasting plays a vital role in resource management for governments and private companies. Considering the scarcity of water and its inherent constraints, demand management and forecasting in this domain are critically important. Several soft computing techniques have been developed over the last few decades for water demand forecasting. This study focuses on soft computing methods of water consumption forecasting published between 2005 and 2015. These methods include artificial neural networks (ANNs), fuzzy and neuro-fuzzy models, support vector machines, metaheuristics, and system dynamics. Furthermore, it was discussed that while in short-term forecasting, ANNs have been superior in many cases, but it is still very difficult to pick a single method as the overall best. According to the literature, various methods and their hybrids are applied to water demand forecasting. However, it seems soft computing has a lot more to contribute to water demand forecasting. These contribution areas include, but are not limited, to various ANN architectures, unsupervised methods, deep learning, various metaheuristics, and ensemble methods. Moreover, it is found that soft computing methods are mainly used for short-term demand forecasting.

Modelling catchment areas for secondary care providers: a case study.

Science.gov (United States)

Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

2011-09-01

Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

Steam coal trade: demand, supply and prices to 2020

Energy Technology Data Exchange (ETDEWEB)

1993-04-01

This report on the international seaborne steam coal market was prepared using an electricity generation model developed for each coal-importing country, with the aid of WEFA Energy's power station database. The report contains chapters on: import demand forecasting methodology; orimulsion (environmental considerations and market potential); Scandinavia; North West Europe; British Isles; South West Europe; Eastern Europe; Eastern Mediterranean and North Africa; Asia; Latin America; North America; world steam coal demand summary; trade and price forecasting methodology; base case forecast; shipping rates; import demand; export supply and foreign exchange rates.

On the path independence conditions for discrete-continuous demand

DEFF Research Database (Denmark)

Batley, Richard; Ibáñez Rivas, Juan Nicolás

2013-01-01

We consider the manner in which the well-established path independence conditions apply to Small and Rosen's (1981) problem of discrete-continuous demand, focussing especially upon the restricted case of discrete choice (probabilistic) demand. We note that the consumer surplus measure promoted...... by Small and Rosen, which is specific to the probabilistic demand, imposes path independence to price changes a priori. We find that path independence to income changes can further be imposed provided a numeraire good is available in the consumption set. We show that, for practical purposes, Mc...

Caring experiences of nurse educators.

Science.gov (United States)

Grigsby, K A; Megel, M E

1995-12-01

Central to nursing practice today is the theme of caring. Yet nursing faculty are themselves experiencing a lack of caring. Faculty frequently voice the complaint that no one in the school of nursing work environment cares about them as they struggle to balance the demands of work with the demands of a personal life. A descriptive phenomenological approach was used to facilitate understanding of the caring experiences of nurses who teach. The question guiding this study was, "How do nurse educators experience caring in their work situations?" Nomination and purposive sampling techniques were used to select seven nurse faculty as participants. Unstructured interviews, lasting approximately one hour, were audiotaped and transcribed. Colaizzi's (1978) methodology was used to analyze the resulting data. Resulting themes included: 1) Caring is Connection and 2) Caring is a Pattern of Establishing and Maintaining Relationships. The use of narrative, journaling, and dialogue are suggested as techniques that will help nurse educators experience caring in schools of nursing.

Characterization of the elastic displacement demand: Case study - Sofia city

International Nuclear Information System (INIS)

Paskaleva, I.; Kouteva, M.; Vaccari, F.; Panza, G.F.

2008-02-01

The results of the study on the seismic site response in a part of the metropolitan Sofia are discussed. The neo-deterministic seismic hazard assessment procedure has been used to compute realistic synthetic waveforms considering four earthquake scenarios, with magnitudes M = 3.7, M = 6.3 and M = 7.0. Source and site specific ground motion time histories are computed along three investigated cross sections, making use of the hybrid approach, combining the modal summation technique and the finite differences scheme. Displacement and acceleration response spectra are considered. These results are validated against the design elastic displacement response spectra and displacement demand, recommended in Eurocode 8. The elastic response design spectrum from the standard pseudo-acceleration, versus natural period, Tn, format is converted to the Sa - Sd format. The elastic displacement response spectra and displacement demand are discussed with respect to the earthquake magnitude, the seismic source-to-site distance, seismic source mechanism, and the local geological site conditions. (author)

Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.

Science.gov (United States)

Vickery, Erin L; Seidler, Elizabeth M; Jones, Todd E; Veledar, Emir; Chen, Suephy C

2014-11-01

There is an increasing demand for a limited number of pigmented lesion clinic (PLC) visits at dermatology centers. To determine the proportion of visits to PLCs that are more frequent ("additional screening") than the recommended ("standard") follow-up schedule and to determine if certain patient characteristics correlate with the demand for these visits. A retrospective medical chart review of all PLC visits at an academic dermatology center from October 2010 to January 2012. A total of 609 patients associated with 1756 visits were identified. Of these, 25 patients associated with 26 visits were excluded owing to lack of melanoma diagnosis or risk factors, leaving 584 patients and 1730 visits. Diagnoses of these patients included in situ and invasive melanoma, dysplastic nevi, Spitz nevi, atypical nevus syndrome, family history of melanoma only, and other risk factors. The mean (SD) age was 48 (16) years, and 235 (40.2%) of the patients were male. The proportion of additional screening visits compared with standard visits. Standard visits were defined as occurring at the following frequencies: annually for mildly dysplastic nevi, Spitz nevi, or solely family history of melanoma; biannually for the first year, then annually thereafter for moderately dysplastic nevi or atypical nevus syndrome; biannually for up to 3 years, then annually thereafter for severely dysplastic nevi or melanomas in situ; every 3 months for 2 years, biannually for the following 2 years, then annually thereafter for invasive melanoma. A total of 1400 visits (80.9%) were standard, 257 (14.9%) were for additional screening, and 73 (4.2%) were "problem focused." Thirty percent of patients had at least 1 additional screening visit. The distribution of diagnoses among standard vs additional screening visits differed significantly, with "family history only" and "other risk factors" taking up a larger percentage of standard visits (15.1%) than the percentage of additional screening visits (8

Bacterial transmission from lens storage cases to contact lenses-Effects of lens care solutions and silver impregnation of cases.

Science.gov (United States)

Vermeltfoort, Pit B J; Hooymans, Johanna M M; Busscher, Henk J; van der Mei, Henny C

2008-10-01

The killing efficacies of multipurpose lens care solutions on planktonic and biofilm bacteria grown in polypropylene contact lens storage cases with and without silver impregnation and effects on bacterial transmission from storage cases to silicone hydrogel contact lenses were investigated. For transmission studies, biofilms of Staphylococcus aureus 835 or Pseudomonas aeruginosa no. 3 were grown on lens storage cases and incubated with a contact lens in different multipurpose lens care solutions (Opti-Free(R)Express(R), ReNu(R) MultiPlus(R), and SoloCare Aquatrade mark) or 0.9% NaCl. In addition, planktonic bacteria were directly suspended in multipurpose solutions and their killing efficacies were determined. The numbers of transmitted live and dead bacteria on the lenses were measured using a combination of plate counting and fluorescence microscopy. The highest killing efficacies were shown by Opti-Free(R) Express(R) for planktonic as well as for biofilm bacteria. Silver impregnation of lens cases in combination with the prescribed solution increased the killing efficacy for P. aeruginosa in biofilms, whereas effects for S. aureus were minor. Lowest numbers of live and dead bacteria were transmitted to a lens in Opti-Free(R) Express(R) multipurpose solution, with no significant differences between lens types and no effects of silver impregnation. (c) 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 2008. (c) 2008 Wiley Periodicals, Inc.

Potentials for energy savings and long term energy demands for Croatian households sector

DEFF Research Database (Denmark)

Pukšec, Tomislav; Mathiesen, Brian Vad; Duic, Neven

2011-01-01

demand in the future, based on careful and rational energy planning. Different financial, legal and technological mechanisms can lead to significant savings in the households sector which also leads to lesser greenhouse gas emissions and lower Croatian dependence on foreign fossil fuels....... relevant. In order to plan future energy systems it is important to know future possibilities and needs regarding energy demand for different sectors. Through this paper long term energy demand projections for Croatian households sector will be shown with a special emphasis on different mechanisms, both...... financial, legal but also technological that will influence future energy demand scenarios. It is important to see how these mechanisms influence, positive or negative, on future energy demand and which mechanism would be most influential. Energy demand predictions in this paper are based upon bottom...

Potentials for energy savings and long term energy demands for Croatian households sector

DEFF Research Database (Denmark)

Pukšec, Tomislav; Mathiesen, Brian Vad; Duic, Neven

2013-01-01

demand in the future, based on careful and rational energy planning. Different financial, legal and technological mechanisms can lead to significant savings in the households sector which also leads to lesser greenhouse gas emissions and lower Croatian dependence on foreign fossil fuels....... relevant. In order to plan future energy systems it is important to know future possibilities and needs regarding energy demand for different sectors. Through this paper long term energy demand projections for Croatian households sector will be shown with a special emphasis on different mechanisms, both...... financial, legal but also technological that will influence future energy demand scenarios. It is important to see how these mechanisms influence, positive or negative, on future energy demand and which mechanism would be most influential. Energy demand predictions in this paper are based upon bottom...

Simple future weather files for estimating heating and cooling demand

DEFF Research Database (Denmark)

Cox, Rimante Andrasiunaite; Drews, Martin; Rode, Carsten

2015-01-01

useful estimates of future energy demand of a building. Experimental results based on both the degree-day method and dynamic simulations suggest that this is indeed the case. Specifically, heating demand estimates were found to be within a few per cent of one another, while estimates of cooling demand...... were slightly more varied. This variation was primarily due to the very few hours of cooling that were required in the region examined. Errors were found to be most likely when the air temperatures were close to the heating or cooling balance points, where the energy demand was modest and even...... relatively large errors might thus result in only modest absolute errors in energy demand....

System dynamics modeling on health care: supply and demand of dementia care

NARCIS (Netherlands)

Rouwette, E.A.J.A.

2006-01-01

This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in

Reforming Long-Term Care Funding in Alberta.

Science.gov (United States)

Crump, R Trafford; Repin, Nadya; Sutherland, Jason M

2015-01-01

Like many provinces across Canada, Alberta is facing growing demand for long-term care. Issues with the mixed funding model used to pay long-term care providers had Alberta Health Services concerned that it was not efficiently meeting the demand for long-term care. Consequently, in 2010, Alberta Health Services introduced the patient/care-based funding (PCBF) model. PCBF is similar to activity-based funding in that it directly ties the complexity and care needs of long-term care residents to the payment received by long-term care providers. This review describes PCBF and discusses some of its strengths and weaknesses. In doing so, this review is intended to inform other provinces faced with similar long-term care challenges and contemplating their own funding reforms.

Scheduling Non-Preemptible Jobs to Minimize Peak Demand

Directory of Open Access Journals (Sweden)

Sean Yaw

2017-10-01

Full Text Available This paper examines an important problem in smart grid energy scheduling; peaks in power demand are proportionally more expensive to generate and provision for. The issue is exacerbated in local microgrids that do not benefit from the aggregate smoothing experienced by large grids. Demand-side scheduling can reduce these peaks by taking advantage of the fact that there is often flexibility in job start times. We focus attention on the case where the jobs are non-preemptible, meaning once started, they run to completion. The associated optimization problem is called the peak demand minimization problem, and has been previously shown to be NP-hard. Our results include an optimal fixed-parameter tractable algorithm, a polynomial-time approximation algorithm, as well as an effective heuristic that can also be used in an online setting of the problem. Simulation results show that these methods can reduce peak demand by up to 50% versus on-demand scheduling for household power jobs.

Microeconomic principles in the health sector: The demand for health services in the Republic of Serbia

Directory of Open Access Journals (Sweden)

Stošić Sanja

2015-01-01

Full Text Available Health has become a dominant economic and political issue over the past years, where many nations experience rapid rises in health care spending. The main reason why the health care sector does not operate entirely in accordance with economic market principles is the fact that inequalities in health and access to health care are understood as the lack of humanity and justice. Health care demands might seem as quite inelastic, but because of the health insurance, it shows a certain degree of price, income, cross - price and time elasticity. The subject of this study was the demand for health services in the Republic of Serbia in order to assess the ability of the public sector to meet the demand for providing these services. The underlying assumption was that public health can not adequately meet the needs of citizens due to insufficient investment in the sector and inefficient allocation of resources. To confirm this assumption, basic characteristics of health care market and the factors affecting the supply and demand for health services were discussed. Based on the analysis of investment in the health sector, the existing capacity and organization of health services, our research has shown that the public health system in the Republic of Serbia is not able to adequately meet the demand for health services. In the current economic situation in the Republic of Serbia, which already spends a significant portion of its GDP on health, there is no realistic possibility of increased spending on public health care system, although it can be expected that there will be increasing demand for health services and increase of costs. The health sector is not, and does not have the ability to be a perfectly competitive market, and the questions of its financing, rational and efficient organization is extremely delicate. However, health care economists and experts in health economics should give a significantly higher contribution in organizing health sector

Demand for Health Care Services and Child Health Status in Nigeria ...

African Journals Online (AJOL)

Nigeria has experienced significant increase in economic growth in the last decade yet the health indicators are very poor particularly in the rural sector where ... In addition, improving education among women will enhance the demand for health inputs and improve the health of their children particularly for the poor and ...

Health promotion and disease prevention: a look at demand management programs.

Science.gov (United States)

Fronstin, P

1996-09-01

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health

Managing Cancer Care - Finding Health Care Services

Science.gov (United States)

... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

Demand Uncertainty

DEFF Research Database (Denmark)

Nguyen, Daniel Xuyen

This paper presents a model of trade that explains why firms wait to export and why many exporters fail. Firms face uncertain demands that are only realized after the firm enters the destination. The model retools the timing of uncertainty resolution found in productivity heterogeneity models....... This retooling addresses several shortcomings. First, the imperfect correlation of demands reconciles the sales variation observed in and across destinations. Second, since demands for the firm's output are correlated across destinations, a firm can use previously realized demands to forecast unknown demands...... in untested destinations. The option to forecast demands causes firms to delay exporting in order to gather more information about foreign demand. Third, since uncertainty is resolved after entry, many firms enter a destination and then exit after learning that they cannot profit. This prediction reconciles...

A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

DEFF Research Database (Denmark)

Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

2012-01-01

BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...

Motivation Of Health Care Workers In Tanzania: A Case Study Of ...

African Journals Online (AJOL)

Motivation Of Health Care Workers In Tanzania: A Case Study Of Muhimbili National Hospital. ... workers were female. ... between workers and management, lack of participation in decision-making processes, and a general lack of concern for ...

Embedding care management in the medical home: a case study.

Science.gov (United States)

Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

2014-04-01

Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

A Novel Technique to Enhance Demand Responsiveness

DEFF Research Database (Denmark)

Farashbashi-Astaneh, Seyed-Mostafa; Bhattarai, Bishnu Prasad; Bak-Jensen, Birgitte

2015-01-01

In this study, a new pricing approach is proposed to increase demand responsiveness. The proposed approach considers two well-known demand side management techniques, namely peak shaving and valley filling. This is done by incentivising consumers by magnifying price difference between peak and off......-peak hours. The usefulness of the suggested method is then investigated by its combination with an electric vehicle optimal scheduling methodology which captures both economic valuation and grid technical constraints. This case is chosen in this study to address network congestion issues, namely under...

The Q(s,S) control policy for the joint replenishment problem extended to the case of correlation among item-demands

DEFF Research Database (Denmark)

Larsen, Christian

  We develop an algorithm to compute an optimal Q(s,S) policy for the joint replenishment problem when demands follow a compound correlated Poisson process. It is a non-trivial generalization of the work by Nielsen and Larsen (2005). We make some numerical analyses on two-item problems where we...... compare the optimal Q(s,S) policy to the optimal uncoordinated (s,S) policies. The results indicate that the more negative the correlation the less advantageous it is to coordinate. Therefore, in some cases the degree of correlation determines whether to apply the coordinated Q(s,S) policy...... or the uncoordinated (s,S) policies. Finally, we compare the Q(s,S) policy and the closely connected P(s,S) policy. Here we explain why the Q(s,S) policy is a better choice if item-demands are correlated....

When the body is past fixing: caring for bodies, caring for people.

Science.gov (United States)

Melia, Kath M

2014-03-01

To discuss the social context within which end-of-life nursing care takes place and to consider palliative options of last resort and the differences between societal and professional views on these. The distinction between life and death is not so straightforward as was once the case. Resuscitation and the increasing capability of intensive care to 'save' patients have implications for nursing practice in a society where there is an increasing demand that individuals should be able to choose the time of their death. This is a discursive paper. There are differences between the professional view on end-of-life options and the societal debates calling for a more libertarian approach. The problem for professionals is that the call for choice of the individual involves a different approach to end-of-life care, an approach that does not sit well with current professional ethics. One way forward might be a gradual reconsidering of what end-of-life care might reasonably encompass. Nurses are the healthcare workers who have the most prolonged and intimate contact with bodies. The way in which we conceptualise the body is central to much of the work carried out in the transition between life and death and is an important part of nursing. © 2013 John Wiley & Sons Ltd.

Assessment of utility side financial benefits of demand side management considering environmental impacts

Science.gov (United States)

Abeygunawardane, Saranga Kumudu

2018-02-01

Any electrical utility prefers to implement demand side management and change the shape of the demand curve in a beneficial manner. This paper aims to assess the financial gains (or losses) to the generating sector through the implementation of demand side management programs. An optimization algorithm is developed to find the optimal generation mix that minimizes the daily total generating cost. This daily total generating cost includes the daily generating cost as well as the environmental damage cost. The proposed optimization algorithm is used to find the daily total generating cost for the base case and for several demand side management programs using the data obtained from the Sri Lankan power system. Results obtained for DSM programs are compared with the results obtained for the base case to assess the financial benefits of demand side management to the generating sector.

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care.

Science.gov (United States)

Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders

2009-09-18

Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

Modelling energy demand in the Norwegian building stock

Energy Technology Data Exchange (ETDEWEB)

Sartori, Igor

2008-07-15

Energy demand in the building stock in Norway represents about 40% of the final energy consumption, of which 22% goes to the residential sector and 18% to the service sector. In Norway there is a strong dependency on electricity for heating purposes, with electricity covering about 80% of the energy demand in buildings. The building sector can play an important role in the achievement of a more sustainable energy system. The work performed in the articles presented in this thesis investigates various aspects related to the energy demand in the building sector, both in singular cases and in the stock as a whole. The work performed in the first part of this thesis on development and survey of case studies provided background knowledge that was then used in the second part, on modelling the entire stock. In the first part, a literature survey of case studies showed that, in a life cycle perspective, the energy used in the operating phase of buildings is the single most important factor. Design of low-energy buildings is then beneficial and should be pursued, even though it implies a somewhat higher embodied energy. A case study was performed on a school building. First, a methodology using a Monte Carlo method in the calibration process was explored. Then, the calibrated model of the school was used to investigate measures for the achievement of high energy efficiency standard through renovation work. In the second part, a model was developed to study the energy demand in a scenario analysis. The results showed the robustness of policies that included conservation measures against the conflicting effects of the other policies. Adopting conservation measures on a large scale showed the potential to reduce both electricity and total energy demand from present day levels while the building stock keeps growing. The results also highlighted the inertia to change of the building stock, due to low activity levels compared to the stock size. It also became clear that a deeper

Access to health care: solidarity and justice or egoism and injustice?

Science.gov (United States)

Prudil, Lukas

2008-09-01

The aim of this paper is to answer the question whether there is a real demand for equal access to health care or--better--to medical care and which interest groups (patients, health care professionals, policy makers and others) are interested in equal access. The focus is on EU countries including recent case law from the European Court of Justice and the European Court of Human Rights. We discuss whether there is a need to have legislative safeguards to protect equal access to medical care and whether such norms really work. The paper concludes that some of the key players in medical care are not primarily governed by a real willingness to have equal and just access to medical care, but by rather egoistic approaches. It seems that policy makers and politicians are the only ones who, surprisingly, must at least formally call for and enforce equal access to medical care. Interests of other groups seem to be different.

Getting help from others: the effects of demand and supply.

Science.gov (United States)

Wolf, Douglas A

2014-11-01

This article investigates whether the help with care needs that is received from others depends on the potential supply of family helpers. Data from the first round of survey data collected in the National Health and Aging Trends Study are used to create measures of whether help is received, the number of helpers, and the hours of help received. Regression analysis is used to relate these outcomes to indicators of the demand for and supply of helpers. Analyses suggest limited evidence that the receipt of help is a supply-driven phenomenon. Although the measures of child-caregiver supply are not associated with a binary indicator of help received, caregiver-supply factors are associated with the number of helpers and the total hours of help received. Findings on the total number of helpers and total hours of care have implications for the division of care labor within families and between families and nonfamily members. Foreseeable trends in the demand for and the supply of help suggest further evolution in patterns of elders' receipt of help with care needs. Even if those with needs for care continue to have their needs addressed by one or more helpers, the number of helpers, and the aggregate amount of help they provide, is likely to undergo adjustment in response to changing family patterns. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Exact Fill Rates for the (R, S Inventory Control with Discrete Distributed Demands for the Backordering Case

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Eugenia BABILONI

2012-01-01

Full Text Available The fill rate is usually computed by using the traditional approach, which calculates it as the complement of the quotient between the expected unfulfilled demand and the expected demand per replenishment cycle, instead of directly the expected fraction of fulfilled demand. Furthermore the available methods to estimate the fill rate apply only under specific demand conditions. This paper shows the research gap regarding the estimation procedures to compute the fill rate and suggests: (i a new exact procedure to compute the traditional approximation for any discrete demand distribution; and (ii a new method to compute the fill rate directly as the fraction of fulfilled demand for any discrete demand distribution. Simulation results show that the latter methods outperform the traditional approach, which underestimates the simulated fill rate, over different demand patterns. This paper focuses on the traditional periodic review, base stock system when backlogged demands are allowed.

Health insurance and health care in India: a supply-demand perspective

OpenAIRE

Perianayagam, Arokiasamy; Goli, Srinivas

2013-01-01

India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cove...

Price-elastic demand in deregulated electricity markets

Energy Technology Data Exchange (ETDEWEB)

Siddiqui, Afzal S.

2003-05-01

The degree to which any deregulated market functions efficiently often depends on the ability of market agents to respond quickly to fluctuating conditions. Many restructured electricity markets, however, experience high prices caused by supply shortages and little demand-side response. We examine the implications for market operations when a risk-averse retailer's end-use consumers are allowed to perceive real-time variations in the electricity spot price. Using a market-equilibrium model, we find that price elasticity both increases the retailers revenue risk exposure and decreases the spot price. Since the latter induces the retailer to reduce forward electricity purchases, while the former has the opposite effect, the overall impact of price responsive demand on the relative magnitudes of its risk exposure and end-user price elasticity. Nevertheless, price elasticity decreases cumulative electricity consumption. By extending the analysis to allow for early settlement of demand, we find that forward stage end-user price responsiveness decreases the electricity forward price relative to the case with price-elastic demand only in real time. Moreover, we find that only if forward stage end-user demand is price elastic will the equilibrium electricity forward price be reduced.

Toward Customized Care

Science.gov (United States)

Minvielle, Etienne

2018-01-01

Patients want their personal needs to be taken into account. Accordingly, the management of care has long involved some degree of personalization. In recent times, patients’ wishes have become more pressing in a moving context. As the population ages, the number of patients requiring sophisticated combinations of longterm care is rising. Moreover, we are witnessing previously unvoiced demands, preferences and expectations (eg, demand for information about treatment, for care complying with religious practices, or for choice of appointment dates). In view of the escalating costs and the concerns about quality of care, the time has now come to rethink healthcare delivery. Part of this reorganization can be related to customization: what is needed is a customized business model that is effective and sustainable. Such business model exists in different service sectors, the customization being defined as the development of tailored services to meet consumers’ diverse and changing needs at near mass production prices. Therefore, its application to the healthcare sector needs to be seriously considered. PMID:29524957

Transforming Cultures of Care: A Case Study in Organizational Change

Science.gov (United States)

Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary

2012-01-01

The authors report on a small organizational case study highlighting the dimensions of trauma-informed care, the processes of organizational change, and the growth of caregiver expertise. The article is framed by the notion of caregiving cultures, which refers to the beliefs, languages, and practices of caregivers and caregiving organizations.…

THE DEMAND FOR MEAT PRODUCTS IN THE UNITED STATES: AN EMPIRICAL ANALYSIS

OpenAIRE

Olowolayemo, Surajudeen O.; Martin, Neil R., Jr.; Raymond, Jennie E.

1993-01-01

Given the importance of meat consumption, and the proportion of consumers' income spent on meat, this study estimates the demand for eight meat categories using two different functional forms. An inverse almost ideal demand system (IAIDS), and linear double-log price dependent demand models are specified. In most cases, flexibilities obtained from both methods are comparable and show that the demand for meat products is price inflexible. In addition, there are regional as well as seasonal var...

Energy and electricity demand forecasting for nuclear power planning in developing countries

International Nuclear Information System (INIS)

1988-07-01

This Guidebook is designed to be a reference document to forecast energy and electricity demand. It presents concepts and methodologies that have been developed to make an analytical approach to energy/electricity demand forecasting as part of the planning process. The Guidebook is divided into 6 main chapters: (Energy demand and development, energy demand analysis, electric load curve analysis, energy and electricity demand forecasting, energy and electricity demand forecasting tools used in various organizations, IAEA methodologies for energy and electricity demand forecasting) and 3 appendices (experience with case studies carried out by the IAEA, reference technical data, reference economic data). A bibliography and a glossary complete the Guidebook. Refs, figs and tabs

Technological progress and long-term energy demand - a survey of recent approaches and a Danish case

DEFF Research Database (Denmark)

Klinge Jacobsen, Henrik

2001-01-01

This paper discusses di!erent approaches to incorporating technological progress in energy-economy models and the e!ecton long-term energy demand projections. Approaches to modelling based on an exogenous annual change of energy e$ciencyto an endogenous explanation of innovation for energy...... technologies are covered. Technological progress is an important issue for modelling long-term energy demand and is often characterised as the main contributor to the di!erent energy demand forecasts from di!erent models. New economic theoretical developments in the "elds of endogenous growth and industrial...... description, two models of residential energy demand in Denmark are compared. A Danish macroeconometric model is compared to a technological vintage model that is covering electric appliances and residential heating demand. The energy demand projection of the two models diverges, and the underlying...

[The phenomenon of the inducement of demand and various concepts in the economics of health].

Science.gov (United States)

Renckens, An; Decaluwe, Frida

2006-01-01

The article looks at the behaviour of practitioners and patients from an economic point of view, in particular at supplier-induced demand (SID). The objective is to be able to describe the factors which impact on the market for health care. To define the market for health care/dental care in general and the SID concept in particular, the following economic terminology is relevant. uncertainty, asymmetric information, moral hazard, and the agency relationship between practitioner and patient. Essentially SID results from the existence of asymmetric information (information "gap") on the health care market. The patient is less informed than the practitioner and cannot accurately assess his need for medical care. Hence decision-making authority is delegated to the practitioner who acts as the patient's agent to determine the optimal (amount of) care. This enables the practitioner to influence the demand for medical/dental care. If the practitioner is more interested in the rate of return than in the patient s need for care, a difference might arise between the care recommended by the practitioner and the care the patient would have asked for if he had the same level of information as the practitioner. This difference is called the amount of SID.

Aflaj’s Irrigation Water Demand/Supply Ratio: Two Case Studies

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Abdullah Al-Ghafri

2006-01-01

Full Text Available Due to the geographical location of Oman in an arid zone, agricultural production depends fully on irrigation. The traditional irrigation systems (Aflaj, sing. falaj supply more than one third of water for agriculture. Falaj is defined in the context of this paper as a canal system which provides water for domestic and agricultural uses. Oman has 3,107 active Aflaj producing about 680 Mm3 of water per year. The main objective of this study was to estimate the irrigation performance of Aflaj in Oman. Falaj al-Dariz and al-Nujaid were chosen as case studies. Both Aflaj are located in an extremely arid environment, where the rainfall is low and evapotranspiration is high. The study utilized an approach to estimate the irrigation performance of Aflaj by considering the falaj as a single unit of irrigation. The irrigation demand/supply ratio (D/S was used in the analysis as a tool of evaluation. Date palm, the dominant crop irrigated by Aflaj, was selected for the analysis. In falaj al-Dariz the date palms were slightly under irrigated on a yearly basis. On a monthly basis, in winter, the D/S was below 0.6 and in summer it was above 1.0. On the other hand, falaj al-Nujaid was supplying too much water than the date palms needed all round the year. In winter the D/S ratio was as low as 0.25. Even in summer, the D/S ratio did not much exceed 1.0.

Case report of physiotherapy care in patient with facial nervus palsy.

OpenAIRE

Zachová, Lenka

2012-01-01

Title: Case report of physiotherapy care in patient with facial nervus peripheral palsy. Objective: Summary of theoretical knowledge and working out the case report of patient diagnosed with peripheral palsy of right facial nerve. Methode and result: This thesis comprehensively summarizes the findings of peripheral facial nerve palsy and its treatment, especially with physiotherapeutic methods. It gives a wide view at the issue of physiotherapy in facial nerve palsy which is a symptom of many...

Impact of Demand Side Management in Active Distribution Networks

DEFF Research Database (Denmark)

Ponnaganti, Pavani; Bak-Jensen, Birgitte; Pillai, Jayakrishnan Radhakrishna

2017-01-01

Demand Side Management (DSM) is an efficient flexible program which helps distribution network operators to meet the future critical peak demand. It is executed in cases of not only technical issues like voltage sag or swell, transformer burdening, cable congestions, but also to increase the degree...... of visibility in the electricity markets. The aim of this paper is to find the optimal flexible demands that can be shifted to another time in order to operate the active distribution system within secure operating limits. A simple mechanism is proposed for finding the flexibility of the loads where electric...

[Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a 20-year period].

Science.gov (United States)

Monge Galindo, L; López-Pisón, J; Samper Villagrasa, P; Peña Segura, J L

2014-01-01

The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

Science.gov (United States)

Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

2015-08-21

Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a

Midwifery care: a perinatal mental health case scenario.

Science.gov (United States)

Marnes, Joanne; Hall, Pauline

2013-12-01

The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied. Copyright © 2013 Australian College of Midwives. All rights reserved.

Sectoral demand articulation : The case of emerging sensor technologies in the drinking water sector

NARCIS (Netherlands)

te Kulve, Haico; Konrad, Kornelia Elke

Demand articulation plays a central role in innovation processes as it reduces uncertainties for innovating firms and offers guidance in innovation processes. Studies into demand articulation processes have mostly focused on users and user-producer interactions and paid less attention to the role of

A Framework for Sustainable Urban Water Management through Demand and Supply Forecasting: The Case of Istanbul

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Murat Yalçıntaş

2015-08-01

Full Text Available The metropolitan city of Istanbul is becoming overcrowded and the demand for clean water is steeply rising in the city. The use of analytical approaches has become more and more critical for forecasting the water supply and demand balance in the long run. In this research, Istanbul’s water supply and demand data is collected for the period during 2006 and 2014. Then, using an autoregressive integrated moving average (ARIMA model, the time series water supply and demand forecasting model is constructed for the period between 2015 and 2018. Three important sustainability metrics such as water loss to supply ratio, water loss to demand ratio, and water loss to residential demand ratio are also presented. The findings show that residential water demand is responsible for nearly 80% of total water use and the consumption categories including commercial, industrial, agriculture, outdoor, and others have a lower share in total water demand. The results also show that there is a considerable water loss in the water distribution system which requires significant investments on the water supply networks. Furthermore, the forecasting results indicated that pipeline projects will be critical in the near future due to expected increases in the total water demand of Istanbul. The authors suggest that sustainable management of water can be achieved by reducing the residential water use through the use of water efficient technologies in households and reduction in water supply loss through investments on distribution infrastructure.

Nuclear accidents, consumers' perspectives and demands

International Nuclear Information System (INIS)

Alevritou-Goulielmou, H.

2005-01-01

The public's reaction to life threatening situations is determined by a variety of factors. In the case of nuclear accidents, the panic experienced by citizens may be reasonably justified. This paper briefly describes the parameters that cause panic reactions from a consumer's point of view and summarizes citizen's demands concerning nuclear crisis management

Coping with unexpected oil demand movements

International Nuclear Information System (INIS)

Anon.

2004-01-01

Continuous upward revisions to world oil demand projections for 2003 and 2004 are compared with the downward revisions that took place in 1998 and 1999, following the 1997 Asian economic crisis. Demand leads supply, in the current case, resulting in a time-lag in the whole supply chain, while supply led demand half a decade ago, with the OECD's commercial stocks reaching record highs. Recent months have seen a reversal of the longstanding inverse relationship between the United States of America's commercial crude oil stock levels and crude prices, and they are now moving in parallel. The fact that the US market is now adequately or even well supplied means that factors other than inventory levels are causing the present high prices. These factors are briefly outlined. OPEC is doing everything it can to maintain market stability, with prices at levels acceptable to producers and consumers. The agreement reached in Beirut on 3 June is the latest example of this. (Author)

Management of demand in the NHS, including the effects of queues and pensioners.

Science.gov (United States)

Groocock, J

1999-01-01

Discusses the methods used in the NHS to bring demand into balance with supply. People with minor illnesses try self-treatments and alternative medicine. Systematic programs to identify ill people are applied to only a few illnesses. Waiting lists for elective surgery cause some richer people to take their demand to private hospitals. An analysis of such waiting lists shows that, other than this, queues are not a method of rationing but are just the effect of bad management of the actual methods, which are then discussed. The same methods are used to ration access to specialist physicians. Providing extra resources would eliminate queues only if another condition was satisfied. It is argued that providing fully adequate medical care for patients of working age, although expensive, might produce a net economic gain, whereas all care for pensioners, including medical care, gives a net economic loss. Therefore it may not be sensible for people to have inadequate medical care for the first 65 years of their lives just because it is economically impracticable for them to have fully adequate medical care when they are pensioners.

KNOWLEDGE AND PRACTICES AMONGST HEALTH CARE PROVIDERS & CARE TAKERS REGARDING MANAGEMENT OF CHILDHOOD DIARRHOEA IN DEMONSTRATION DISTRICTS OF GUJARAT

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Rupani Mihir

2015-12-01

Full Text Available Introduction:Diarrhoea Alleviation through Zinc and ORS Therapy (DAZT project was started in 6 demonstration districtsof Gujarat in 2011. Rationale: In addition to poor feeding/hygiene practices of caretakers, inappropriate prescription from providers and inadequate use of Zinc-ORS are challenges in diarrhoea management. Objectives:To understand prescription practices for childhood diarrhoea, assess knowledge about zinc therapy among health care providers & caretakers in the government/private sectors &assess knowledge about additional information to be provided to caretakersamong health care providers& its practice among care takers. Materials & Methods:Information was collected onstructured questionnaires by interviews of 127care providers&43 care takersin 6 districts.In addition, case records were reviewed for 228 prescriptions – all from government sector. Data collected was entered and analyzedusing Excel. Results:Based on records/interviews, government functionaries dispensed ORS in 97%& zinc in 90% cases of diarrhoea while, private providers prescribed itin 79% &71% respectively. Antibiotics were prescribed in 24% & 59%, anti-amoebic in 20.2% &64.7% in public& private sectors respectively.Knowledge of dosage and duration of zinc therapy was better among public sector providers than private sector ones. Amongst caretakers, 74.4% gave correct dose of zinc to their children but was given for 14 days in 67.4% of cases; common reasons for non-compliance were“improved condition”&“no need to continue”. Foradditional information, such as advice on continued feeding, giving more than usual fluid,hand washing& when to return back to health facility, the responses were better for government providers than private ones. Knowledge about this additional information was also poor amongst care takers. Conclusions:For all the parameters studied, responses were better amongst government providers than those from private sector. Demand

Monopoly models with time-varying demand function

Science.gov (United States)

Cavalli, Fausto; Naimzada, Ahmad

2018-05-01

We study a family of monopoly models for markets characterized by time-varying demand functions, in which a boundedly rational agent chooses output levels on the basis of a gradient adjustment mechanism. After presenting the model for a generic framework, we analytically study the case of cyclically alternating demand functions. We show that both the perturbation size and the agent's reactivity to profitability variation signals can have counterintuitive roles on the resulting period-2 cycles and on their stability. In particular, increasing the perturbation size can have both a destabilizing and a stabilizing effect on the resulting dynamics. Moreover, in contrast with the case of time-constant demand functions, the agent's reactivity is not just destabilizing, but can improve stability, too. This means that a less cautious behavior can provide better performance, both with respect to stability and to achieved profits. We show that, even if the decision mechanism is very simple and is not able to always provide the optimal production decisions, achieved profits are very close to those optimal. Finally, we show that in agreement with the existing empirical literature, the price series obtained simulating the proposed model exhibit a significant deviation from normality and large volatility, in particular when underlying deterministic dynamics become unstable and complex.

2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

Science.gov (United States)

Battafarano, Daniel F; Ditmyer, Marcia; Bolster, Marcy B; Fitzgerald, John D; Deal, Chad; Bass, Ann R; Molina, Rodolfo; Erickson, Alan R; Hausmann, Jonathan S; Klein-Gitelman, Marisa; Imundo, Lisa F; Smith, Benjamin J; Jones, Karla; Greene, Kamilah; Monrad, Seetha U

2018-04-01

To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients. © 2018, American College of Rheumatology.

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

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Kronogård Maria

2009-09-01

Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

Optimized maritime emergency resource allocation under dynamic demand.

Directory of Open Access Journals (Sweden)