Integrated modeling of software cost and quality

International Nuclear Information System (INIS)

Rone, K.Y.; Olson, K.M.

1994-01-01

In modeling the cost and quality of software systems, the relationship between cost and quality must be considered. This explicit relationship is dictated by the criticality of the software being developed. The balance between cost and quality is a viable software engineering trade-off throughout the life cycle. Therefore, the ability to accurately estimate the cost and quality of software systems is essential to providing reliable software on time and within budget. Software cost models relate the product error rate to the percent of the project labor that is required for independent verification and validation. The criticality of the software determines which cost model is used to estimate the labor required to develop the software. Software quality models yield an expected error discovery rate based on the software size, criticality, software development environment, and the level of competence of the project and the developers with respect to the processes being employed

Quality costs in the production process

OpenAIRE

J. Michalska

2006-01-01

Purpose: The aim of this paper is showing the relationship of the quality costs with a production process. In this paper it was worked out and introduced the way of marking the documents with regard to the quality costs.Design/methodology/approach: In the frames of own research it has been analysed the quality costs in the production process from the documents marked using the worked out way of marking.Findings: On the basis of the own research it can be stated, that the majority of the eleme...

Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

Science.gov (United States)

Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

2015-08-01

Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for

The Concepts of Quality, Quality Assurance and Quality Enhancement

Science.gov (United States)

Elassy, Noha

2015-01-01

Purpose: This paper aims to critically review and discuss different definitions of the concepts of quality, quality assurance (QA) and quality enhancement (QE) in higher education (HE) with presenting critical perspectives of the literature. Design/methodology/approach: The paper looks at literature concerns with the meaning of quality, QA and QE,…

NON-QUALITY COSTS AND THEIR CONSEQUENCES IN THE ORGANIZATION

OpenAIRE

ANDREI DIAMANDESCU

2013-01-01

The purpose of this paper is to evaluate and analyze non-quality costs. This approach can be best based on the definition and understanding of the quality costs and then passing to the study of the effects of failures on the quality and the costs of these failures. Finally the paper will suggest several ways to improve the control costs of non-quality.

COST OF QUALITY MODELS AND THEIR IMPLEMENTATION IN MANUFACTURING FIRMS

Directory of Open Access Journals (Sweden)

N.M. Vaxevanidis

2009-03-01

Full Text Available In order to improve quality, an organization must take into account the costs associated with achieving quality since the objective of continuous improvement programs is not only to meet customer requirements, but also to do it at the lowest, possible, cost. This can only obtained by reducing the costs needed to achieve quality, and the reduction of these costs is only possible if they are identified and measured. Therefore, measuring and reporting the cost of quality (CoQ should be considered an important issue for achieving quality excellence. To collect quality costs an organization needs to adopt a framework to classify costs; however, there is no general agreement on a single broad definition of quality costs. CoQ is usually understood as the sum of conformance plus non-conformance costs, where cost of conformance is the price paid for prevention of poor quality (for example, inspection and quality appraisal and cost of non-conformance is the cost of poor quality caused by product and service failure (for example, rework and returns. The objective of this paper is to give a survey of research articles on the topic of CoQ; it opens with a literature review focused on existing CoQ models; then, it briefly presents the most common CoQ parameters and the metrics (indices used for monitoring CoQ. Finally, the use of CoQ models in practice, i.e., the implementation of a quality costing system and cost of quality reporting in companies is discussed, with emphasis in cases concerning manufacturing firms.

Components of the costs of controlling quality: a transaction cost economics approach.

Science.gov (United States)

Stiles, R A; Mick, S S

1997-01-01

This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.

Is higher nursing home quality more costly?

Science.gov (United States)

Giorgio, L Di; Filippini, M; Masiero, G

2016-11-01

Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.

A Technology Enhanced Learning Model for Quality Education

Science.gov (United States)

Sherly, Elizabeth; Uddin, Md. Meraj

Technology Enhanced Learning and Teaching (TELT) Model provides learning through collaborations and interactions with a framework for content development and collaborative knowledge sharing system as a supplementary for learning to improve the quality of education system. TELT deals with a unique pedagogy model for Technology Enhanced Learning System which includes course management system, digital library, multimedia enriched contents and video lectures, open content management system and collaboration and knowledge sharing systems. Open sources like Moodle and Wiki for content development, video on demand solution with a low cost mid range system, an exhaustive digital library are provided in a portal system. The paper depicts a case study of e-learning initiatives with TELT model at IIITM-K and how effectively implemented.

Uncertainty in air quality observations using low-cost sensors

Science.gov (United States)

Castell, Nuria; Dauge, Franck R.; Dongol, Rozina; Vogt, Matthias; Schneider, Philipp

2016-04-01

Air pollution poses a threat to human health, and the WHO has classified air pollution as the world's largest single environmental health risk. In Europe, the majority of the population lives in areas where air quality levels frequently exceed WHO's ambient air quality guidelines. The emergence of low-cost, user-friendly and very compact air pollution platforms allowing observations at high spatial resolution in near real-time, provides us with new opportunities to simultaneously enhance existing monitoring systems as well as enable citizens to engage in more active environmental monitoring (citizen science). However the data sets generated by low-cost sensors show often questionable data quality. For many sensors, neither their error characteristics nor how their measurement capability holds up over time or through a range of environmental conditions, have been evaluated. We have conducted an exhaustive evaluation of the commercial low-cost platform AQMesh (measuring NO, NO2, CO, O3, PM10 and PM2.5) in laboratory and in real-world conditions in the city of Oslo (Norway). Co-locations in field of 24 platforms were conducted over a 6 month period (April to September 2015) allowing to characterize the temporal variability in the performance. Additionally, the field performance included the characterization on different monitoring urban monitoring sites characteristic of both traffic and background conditions. All the evaluations have been conducted against CEN reference method analyzers maintained according to the Norwegian National Reference Laboratory quality system. The results show clearly that a good performance in laboratory does not imply similar performance in real-world outdoor conditions. Moreover, laboratory calibration is not suitable for subsequent measurements in urban environments. In order to reduce the errors, sensors require on-site field calibration. Even after such field calibration, the platforms show a significant variability in the performance

Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital.

Science.gov (United States)

Kosmidis, Dimitrios; Koutsouki, Sotiria; Lampiri, Klairi; Nagy, Eva Ottilia; Papaioannou, Vasilios; Pneumatikos, Ioannis; Anastassopoulos, George

2017-11-01

Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

Factors Affecting Time, Cost and Quality Management in Building ...

African Journals Online (AJOL)

The study is an assessment of time, cost and quality management in the Nigerian construction industry, and it aims to explore time cost and quality management in the construction industry. The objective of the study is to identify factors affecting time; cost and quality management in building construction projects. This study ...

Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology.

Science.gov (United States)

Falls, Christopher Edward

2008-01-01

American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.

The Costs of an Enhanced Employee Assistance Program (EAP) Intervention.

Science.gov (United States)

French, Michael T.; Dunlap, Laura J.; Zarkin, Gary A.; Karuntzos, Georgia T.

1998-01-01

This study estimates the economic costs of an enhanced Employee Assistance Program (EAP) intervention at a large midwestern EAP that serves 90 worksites. Results specify developmental and implementation costs and provide benchmark cost estimated for other EAPs that may be considering enhanced services. (SLD)

Effects of a preceptorship programme on turnover rate, cost, quality and professional development.

Science.gov (United States)

Lee, Tso-Ying; Tzeng, Wen-Chii; Lin, Chia-Huei; Yeh, Mei-Ling

2009-04-01

The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development. A high turnover rate of nurses is a common global problem. How to improve nurses' willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well-designed preceptorship programmes could possibly decrease turnover rates and improve professional development. A quasi-experimental research design was used. First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi-experimental design was used to evaluate the preceptorship programme. Data on new nurses' turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor's teaching and preceptor's perception were measured. After conducting the preceptorship programme, the turnover rate was 46.5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50-0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance. The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses. Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.

Cost Analysis of Poor Quality Using a Software Simulation

Directory of Open Access Journals (Sweden)

Jana Fabianová

2017-02-01

Full Text Available The issues of quality, cost of poor quality and factors affecting quality are crucial to maintaining a competitiveness regarding to business activities. Use of software applications and computer simulation enables more effective quality management. Simulation tools offer incorporating the variability of more variables in experiments and evaluating their common impact on the final output. The article presents a case study focused on the possibility of using computer simulation Monte Carlo in the field of quality management. Two approaches for determining the cost of poor quality are introduced here. One from retrospective scope of view, where the cost of poor quality and production process are calculated based on historical data. The second approach uses the probabilistic characteristics of the input variables by means of simulation, and reflects as a perspective view of the costs of poor quality. Simulation output in the form of a tornado and sensitivity charts complement the risk analysis.

Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

Science.gov (United States)

Kohli, R; Tan, J K; Piontek, F A; Ziege, D E; Groot, H

1999-08-01

Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

[Costs and benefits of quality management].

Science.gov (United States)

Schroeder-Printzen, I

2014-01-01

The establishment of quality management (QM) has been mandatory for health care providers of the national health insurance since 2004; however, certification is so far only compulsory for rehabilitation clinics. The costs have so far only been quantified in a few medical studies, while they are widely known in business administration with a basic distinction made between planning, steering, auditing, and declaration costs. Another business economics approach differentiates between prevention, appraisal, and non-conformance costs. The benefits of QM relates to customers, employees, external service providers, and health insurance providers. Also important in our consideration of the patient as a customer is that they should not be considered a customer in the usual business sense because the patient is in an emergency situation and can not freely decide. Improvements in treatment quality and in reducing the rate of adverse events make up the largest portion of the benefits of QM. Furthermore, QM can have a positive influence on motivation and employee recruitment. In addition, the cost savings that result despite costs for QM must not be forgotten.

The Effects of Quality of Care on Costs: A Conceptual Framework

Science.gov (United States)

Nuckols, Teryl K; Escarce, José J; Asch, Steven M

2013-01-01

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed

Quality Cost in the Construction Industry ' Preliminary Findings in Malaysia

Directory of Open Access Journals (Sweden)

Mukhtar Che Ali

2010-06-01

Full Text Available One of the key areas being emphasis in ISO 9001 Quality Management System (QMS is performance measurement towards continual improvement. Among the primary measuring tools is quality cost approach. Quality cost has been well practice in manufacturing sector but slowly gain its importance in construction industry. In fact Project Management Body of Knowledge (PMBOK has reckoned quality cost as one of the tool and technique in few of its management processes. In view of such circumstances that has prompted an effort to undertake a study to ascertain the level of knowledge and practice on quality cost in Malaysian construction landscape. The targeted group of respondents was the personnel in the project management team. Capitalizing Construction Industry Development Board (CIDB National Electronic Tendering Initiatives (NETI road shows which were held in year 2007 throughout the country, the author was able to garner 263 respondents representing the project management team. Subsequently the data gathered from the completed forms were analyzed using Statistical Package for Social Science (SPSS software. General findings indicated that the level of knowledge and practice on quality cost among the project management team were relatively low. One of the main contributing factors was poor knowledge in the area related to quality cost. Despite of such scenario most of the respondents showed their interest in acquiring knowledge in the field of quality cost. Hence quality cost approach is at the infancy stage in Malaysian construction industry.

From Quality Assurance to Quality Enhancement in the European Higher Education Area

Science.gov (United States)

Gvaramadze, Irakli

2008-01-01

This article focuses on recent trends in quality assurance initiatives, analyses how the European Higher Education Area promotes quality enhancement mechanisms and their implications for quality cultures in universities. It presents and discusses two approaches towards quality enhancement both at the institutional and programme level: 1. Quality…

Course Evaluation Systems for Open-ended Quality Enhancement

DEFF Research Database (Denmark)

Piihl, Jesper; Rasmussen, Jens Smed

2013-01-01

Quality in higher education is widely controlled through surveys asking students to evaluate teaching. However, control of quality does not necessarily lead to enhancement of quality. Drawing on accounting research and a case study, a measurement-based and open-ended quality control system...... emphasising quality enhancement is suggested. The case shows how interactive use of performance measurement can lead to more engaged and enabling dialogue amongst involved actors concerning quality enhancement, however institutionalised beliefs regarding course evaluation systems makes a change challenging....... The chapter suggests that open-ended measurement systems enabling stakeholders to take responsibility for quality enhancement is not so much a matter of technical design as a matter of an enabling style of use....

26 CFR 1.43-4 - Qualified enhanced oil recovery costs.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified enhanced oil recovery costs. 1.43-4... TAXES Credits Against Tax § 1.43-4 Qualified enhanced oil recovery costs. (a) Qualifying costs—(1) In... “qualified enhanced oil recovery costs” if the amounts are paid or incurred with respect to an asset which is...

Controlling for quality in the hospital cost function.

Science.gov (United States)

Carey, Kathleen; Stefos, Theodore

2011-06-01

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services.

Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction.

Science.gov (United States)

Oh, Christine; Moriarty, James; Borah, Bijan J; Mara, Kristin C; Harmsen, William S; Saint-Cyr, Michel; Lemaine, Valerie

2018-06-01

Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. A standardized ERAS pathway was developed through multidisciplinary collaboration. It addressed all phases of surgical care for patients undergoing free-flap breast reconstruction utilizing an abdominal donor site. In this retrospective cohort study, clinical variables associated with hospitalization costs for patients who underwent free-flap breast reconstruction with the ERAS pathway were compared with those of historical controls, termed traditional recovery after surgery (TRAS). All patients included in the study underwent surgery between September 2010 and September 2014. Predicted costs of the study groups were compared using generalized linear modeling. A total of 200 patients were analyzed: 82 in the ERAS cohort and 118 in the TRAS cohort. Clinical variables that were identified to potentially affect costs were found to have a statistically significant difference between groups and included unilateral versus bilateral procedures (p = 0.04) and the need for postoperative blood transfusion (p = 0.03). The cost regression analysis on the two cohorts was adjusted for these significant variables. Adjusted mean costs of patients with ERAS were found to be $4,576 lesser than those of the TRAS control group ($38,688 versus $43,264). Implementation of the ERAS pathway was associated with significantly decreased costs when compared to historical controls. There has been a healthcare focus toward prudent resource allocation, which dictates the need for plastic surgeons to recognize economic evaluation of clinical practice. The ERAS pathway can increase healthcare accountability by improving

FlexSAR, a high quality, flexible, cost effective, prototype SAR system

Science.gov (United States)

Jensen, Mark; Knight, Chad; Haslem, Brent

2016-05-01

The FlexSAR radar system was designed to be a high quality, low-cost, flexible research prototype instrument. Radar researchers and practitioners often desire the ability to prototype new or advanced configurations, yet the ability to enhance or upgrade existing radar systems can be cost prohibitive. FlexSAR answers the need for a flexible radar system that can be extended easily, with minimal cost and time expenditures. The design approach focuses on reducing the resources required for developing and validating new advanced radar modalities. Such an approach fosters innovation and provides risk reduction since actual radar data can be collected in the appropriate mode, processed, and analyzed early in the development process. This allows for an accurate, detailed understanding of the corresponding trade space. This paper is a follow-on to last years paper and discusses the advancements that have been made to the FlexSAR system. The overall system architecture is discussed and presented along with several examples illustrating the system utility.

Taguchi Approach to Design Optimization for Quality and Cost: An Overview

Science.gov (United States)

Unal, Resit; Dean, Edwin B.

1990-01-01

Calibrations to existing cost of doing business in space indicate that to establish human presence on the Moon and Mars with the Space Exploration Initiative (SEI) will require resources, felt by many, to be more than the national budget can afford. In order for SEI to succeed, we must actually design and build space systems at lower cost this time, even with tremendous increases in quality and performance requirements, such as extremely high reliability. This implies that both government and industry must change the way they do business. Therefore, new philosophy and technology must be employed to design and produce reliable, high quality space systems at low cost. In recognizing the need to reduce cost and improve quality and productivity, Department of Defense (DoD) and National Aeronautics and Space Administration (NASA) have initiated Total Quality Management (TQM). TQM is a revolutionary management strategy in quality assurance and cost reduction. TQM requires complete management commitment, employee involvement, and use of statistical tools. The quality engineering methods of Dr. Taguchi, employing design of experiments (DOE), is one of the most important statistical tools of TQM for designing high quality systems at reduced cost. Taguchi methods provide an efficient and systematic way to optimize designs for performance, quality, and cost. Taguchi methods have been used successfully in Japan and the United States in designing reliable, high quality products at low cost in such areas as automobiles and consumer electronics. However, these methods are just beginning to see application in the aerospace industry. The purpose of this paper is to present an overview of the Taguchi methods for improving quality and reducing cost, describe the current state of applications and its role in identifying cost sensitive design parameters.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

Science.gov (United States)

Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

2013-01-01

With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.

IMPLICATIONS AND OPPORTUNITIES REGARDING THE ORGANIZATION OF QUALITY COST MANAGEMENT ACCOUNTING

Directory of Open Access Journals (Sweden)

ION IONESCU

2014-02-01

Full Text Available Taking into considerations the obvious importance of the concept of quality, the inevitable question arises "What is the cost of quality?", clearly reaching the notion of "cost". It would seem absolutely logical and natural, that when we are referring to the total quality cost, from the professional point of view, to have an accountant that should take care of recording and supply of all the necessary data in terms of the inventory of this cost. The practical reality, however, shows that the accounting side of an economic entity does not provide comprehensive information regarding a complete definition of the quality cost. From this perspective, the present paper aims to consider a relevant discussion on the necessity and importance of the existence of the management accounting regarding the cost of quality

Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

Science.gov (United States)

Lam, Hwai-Tai Chen

In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost

Cost-effectiveness of a pressure ulcer quality collaborative

Directory of Open Access Journals (Sweden)

Bal Roland

2010-06-01

Full Text Available Abstract Background A quality improvement collaborative (QIC in the Dutch long-term care sector (nursing homes, assisted living facilities, home care used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs. The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. Methods We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials. Quality of life (Qol weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1 not sustained, (2 partially sustained, and (3 completely sustained. Results Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol of patients increased by 0.02 Quality Adjusted Life Years (QALYs in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. Conclusions During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

Cost-effectiveness of a pressure ulcer quality collaborative.

Science.gov (United States)

Makai, Peter; Koopmanschap, Marc; Bal, Roland; Nieboer, Anna P

2010-06-01

A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

Reconciling quality and cost: A case study in interventional radiology

International Nuclear Information System (INIS)

Zhang, Li; Mahnken, Andreas; Domroese, Sascha

2015-01-01

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 EUR to 294 EUR, and marginal delay costs from approximately 2000 EUR to 500 EUR, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 EUR. The yearly delay cost saved was approximately 150,000 EUR. With increased revenue of 10,000 EUR in project phase 2, the yearly total cost saved was approximately 290,000 EUR. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. (orig.)

Reconciling quality and cost: A case study in interventional radiology

Energy Technology Data Exchange (ETDEWEB)

Zhang, Li; Mahnken, Andreas [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic and Interventional Radiology, Baldinger Strasse, Marburg (Germany); Domroese, Sascha [University Hospital Giessen and Marburg, Philipps University of Marburg, Division of Controlling, Baldinger Strasse, Marburg (Germany)

2015-10-15

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 EUR to 294 EUR, and marginal delay costs from approximately 2000 EUR to 500 EUR, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 EUR. The yearly delay cost saved was approximately 150,000 EUR. With increased revenue of 10,000 EUR in project phase 2, the yearly total cost saved was approximately 290,000 EUR. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. (orig.)

Internal Quality Assurance--Enhancing Quality Culture. ENQA Workshop Report 16

Science.gov (United States)

ENQA (European Association for Quality Assurance in Higher Education), 2010

2010-01-01

The European Association for Quality Assurance in Higher Education (ENQA), in cooperation with the Quality Assurance Agency (QAA, UK), organised a seminar on theme "Internal Quality Assurance--Enhancing quality culture" which was held on 8-9 June, 2010 in London, United Kingdom. The seminar marked the fourth annual meeting of the ENQA…

Student Engagement in the Scottish Quality Enhancement Framework

Science.gov (United States)

Gvaramadze, Irakli

2011-01-01

The research addressed the interplay of student engagement and quality enhancement mechanisms in the Scottish higher education system. The paper demonstrates increasing focus on student learning, learning experience and high-quality learning in the current quality enhancement approaches. The student-university coproduction model is used to…

The Quality of Cost-Utility Analyses in Orthopedic Trauma.

Science.gov (United States)

Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

2015-08-01

As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

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Lue-Ping Zhao

Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

Quality-Adjusted Cost Functions for Child-Care Centers.

OpenAIRE

Mocan, H Naci

1995-01-01

Using a newly compiled data set, this paper estimates multi- product translog cost functions for 399 child care centers from California, Colorado, Connecticut, and North Carolina. Quality of child care is controlled by a quality index, which has been shown to be positively related to child outcomes by previous research. Nonprofit centers that receive public money, either from the state or federal government, (which is tied to higher standards), have total variable costs that are 18 percent hi...

Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

Science.gov (United States)

Schwartz, Marshall Z

2012-01-01

The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

Science.gov (United States)

Park, Claire Su-Yeon

2017-08-01

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

COSTING OF QUALITY IN BUSINESS BASE UNIT SEVERAL PRODUCTIONS, CIENFUEGOS

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Gómez Alfonso, Elizabeth

2013-01-01

Full Text Available The calculation of quality costs as a component of the System of Quality Management, is a must for Cuban business managers, to provide a technique identified as an advanced instrument of management, which will lead to improved competitiveness and serve as an informative source. Identify and calculate the costs of quality, as well as propose measured plans, to promote a decrease in operating expenses, which can be used as a tool to improve processes. The Business Unit of Several Base Productions of Cienfuegos presents the fault to give way to Business Improvement and certification of its Quality Management System, according to the norm ISO 9001:2008 and the decree law 281, so that the objective research was to estimate the costs of quality processes in the company. To achieve this level were used empirical methods and techniques such as direct observation, document review and work in groups, which allowed to calculate the costs of quality in all processes. The results obtained are applicable to companies that operate in the Cuban economy and according to the Cuban economic model implemented from the year 2011.

INTERDEPENDENCE OF COST AND QUALITY OF ITEMS OF REAL ESTATE

Directory of Open Access Journals (Sweden)

Lukmanova Inessa Galeevna

2012-10-01

Calculation of reduction of the overall cost of the real estate item that has improved quality indicators in comparison with the overall cost of the real estate item of satisfactory quality, taken as a benchmark, is made. The nature of interrelation between the quality of building works and maintenance expenses is provided. The overall cost of the item increases alongside with the increase of its quality, therefore the pre-set quality indicator should be defined by taking account of the market conditions, rates charged for building works and payable by buyers, and the amount of building works that sell at a higher price. The indicator of the overall cost of the item of real estate, if forthcoming operational expenses are taken into account, i.e. calculated for the course of the overall life cycle of the item, is essential if the investor is going to maintain the building. Investors often act as sellers of completed buildings; therefore, the product price set at the time when it is offered for sale is of particular importance.

A project management quality cost information system for the construction industry

OpenAIRE

Love, PED; Irani, Z

2003-01-01

A prototype Project Management Quality Cost System (PROMQACS) was developed to determine quality costs in construction projects. The structure and information requirements that are needed to provide a classification system of quality costs were identified and discussed. The developed system was tested and implemented in two case study construction projects to determine the information and management issues needed to develop PROMQACS into a software program. In addition, the system was used to...

The low cost of quality improvements in the electricity distribution sector of Brazil

International Nuclear Information System (INIS)

Corton, Maria Luisa; Zimmermann, Aneliese; Phillips, Michelle Andrea

2016-01-01

We analyze the impact of introducing output-based incentives in the price-cap regulatory regime of the Brazilian electricity distribution sector. We focus on the trade-off between operating costs and quality improvement, hypothesizing a positive relationship. Operating costs include maintenance and repair expenses. The regulator sets limits for service continuity and non-technical energy losses in each regulatory period. Service continuity refers to the average length of interruptions in electricity distribution. Non-technical losses refer to losses due to factors specific to the distribution segment. Quality incentives include peer-pressure and penalties/rewards for compliance with minimum quality standards. We model operating costs using a GMM framework to acknowledge endogeneity of variables. The model is dynamic given the inclusion of regulatory lags to recognize past cost behavior. Findings reveal a small trade-off between costs and quality. We conclude that quality improvements are not costly relative to the potential savings from complying with quality standards. We also find that the impact on operating costs is larger when energy losses increase compared to the cost effect due to increases in duration of outages. These findings suggest areas of attention in managerial decision making, and serve as valuable information to the regulator in tailoring quality incentives for this sector. - Highlights: • The article focuses on the impact of quality improvements on operating costs. • We find a very small tradeoff between quality improvements and operating costs. • We find the impact of a large share of electricity losses on costs larger compared to the impact of longer outages. • The results serve the regulator to adjust incentives for quality improvement. • The results serve the regulator in tailoring regulatory values for electricity losses and outages.

Internal cost control on the ecological quality of products

Directory of Open Access Journals (Sweden)

N.P. Syroid

2018-04-01

Full Text Available To improve the environmental quality of products due attention should be paid to control the processes related to environmental quality input of the product. The results of the study help to state the purpose and objectives of the control, also to define objects for internal control of operations cost of environmental quality. So, we believe that the main purpose of internal cost control on the ecological quality of products is the establishment of the correctness and legality of business operations, prevention of violations and abuses in the expenditure of natural, labour, material and financial resources to ensure the minimization of negative impact on the health of consumers and the environment. The basic objectives of internal control of expenditure are brought forward, but it should be noted that they can vary and depend on the size, structure, spheres and types of economic activity of the enterprise, the requirements of management personnel. In the process of identifying the objects of control of environmental quality it should be noted that this list is not exhaustive, but it is most relevant to highlight objects such as genetically modified organisms and waste production. Also the subjects of cost control to environmental quality, their functions and the information base for monitoring are determined. Proper organization of the process of internal cost control on the ecological quality of products would benefit from a clear documentation of transactions, timely and complete registration of accounting data in the registers, the true reflection of information in managerial financial reporting and ensure reduction of the negative impact on the health of consumers and the environment.

Waste Management facilities cost information: System Cost Model Software Quality Assurance Plan. Revision 2

International Nuclear Information System (INIS)

Peterson, B.L.; Lundeen, A.S.

1996-02-01

In May of 1994, Lockheed Idaho Technologies Company (LITCO) in Idaho Falls, Idaho and subcontractors developed the System Cost Model (SCM) application. The SCM estimates life-cycle costs of the entire US Department of Energy (DOE) complex for designing; constructing; operating; and decommissioning treatment, storage, and disposal (TSD) facilities for mixed low-level, low-level, transuranic, and mixed transuranic waste. The SCM uses parametric cost functions to estimate life-cycle costs for various treatment, storage, and disposal modules which reflect planned and existing facilities at DOE installations. In addition, SCM can model new facilities based on capacity needs over the program life cycle. The SCM also provides transportation costs for truck and rail, which include transport of contact-handled, remote-handled, and alpha (transuranic) wastes. The user can provide input data (default data is included in the SCM) including the volume and nature of waste to be managed, the time period over which the waste is to be managed, and the configuration of the waste management complex (i.e., where each installation's generated waste will be treated, stored, and disposed). Then the SCM uses parametric cost equations to estimate the costs of pre-operations (designing), construction costs, operation management, and decommissioning these waste management facilities. For the product to be effective and useful the SCM users must have a high level of confidence in the data generated by the software model. The SCM Software Quality Assurance Plan is part of the overall SCM project management effort to ensure that the SCM is maintained as a quality product and can be relied on to produce viable planning data. This document defines tasks and deliverables to ensure continued product integrity, provide increased confidence in the accuracy of the data generated, and meet the LITCO's quality standards during the software maintenance phase. 8 refs., 1 tab

Waste Management facilities cost information: System Cost Model Software Quality Assurance Plan. Revision 2

Energy Technology Data Exchange (ETDEWEB)

Peterson, B.L.; Lundeen, A.S.

1996-02-01

In May of 1994, Lockheed Idaho Technologies Company (LITCO) in Idaho Falls, Idaho and subcontractors developed the System Cost Model (SCM) application. The SCM estimates life-cycle costs of the entire US Department of Energy (DOE) complex for designing; constructing; operating; and decommissioning treatment, storage, and disposal (TSD) facilities for mixed low-level, low-level, transuranic, and mixed transuranic waste. The SCM uses parametric cost functions to estimate life-cycle costs for various treatment, storage, and disposal modules which reflect planned and existing facilities at DOE installations. In addition, SCM can model new facilities based on capacity needs over the program life cycle. The SCM also provides transportation costs for truck and rail, which include transport of contact-handled, remote-handled, and alpha (transuranic) wastes. The user can provide input data (default data is included in the SCM) including the volume and nature of waste to be managed, the time period over which the waste is to be managed, and the configuration of the waste management complex (i.e., where each installation`s generated waste will be treated, stored, and disposed). Then the SCM uses parametric cost equations to estimate the costs of pre-operations (designing), construction costs, operation management, and decommissioning these waste management facilities. For the product to be effective and useful the SCM users must have a high level of confidence in the data generated by the software model. The SCM Software Quality Assurance Plan is part of the overall SCM project management effort to ensure that the SCM is maintained as a quality product and can be relied on to produce viable planning data. This document defines tasks and deliverables to ensure continued product integrity, provide increased confidence in the accuracy of the data generated, and meet the LITCO`s quality standards during the software maintenance phase. 8 refs., 1 tab.

Measuring the Cost of Quality in Higher Education: A Faculty Perspective

Science.gov (United States)

Ruhupatty, LeRoy; Maguad, Ben A.

2015-01-01

Most critical activities in colleges and universities are driven by financial considerations. It is thus important that revenues are found to support these activities or ways identified to streamline costs. One way to cut cost is to improve the efficiency of schools to address the issue of poor quality. In this paper, the cost of poor quality in…

Costs of Quality: Exploratory Analysis of Hidden Elements and Prioritization using Analytic Hierarchy Process

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Sailaja A

2015-02-01

Full Text Available Cost of Quality analysis is emerged as an effective tool for the industrial managers for pinpointing the deficiencies in the system as well as for identifying the improvement areas by highlighting the cost reduction opportunities. However , this analysis will be fully effective only if it is further extended to identify the cost incurred in ensuring quality in all areas of the supply chain including the hidden costs and costs of missed out opportunities. Most of the hidden elements of quality costs are difficult to track and not accounted by the traditional accounting tools. An exploratory analysis is made in this research to identify the hidden elements of quality costs in manufacturing industry. Further, the identified cost elements are classified into various groups for better analysis and, finally, prioritized to identify the vital few among them. Analytic Hierarchy Process (AHP technique which is one of the most popular Multi Criteria Decision Method (MCDM and Pareto analysis were used in this study for prioritizing the hidden quality cost elements based on their degree of impact on overall cost of quality. By this analysis, the key cost elements which are to be addressed to reduce the overall cost of quality are identified.

Costs and Clinical Quality Among Medicare Beneficiaries..

Data.gov (United States)

U.S. Department of Health & Human Services — Authors of Costs and Clinical Quality Among Medicare Beneficiaries - Associations with Health Center Penetration of Low-Income Residents, published in Volume 4,...

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

Science.gov (United States)

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

The financial and quality-of-life cost to patients living with a chronic wound in the community.

Science.gov (United States)

Kapp, Suzanne; Santamaria, Nick

2017-12-01

required to reduce the financial and personal costs experienced by people who have chronic wounds. It is imperative that healthcare funding is directed to people who have chronic wounds, in particular to alleviate the out-of-pocket costs experienced by self-funders. Continued attention to the quality of life of people who have chronic wounds is required to minimise the negative effects of this condition and enhance well-being. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

Science.gov (United States)

Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

2015-04-01

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

AIRQino, a low-cost air quality mobile platform

Science.gov (United States)

Zaldei, Alessandro; Vagnoli, Carolina; Di Lonardo, Sara; Gioli, Beniamino; Gualtieri, Giovanni; Toscano, Piero; Martelli, Francesca; Matese, Alessandro

2015-04-01

Recent air quality regulations (Directive 2008/50/EC) enforce the transition from point-based monitoring networks to new tools that must be capable of mapping and forecasting air quality on the totality of land area, and therefore the totality of citizens. This implies new technologies such as models and additional indicative measurements, are needed in addition to accurate fixed air quality monitoring stations, that until now have been taken as reference by local administrators for the enforcement of various mitigation strategies. However, due to their sporadic spatial distribution, they cannot describe the highly resolved spatial pollutant variations within cities. Integrating additional indicative measurements may provide adequate information on the spatial distribution of the ambient air quality, also allowing for a reduction of the required minimum number of fixed sampling points, whose high cost and complex maintenance still remain a crucial concern for local administrators. New low-cost and small size sensors are becoming available, that could be employed in air quality monitoring including mobile applications. However, accurate assessment of their accuracy and performance both in controlled and real monitoring conditions is crucially needed. Quantifying sensor response is a significant challenge due to the sensitivity to ambient temperature and humidity and the cross-sensitivity to others pollutant species. This study reports the development of an Arduino compatible electronic board (AIRQino) which integrates a series of low-cost metal oxide and NDIR sensors for air quality monitoring, with sensors to measure air temperature, relative humidity, noise, solar radiation and vertical acceleration. A comparative assessment was made for CO2, CO, NO2, CH4, O3, VOCs concentrations, temperature and relative humidity. A controlled climatic chamber study (-80°C / +80°C) was performed to verify temperature and humidity interference using reference gas cylinders and

Air Quality Management Using Modern Remote Sensing and Spatial Technologies and Associated Societal Costs

Directory of Open Access Journals (Sweden)

Waheed Uddin

2006-09-01

Full Text Available This paper presents a study of societal costs related to public health due to the degradation of air quality and the lack of physical activity, both affected by our built environment. The paper further shows road safety as another public health concern. Traffic fatalities are the number one cause of death in the world. Traffic accidents result in huge financial loss to the people involved and the related public health cost is a significant part of the total societal cost. Motor vehicle exhausts and industrial emissions, gasoline vapors, and chemical solvents as well as natural sources emit nitrogen oxides and volatile organic compounds, which are precursors to the formation of ground-level Ozone. High concentration values of ground-level Ozone in hot summer days produce smog and lead to respiratory problems and loss in worker’s productivity. These factors and associated economic costs to society are important in establishing public policy and decision-making for sustainable transportation and development of communities in both industrialized and developing countries. This paper presents new science models for predicting ground-level Ozone and related air quality degradation. The models include predictor variables of daily climatological data, traffic volume and mix, speed, aviation data, and emission inventory of point sources. These models have been implemented in the user friendly AQMAN computer program and used for a case study in Northern Mississippi. Lifecycle benefits from reduced societal costs can be used to implement sustainable transportation policies, enhance investment decision-making, and protect public health and the environment.

Quality assurance. 6. ed.

International Nuclear Information System (INIS)

Masing, W.

1979-01-01

Brief introduction to the quality sector. After some explanations of the terms of quality, feature, and defect, the article discusses the planning of quality and testing, industrial metrology, the test risk, quality assurance, quality enhancement, quality cost, and organisational problems. (RW) [de

QUALITY ATTRIBUTES IN COST MANAGEMENT AND ACCOUNTING SUBJECTS: THE STUDENTS’ VIEWPOINT

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Jucelia Appio Tibola

2012-11-01

Full Text Available The aim in this research is to identify the quality attributes students perceive in cost management and accounting subjects. The subjects were 126 students who took the subjects Cost Applied to Administration, Cost Accounting and Cost Analysis, corresponding to all students in the semester during which the research was undertaken. Thus, a census study was adopted. The research institution is a public university that offers graduate (M.Sc. and Ph.D. programs in Accountancy and Business Administration, particularly in the South of Brazil. An exploratory and qualitative research design was used in the first part and a descriptive and quantitative design in the second. Data were collected with the help of a structured questionnaire with open questions, applying the Critical Incident Technique. Content Analysis was used to classify and categorize the respondents’ answers into units of meaning. In the second phase, these categories were transformed into categorical variables and analyzed through statistical procedures. The results evidenced that the quality attributes constituted an Axis. In the Cost Analysis subjects, they privileged the lecturer’s quality. In Cost Accounting, the students evidenced the teacher’s commitment and the application of practical examples as a relevant attribute. In Cost Applied to Administration, the results indicated that understanding about the subject, clarification of doubts and the lecturer’s didactics served as quality attributes.

QUALITY COSTS AS THE FACTOR OF COMPETITIVENESS INCREASE AT DOMESTIC AND FOREIGN MARKET

OpenAIRE

Lazibat, Tonći; Matić, Božo

2000-01-01

The paper discusses the importance of quality costs as the factor of competitiveness at the world market. For this purpose it is given definition of quality costs, their structure and characteristics, and the control system-supervision, as the subsystem of quality system determined by international standards ISO 9000ff. There are also analyzed experiences in monitoring the quality costs in developed countries and countries in transition-transitional countries, with a special retrospect to the...

Complementary effect of patient volume and quality of care on hospital cost efficiency.

Science.gov (United States)

Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

2017-06-01

This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

Strategies for cost-effective and enhanced production of bacterial cellulose.

Science.gov (United States)

Islam, Mazhar Ul; Ullah, Muhammad Wajid; Khan, Shaukat; Shah, Nasrullah; Park, Joong Kon

2017-09-01

Bacterial cellulose (BC) has received substantial attention because of its high purity, mechanical strength, crystallinity, liquid-absorbing capabilities, biocompatibility, and biodegradability etc. These properties allow BC to be used in various fields, especially in industries producing medical, electronic, and food products etc. A major discrepancy associated with BC is its high production cost, usually much higher than the plant cellulose. To address this limitations, researchers have developed several strategies for enhanced production of BC including the designing of advanced reactors and utilization of various carbon sources. Another promising approach is the production of BC from waste materials such as food, industrial, agricultural, and brewery wastes etc. which not only reduces the overall BC production cost but is also environment-friendly. Besides, exploration of novel and efficient BC producing microbial strains provides impressive boost to the BC production processes. To this end, development of genetically engineered microbial strains has proven useful for enhanced BC production. In this review, we have summarized major efforts to enhance BC production in order to make it a cost-effective biopolymer. This review can be of interest to researchers investigating strategies for enhanced BC production, as well as companies exploring pilot projects to scale up BC production for industrial applications. Copyright © 2017 Elsevier B.V. All rights reserved.

Enhancing lean supply chain through traffic light quality management system

Directory of Open Access Journals (Sweden)

Md. Mazharul Islam

2013-03-01

Full Text Available Lean is a continuous journey to grow and excel the company. Any company want to develop and cope with the world pace must adopt lean. However, in most of the organizations the management culture or people’s mentality is not so good to embrace change. They have predestined mind set where no change is normally allowed. Lean is a cooperative way of working that involves all departments and all personnel to work together in a team for the betterment of the entire company. Without providing fixed solution of any problem it suggests the best way that people willingly accept to do. Lean normally deals with highest quality, shorter lead time and lowest cost. In Bangladesh, most of the garment manufacturing companies are experiencing a massive quality problem. We describe a case where traffic light, a tool of lean quality system was adopted to a garment manufacturing company in Bangladesh. We also provide the charts to contrast the before and after scenario in detail, in order to illustrate the company benefits. After the traffic light system being implemented, the quality status was improved, production capacity was increased; significant days were saved that enhanced the lead time and thus strengthen the supply chain.

Cost effectiveness of adopted quality requirements in hospital laboratories.

Science.gov (United States)

Hamza, Alneil; Ahmed-Abakur, Eltayib; Abugroun, Elsir; Bakhit, Siham; Holi, Mohamed

2013-01-01

The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189. The quality management intervention based on ISO 15189 was conceded through three phases; pre - intervention phase, Intervention phase and Post-intervention phase. In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen's d) of (0.00) in pre-intervention phase and (0.99) in post - intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase. The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.

Enhancing mathematics teachers' quality through Lesson Study.

Science.gov (United States)

Lomibao, Laila S

2016-01-01

The efficiency and effectivity of the learning experience is dependent on the teacher quality, thus, enhancing teacher's quality is vital in improving the students learning outcome. Since, the usual top-down one-shot cascading model practice for teachers' professional development in Philippines has been observed to have much information dilution, and the Southeast Asian Ministers of Education Organization demanded the need to develop mathematics teachers' quality standards through the Southeast Asia Regional Standards for Mathematics Teachers (SEARS-MT), thus, an intensive, ongoing professional development model should be provided to teachers. This study was undertaken to determine the impact of Lesson Study on Bulua National High School mathematics teachers' quality level in terms of SEARS-MT dimensions. A mixed method of quantitative-qualitative research design was employed. Results of the analysis revealed that Lesson Study effectively enhanced mathematics teachers' quality and promoted teachers professional development. Teachers positively perceived Lesson Study to be beneficial for them to become a better mathematics teacher.

A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

Science.gov (United States)

Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

2016-02-01

Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

On the Cost-vs-Quality Tradeoff in Make-or-Buy Decisions

OpenAIRE

Andersson, Fredrik

2010-01-01

The make-or-buy decision is analyzed in a simple two-task principal-agent model. There is a cost-saving/quality tradeoff in effort provision. The principal faces a dichotomous choice between weak ("make") and strong ("buy") cost-saving incentives for the agent; the dichotomy is due to an incomplete-contracting limitation necessitating that one party be residual claimant. Choosing "buy" rather than "make" leads to higher cost-saving effort and -- in a plausible "main case" -- to lower quality ...

Assessing Participation in Secondary Education Quality Enhancement

African Journals Online (AJOL)

Assessing Participation in Secondary Education Quality Enhancement: Teachers, Parents and Communities in Cross River State. ... ailing economy, low moral values and philosophy of the end justifies the means were reasons for low parents and communities involvement in secondary education-quality improvement.

Monitoring urban air quality using a high-density network of low-cost sensor nodes in Oslo, Norway.

Science.gov (United States)

Castell, Nuria; Schneider, Philipp; Vogt, Matthias; Dauge, Franck R.; Lahoz, William; Bartonova, Alena

2017-04-01

Urban air quality represents a major public health burden and is a long-standing concern to citizens. Air pollution is associated with a range of diseases, symptoms and conditions that impair health and quality of life. In Oslo, traffic, especially exhaust from heavy-duty and private diesel vehicles and dust resuspension from studded tyres, together with wood burning in winter, are the main sources of pollution. Norway, as part of the European Economic Area, is obliged to comply with the European air quality regulations and ensure clean air. Despite this, Oslo has exceeded both the NO2 and PM10 thresholds for health protection defined in the Directive 2008/50/EC. The air quality in the Oslo area is continuously monitored in 12 compliance monitoring stations. These stations provide reliable and accurate data but their density is too low to provide a detailed spatial distribution of air quality. The emergence of low-cost nodes enables observations at high spatial resolution, providing the opportunity to enhance existing monitoring systems. However, the data generated by these nodes is significantly less accurate and precise than the data provided by reference equipment. We have conducted an evaluation of low-cost nodes to monitor NO2 and PM10, comparing the data collected with low-cost nodes against CEN (European Standardization Organization) reference analysers. During January and March 2016, a network of 24 nodes was deployed in Oslo. During January, high NO2 levels were observed for several days in a row coinciding with the formation of a thermal inversion. During March, we observed an episode with high PM10 levels due to road dust resuspension. Our results show that there is a major technical challenge associated with current commercial low-cost sensors, regarding the sensor robustness and measurement repeatability. Despite this, low-cost sensor nodes are able to reproduce the NO2 and PM10 variability. The data from the sensors was employed to generate detailed

Partial and incremental PCMH practice transformation: implications for quality and costs.

Science.gov (United States)

Paustian, Michael L; Alexander, Jeffrey A; El Reda, Darline K; Wise, Chris G; Green, Lee A; Fetters, Michael D

2014-02-01

To examine the associations between partial and incremental implementation of the Patient Centered Medical Home (PCMH) model and measures of cost and quality of care. We combined validated, self-reported PCMH capabilities data with administrative claims data for a diverse statewide population of 2,432 primary care practices in Michigan. These data were supplemented with contextual data from the Area Resource File. We measured medical home capabilities in place as of June 2009 and change in medical home capabilities implemented between July 2009 and June 2010. Generalized estimating equations were used to estimate the mean effect of these PCMH measures on total medical costs and quality of care delivered in physician practices between July 2009 and June 2010, while controlling for potential practice, patient cohort, physician organization, and practice environment confounders. Based on the observed relationships for partial implementation, full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population. Estimated effects of the PCMH model on quality and cost of care appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation. © Health Research and Educational Trust.

The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

Science.gov (United States)

Niquille, Anne; Ruggli, Martine; Buchmann, Michel; Jordan, Dominique; Bugnon, Olivier

2010-04-01

Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

Science.gov (United States)

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

A mathematical model for crashing projects by considering time, cost, quality and risk

Directory of Open Access Journals (Sweden)

Amin Mahmoudi

2017-01-01

Full Text Available Employers are looking for reducing execution time and maintaining the quality of the projects that are the main objective of the projects. In this article, we focus on crashing projects by con-sidering different factors such as cost, time, quality and risk. For the proposed integer linear model, cost of conformance and cost of non-conformance are considered as parts of the costs of quality of deliverables in projects. The cost of conformance consists of the costs of training the project team, inspection and test of deliverables. The cost of non-conformance also includes costs of rework and scrap. Project risk management is one of the important aspects of the pro-jects. The present study also considers the impact of risks, which is highly applicable in projects with a high level of uncertainty. Results are presented using integer programming approach with the aim of minimizing the costs of the project.

Avoiding a bad apple: Insect pollination enhances fruit quality and economic value☆

Science.gov (United States)

Garratt, M.P.D.; Breeze, T.D.; Jenner, N.; Polce, C.; Biesmeijer, J.C.; Potts, S.G.

2014-01-01

Insect pollination is important for food production globally and apples are one of the major fruit crops which are reliant on this ecosystem service. It is fundamentally important that the full range of benefits of insect pollination to crop production are understood, if the costs of interventions aiming to enhance pollination are to be compared against the costs of the interventions themselves. Most previous studies have simply assessed the benefits of pollination to crop yield and ignored quality benefits and how these translate through to economic values. In the present study we examine the influence of insect pollination services on farmgate output of two important UK apple varieties; Gala and Cox. Using field experiments, we quantify the influence of insect pollination on yield and importantly quality and whether either may be limited by sub-optimal insect pollination. Using an expanded bioeconomic model we value insect pollination to UK apple production and establish the potential for improvement through pollination service management. We show that insects are essential in the production of both varieties of apple in the UK and contribute a total of £36.7 million per annum, over £6 million more than the value calculated using more conventional dependence ratio methods. Insect pollination not only affects the quantity of production but can also have marked impacts on the quality of apples, influencing size, shape and effecting their classification for market. These effects are variety specific however. Due to the influence of pollination on both yield and quality in Gala, there is potential for insect pollination services to improve UK output by up to £5.7 million per annum. Our research shows that continued pollinator decline could have serious financial implications for the apple industry but there is considerable scope through management of wild pollinators or using managed pollinator augmentation, to improve the quality of production. Furthermore, we

Avoiding a bad apple: Insect pollination enhances fruit quality and economic value.

Science.gov (United States)

Garratt, M P D; Breeze, T D; Jenner, N; Polce, C; Biesmeijer, J C; Potts, S G

2014-02-01

Insect pollination is important for food production globally and apples are one of the major fruit crops which are reliant on this ecosystem service. It is fundamentally important that the full range of benefits of insect pollination to crop production are understood, if the costs of interventions aiming to enhance pollination are to be compared against the costs of the interventions themselves. Most previous studies have simply assessed the benefits of pollination to crop yield and ignored quality benefits and how these translate through to economic values. In the present study we examine the influence of insect pollination services on farmgate output of two important UK apple varieties; Gala and Cox. Using field experiments, we quantify the influence of insect pollination on yield and importantly quality and whether either may be limited by sub-optimal insect pollination. Using an expanded bioeconomic model we value insect pollination to UK apple production and establish the potential for improvement through pollination service management. We show that insects are essential in the production of both varieties of apple in the UK and contribute a total of £36.7 million per annum, over £6 million more than the value calculated using more conventional dependence ratio methods. Insect pollination not only affects the quantity of production but can also have marked impacts on the quality of apples, influencing size, shape and effecting their classification for market. These effects are variety specific however. Due to the influence of pollination on both yield and quality in Gala, there is potential for insect pollination services to improve UK output by up to £5.7 million per annum. Our research shows that continued pollinator decline could have serious financial implications for the apple industry but there is considerable scope through management of wild pollinators or using managed pollinator augmentation, to improve the quality of production. Furthermore, we

Pain, Itch, Quality of Life, and Costs after Herpes Zoster.

Science.gov (United States)

van Wijck, Albert J M; Aerssens, Yannick R

2017-07-01

Herpes zoster (HZ) and postherpetic neuralgia are known to have a profound effect on the patient's quality of life, but the incidence and severity of itch and its relation with pain and quality of life in the long term are still relatively unknown. The aim of this study was to measure the presence and severity of pain and itch and impact on quality of life in patients over 50 years old with HZ. We enrolled 661 patients with HZ in this 12-month observational study. Patient data were collected via a web-based questionnaire. Outcomes were pain, itch, burden of illness, impact on patient's daily life, impact on quality of life, and healthcare costs. At inclusion, 94% of patients reported any pain, 74.3% significant pain, and 26% severe pain. After 3 months, 18.8% of patients suffered from postherpetic neuralgia. At inclusion, 70.8% of patients had any itch, 39.2% significant itch, and 7.3% severe itch. The occurrence of pain increases costs and has a high impact on the quality of life, lowering EQ-5D scores by an average of 18%. In contrast, itch has little effect on the quality of life. Pain and itch are highly prevalent months after HZ. Pain caused by HZ has a large impact on quality of life, burden of illness, impact on daily life, and health care costs for these patients. The impact of itch on quality of life is relatively small. © 2016 World Institute of Pain.

Putting strategy to work: Tools for cost and quality management in the 1990s

International Nuclear Information System (INIS)

1991-12-01

Utilities face challenges in implementing cost and quality management approaches that will bring bottom-line results in all operational areas. This report identifies successful implementations of approaches that improve productivity and asset utilization and also achieve cost and quality management objectives. It provides insight and direction based on real-life management experience spanning the past decade. This document, Volume 3, Cost and Quality Guidebook, defines the 17 approaches most often used in cost and quality improvement efforts by the nation's leading companies. This volume includes survey results, case studies pertinent to each approach, a literature reference list, and a list of contacts

Reduction of cost of poor quality in nuclear fuel manufacturing

International Nuclear Information System (INIS)

Holmqvist, B.

2000-01-01

Within ABB reduction of Cost of Poor Quality (COPQ) has become an important process to focus quality improvement initiatives on bottom-line results. The process leads to improved bottom-line results, through cost savings, but it also leads to quality improvements in our processes, products and services. The traditional way of measuring and controlling COPQ in the production workshops is not enough. It is of vital importance to include other non-value creating costs as well, both internally, e.g. in the engineering work, and externally, in delivered products and purchased goods. ABB Atom has since a number of years used the COPQ process in the various steps of nuclear fuel manufacturing. The definition has been expanded to cover, for instance: Scrap, rework and deviations; Margin slippage; Warranty costs; Lack of supplier performance; Excess and obsolete inventory. Each of the COPQ elements has a responsible 'owner' within the management of the Nuclear Fuel Division. The owners form a COPQ task force, which is responsible for analyzing results, setting goals and initiating improvement actions. The COPQ result is updated each month and is presented to all employees in several ways, such as Intranet. For the various COPQ elements improvement initiatives have been implemented. The presentation will describe some of them, such as reduction of: Scrap, rework and deviations through a process with zero defect meetings, high level of process automation, statistical methods; Margin slippage through business process re-engineering; Warranty costs through an improved design review process and expanded testing of new products; Costs for lack in supplier performance through a new concept for supplier QA/QC. It is our strong belief that both ABB Atom and our Customers will benefit from the COPQ process since it leads to a higher quality for nuclear fuel and control rods and facilitates lower product prices. (author)

Design optimization for cost and quality: The robust design approach

Science.gov (United States)

Unal, Resit

1990-01-01

Designing reliable, low cost, and operable space systems has become the key to future space operations. Designing high quality space systems at low cost is an economic and technological challenge to the designer. A systematic and efficient way to meet this challenge is a new method of design optimization for performance, quality, and cost, called Robust Design. Robust Design is an approach for design optimization. It consists of: making system performance insensitive to material and subsystem variation, thus allowing the use of less costly materials and components; making designs less sensitive to the variations in the operating environment, thus improving reliability and reducing operating costs; and using a new structured development process so that engineering time is used most productively. The objective in Robust Design is to select the best combination of controllable design parameters so that the system is most robust to uncontrollable noise factors. The robust design methodology uses a mathematical tool called an orthogonal array, from design of experiments theory, to study a large number of decision variables with a significantly small number of experiments. Robust design also uses a statistical measure of performance, called a signal-to-noise ratio, from electrical control theory, to evaluate the level of performance and the effect of noise factors. The purpose is to investigate the Robust Design methodology for improving quality and cost, demonstrate its application by the use of an example, and suggest its use as an integral part of space system design process.

Fold-Back: Using Emerging Technologies to Move from Quality Assurance to Quality Enhancement

Science.gov (United States)

Leonard, Simon N.; Fitzgerald, Robert N.; Bacon, Matt

2016-01-01

Emerging technologies offer an opportunity for the development, at the institutional level, of quality processes with greater capacity to enhance learning in higher education than available through current quality processes. These systems offer the potential to extend use of learning analytics in institutional-level quality processes in addition…

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs.

Science.gov (United States)

Brady, Brenna L; Tkacz, Joseph; Meyer, Roxanne; Bolge, Susan C; Ruetsch, Charles

2017-02-01

The objective was to examine the relationship between health care costs and quality in rheumatoid arthritis (RA). Administrative claims were used to calculate 8 process measures for the treatment of RA. Associated health care costs were calculated for members who achieved or did not achieve each of the measures. Medical, pharmacy, and laboratory claims for RA patients (International Classification of Diseases, Ninth Revision, Clinical Modification 714.x) were extracted from the Optum Clinformatics Datamart database for 2011. Individuals were predominately female and in their mid-fifties. Measure achievement ranged from 55.9% to 80.8%. The mean cost of care for members meeting the measure was $18,644; members who did not meet the measures had a mean cost of $14,973. Primary cost drivers were pharmacy and office expenses, accounting for 42.4% and 26.3% of total costs, respectively. Regression analyses revealed statistically significant associations between biologic usage, which was more prevalent in groups attaining measures, and total expenditure across all measures (Ps < 0.001). Pharmacy costs were similar between both groups. Individuals meeting the measures had a higher proportion of costs accounted for by office visits; those not meeting the measures had a higher proportion of costs from inpatient and outpatient visits. These findings suggest that increased quality may lead to lower inpatient and outpatient hospital costs. Yet, the overall cost of RA care is likely to remain high because of intensive pharmacotherapy regimens.

Mandatory cost and other cost coming from the adoption of quality certifications in the hospitality business

OpenAIRE

Sanchez Rebull, M. Victoria; Hernandez, Ana Betriz; Banchieri, Lucia; Campa Planas, Fernando; Ginieis, Matias

2011-01-01

The adaptation to the regulation of hospitality business implies a relevant cost in the profit and loss account. Additionally, some companies in this business decide to add some voluntary quality and environmental certification systems, which also yields to increased costs. The purpose of this paper is to quantify these costs and to analyse if the hotel size influences them. A total of 67 different costs were considered in hotels of all sizes, in the region of Catalonia as one of the most rel...

Secondary Control for Voltage Quality Enhancement in Microgrids

DEFF Research Database (Denmark)

Savaghebi, Mehdi; Jalilian, Alireza; Vasquez, Juan Carlos

2012-01-01

In this paper, a hierarchical control scheme is proposed for enhancement of sensitive load bus (SLB) voltage quality in microgrids. The control structure consists of primary and secondary levels. The primary control level comprises distributed generators (DGs) local controllers. Each of these con......In this paper, a hierarchical control scheme is proposed for enhancement of sensitive load bus (SLB) voltage quality in microgrids. The control structure consists of primary and secondary levels. The primary control level comprises distributed generators (DGs) local controllers. Each...

Cost-benefit analysis of improved air quality in an office building

DEFF Research Database (Denmark)

Djukanovic, R.; Wargocki, Pawel; Fanger, Povl Ole

2002-01-01

A cost-benefit analysis of measures to improve air quality in an existing air-conditoned office building (11581 m2, 864 employees) was carried out for hot, temperate and cold climates and for two operating modes: Variable Air Volume (VAV) with economizer; and Constant Air Volume (CAV) with heat...... recovery. The annual energy cost and first cost of the HVAC system were calculat4ed using DOE 2.1E for different levels of air quality (10-50% dissatisfied). This was achieved by changing the outdoor air supply rate and the pollution loads. Previous studies have documented a 1.1% increase in office...

RURAL-URBAN DIFFERENCES IN NURSING HOME ACCESS, QUALITY AND COST

OpenAIRE

Yu, Wei; Bradford, Garnett L.

1995-01-01

Rural-urban differences in the supply of nursing home services as hypothesized to be jointly affected by competitive and regulatory forces, government policies, and the cost structure. Study findings indicate that rural services are slightly less accessible and lower in quality. A translog cost share function reveals no difference in the operating cost structure of rural and urban homes. Cost shares for nursing care are directly related to the degree of skilled nursing provided by homes. Sign...

AN ENHANCED MODEL TO ESTIMATE EFFORT, PERFORMANCE AND COST OF THE SOFTWARE PROJECTS

Directory of Open Access Journals (Sweden)

M. Pauline

2013-04-01

Full Text Available The Authors have proposed a model that first captures the fundamentals of software metrics in the phase 1 consisting of three primitive primary software engineering metrics; they are person-months (PM, function-points (FP, and lines of code (LOC. The phase 2 consists of the proposed function point which is obtained by grouping the adjustment factors to simplify the process of adjustment and to ensure more consistency in the adjustments. In the proposed method fuzzy logic is used for quantifying the quality of requirements and is added as one of the adjustment factor, thus a fuzzy based approach for the Enhanced General System Characteristics to Estimate Effort of the Software Projects using productivity has been obtained. The phase 3 takes the calculated function point from our work and is given as input to the static single variable model (i.e. to the Intermediate COCOMO and COCOMO II for cost estimation. The Authors have tailored the cost factors in intermediate COCOMO and both; cost and scale factors are tailored in COCOMO II to suite to the individual development environment, which is very important for the accuracy of the cost estimates. The software performance indicators are project duration, schedule predictability, requirements completion ratio and post-release defect density, are also measured for the software projects in my work. A comparative study for effort, performance measurement and cost estimation of the software project is done between the existing model and the authors proposed work. Thus our work analyzes the interaction¬al process through which the estimation tasks were collectively accomplished.

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.

Science.gov (United States)

Manzi, Anatole; Mugunga, Jean Claude; Iyer, Hari S; Magge, Hema; Nkikabahizi, Fulgence; Hirschhorn, Lisa R

2018-01-01

Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

Controlling costs without compromising quality: paying hospitals for total knee replacement.

Science.gov (United States)

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P costs ($12,773-$11,512; P costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Lowest cost due to highest productivity and highest quality

Science.gov (United States)

Wenk, Daniel

2003-03-01

Since global purchasing in the automotive industry has been taken up all around the world there is one main key factor that makes a TB-supplier today successful: Producing highest quality at lowest cost. The fact that Tailored Blanks, which today may reach up to 1/3 of a car body weight, are purchased on the free market but from different steel suppliers, especially in Europe and NAFTA, the philosophy on OEM side has been changing gradually towards tough evaluation criteria. "No risk at the stamping side" calls for top quality Tailored- or Tubular Blank products. Outsourcing Tailored Blanks has been starting in Japan but up to now without any quality request from the OEM side like ISO 13919-1B (welding quality standard in Europe and USA). Increased competition will automatically push the quality level and the ongoing approach to combine high strength steel with Tailored- and Tubular Blanks will ask for even more reliable system concepts which enables to weld narrow seams at highest speed. Beside producing quality, which is the key to reduce one of the most important cost driver "material scrap," in-line quality systems with true and reliable evaluation is going to be a "must" on all weld systems. Traceability of all process related data submitted to interfaces according to customer request in combination with ghost-shift-operation of TB systems are tomorrow's state-of-the-art solutions of Tailored Blank-facilities.

A cost-constrained model of strategic service quality emphasis in nursing homes.

Science.gov (United States)

Davis, M A; Provan, K G

1996-02-01

This study employed structural equation modeling to test the relationship between three aspects of the environmental context of nursing homes; Medicaid dependence, ownership status, and market demand, and two basic strategic orientations: low cost and differentiation based on service quality emphasis. Hypotheses were proposed and tested against data collected from a sample of nursing homes operating in a single state. Because of the overwhelming importance of cost control in the nursing home industry, a cost constrained strategy perspective was supported. Specifically, while the three contextual variables had no direct effect on service quality emphasis, the entire model was supported when cost control orientation was introduced as a mediating variable.

Positive Attitude toward Healthy Eating Predicts Higher Diet Quality at All Cost Levels of Supermarkets☆

Science.gov (United States)

Aggarwal, Anju; Monsivais, Pablo; Cook, Andrea J.; Drewnowski, Adam

2014-01-01

Shopping at low-cost supermarkets has been associated with higher obesity rates. This study examined whether attitudes toward healthy eating are independently associated with diet quality among shoppers at low-cost, medium-cost, and high-cost supermarkets. Data on socioeconomic status (SES), attitudes toward healthy eating, and supermarket choice were collected using a telephone survey of a representative sample of adult residents of King County, WA. Dietary intake data were based on a food frequency questionnaire. Thirteen supermarket chains were stratified into three categories: low, medium, and high cost, based on a market basket of 100 commonly eaten foods. Diet-quality measures were energy density, mean adequacy ratio, and total servings of fruits and vegetables. The analytical sample consisted of 963 adults. Multivariable regressions with robust standard error examined relations between diet quality, supermarket type, attitudes, and SES. Shopping at higher-cost supermarkets was associated with higher-quality diets. These associations persisted after adjusting for SES, but were eliminated after taking attitudinal measures into account. Supermarket shoppers with positive attitudes toward healthy eating had equally higher-quality diets, even if they shopped at low-, medium-, or high-cost supermarkets, independent of SES and other covariates. These findings imply that shopping at low-cost supermarkets does not prevent consumers from having high-quality diets, as long as they attach importance to good nutrition. Promoting nutrition-education strategies among supermarkets, particularly those catering to low-income groups, can help to improve diet quality. PMID:23916974

Assessment of compliance costs resulting from implementation of the proposed Great Lakes water quality guidance

International Nuclear Information System (INIS)

Fenner, K.; Podar, M.; Snyder, B.

1993-01-01

The primary purpose of the study was to develop an estimate of the incremental cost to direct dischargers resulting from the implementation of the proposed Great Lakes Water Quality Guidance (GLWQG). This estimate reflects the incremental cost of complying with permit requirements developed using the Implementation Procedures and water quality criteria proposed in the GLWQG versus permit requirements based on existing State water quality standards. Two secondary analyses were also performed, one to develop a preliminary estimate of the costs that would be incurred by indirect dischargers to publicly owned treatment works (POTWs), and another to evaluate the cost-effectiveness of the GLWQG. Finally, several sensitivity analyses were performed to evaluate the impact of several major assumptions on the estimated compliance costs. To estimate compliance costs, permit limitations and conditions based on existing State water quality standards were compared to water quality-based limitations and conditions based on the proposed GLWQG criteria and Implementation Procedures for a sample of plants. The control measures needed to comply with the proposed GLWQG-based effluent limitations were evaluated. Individual plant compliance costs were estimated for these control measures based on information on treatment technology and cost analyses available in the literature. An overall compliance cost was projected from the sample based on statistical methods

Estimating the cost of improving quality in electricity distribution: A parametric distance function approach

International Nuclear Information System (INIS)

Coelli, Tim J.; Gautier, Axel; Perelman, Sergio; Saplacan-Pop, Roxana

2013-01-01

The quality of electricity distribution is being more and more scrutinized by regulatory authorities, with explicit reward and penalty schemes based on quality targets having been introduced in many countries. It is then of prime importance to know the cost of improving the quality for a distribution system operator. In this paper, we focus on one dimension of quality, the continuity of supply, and we estimated the cost of preventing power outages. For that, we make use of the parametric distance function approach, assuming that outages enter in the firm production set as an input, an imperfect substitute for maintenance activities and capital investment. This allows us to identify the sources of technical inefficiency and the underlying trade-off faced by operators between quality and other inputs and costs. For this purpose, we use panel data on 92 electricity distribution units operated by ERDF (Electricité de France - Réseau Distribution) in the 2003–2005 financial years. Assuming a multi-output multi-input translog technology, we estimate that the cost of preventing one interruption is equal to 10.7€ for an average DSO. Furthermore, as one would expect, marginal quality improvements tend to be more expensive as quality itself improves. - Highlights: ► We estimate the implicit cost of outages for the main distribution company in France. ► For this purpose, we make use of a parametric distance function approach. ► Marginal quality improvements tend to be more expensive as quality itself improves. ► The cost of preventing one interruption varies from 1.8 € to 69.2 € (2005 prices). ► We estimate that, in average, it lays 33% above the regulated price of quality.

Relational Climate and Health Care Costs: Evidence From Diabetes Care.

Science.gov (United States)

Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

2018-01-01

Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets.

Science.gov (United States)

Lesser, Cara S; Ginsburg, Paul B

2006-06-01

Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.

Shared visions: Partnership of Rockwell International and NASA Cost Effectiveness Enhancements (CEE) for the space shuttle system integration program

Science.gov (United States)

Bejmuk, Bohdan I.; Williams, Larry

As a result of limited resources and tight fiscal constraints over the past several years, the defense and aerospace industries have experienced a downturn in business activity. The impact of fewer contracts being awarded has placed a greater emphasis for effectiveness and efficiency on industry contractors. It is clear that a reallocation of resources is required for America to continue to lead the world in space and technology. The key to technological and economic survival is the transforming of existing programs, such as the Space Shuttle Program, into more cost efficient programs so as to divert the savings to other NASA programs. The partnership between Rockwell International and NASA and their joint improvement efforts that resulted in significant streamlining and cost reduction measures to Rockwell International Space System Division's work on the Space Shuttle System Integration Contract is described. This work was a result of an established Cost Effectiveness Enhancement (CEE) Team formed initially in Fiscal Year 1991, and more recently expanded to a larger scale CEE Initiative in 1992. By working closely with the customer in agreeing to contract content, obtaining management endorsement and commitment, and involving the employees in total quality management (TQM) and continuous improvement 'teams,' the initial annual cost reduction target was exceeded significantly. The CEE Initiative helped reduce the cost of the Shuttle Systems Integration contract while establishing a stronger program based upon customer needs, teamwork, quality enhancements, and cost effectiveness. This was accomplished by systematically analyzing, challenging, and changing the established processes, practices, and systems. This examination, in nature, was work intensive due to the depth and breadth of the activity. The CEE Initiative has provided opportunities to make a difference in the way Rockwell and NASA work together - to update the methods and processes of the organizations

Shared visions: Partnership of Rockwell International and NASA Cost Effectiveness Enhancements (CEE) for the space shuttle system integration program

Science.gov (United States)

Bejmuk, Bohdan I.; Williams, Larry

1992-01-01

As a result of limited resources and tight fiscal constraints over the past several years, the defense and aerospace industries have experienced a downturn in business activity. The impact of fewer contracts being awarded has placed a greater emphasis for effectiveness and efficiency on industry contractors. It is clear that a reallocation of resources is required for America to continue to lead the world in space and technology. The key to technological and economic survival is the transforming of existing programs, such as the Space Shuttle Program, into more cost efficient programs so as to divert the savings to other NASA programs. The partnership between Rockwell International and NASA and their joint improvement efforts that resulted in significant streamlining and cost reduction measures to Rockwell International Space System Division's work on the Space Shuttle System Integration Contract is described. This work was a result of an established Cost Effectiveness Enhancement (CEE) Team formed initially in Fiscal Year 1991, and more recently expanded to a larger scale CEE Initiative in 1992. By working closely with the customer in agreeing to contract content, obtaining management endorsement and commitment, and involving the employees in total quality management (TQM) and continuous improvement 'teams,' the initial annual cost reduction target was exceeded significantly. The CEE Initiative helped reduce the cost of the Shuttle Systems Integration contract while establishing a stronger program based upon customer needs, teamwork, quality enhancements, and cost effectiveness. This was accomplished by systematically analyzing, challenging, and changing the established processes, practices, and systems. This examination, in nature, was work intensive due to the depth and breadth of the activity. The CEE Initiative has provided opportunities to make a difference in the way Rockwell and NASA work together - to update the methods and processes of the organizations

Cost of quality assurance in radiotherapy: human and material requirements

International Nuclear Information System (INIS)

Caudrelier, V.; Garcia, R.; Chauvet, B.; Bourhis, J.

2005-01-01

In 2004, three new important laws were passed concerning radiotherapy services. The first two concerns the internal and external quality control of linear accelerators and the last concerns the role of the medical physicist, whose presence was made mandatory during the whole length of the treatments. These laws, which aim to improve the quality and the security of treatments, represent an increase in price that we have calculated, and which prevents them being implemented, as a joint study realised by the SFRO and the SFPM has shown. The cost of quality in radiotherapy requires investment in material and manpower and improvement in availability of the accelerators which entails a complete reorganization of the services. Cost analysis is included. The difficulties in implementing these laws have also been evaluated and this evaluation already enables us to propose certain elements enabling us to go forward to globally improve the quality and security in radiotherapy. (author)

Quality upgrading and cost reducing effects of using an operation control system for performance of maintenance tasks

International Nuclear Information System (INIS)

Ramler, K.

1996-01-01

According to available results, the use of an operation control system has come up to expections with respect to a quality enhancement of maintenance work. The tasks are performed more safely and there is more insight into the processes. so that, as indirect results, cost savings and rationalisation effects are to be expected. However, the cost savings achieved through the operation control system for maintenance tasks will remain modest. The truly cost-effective optimisation potentials in the maintenance area primarily consist in a reduction of preventive measures to the required scope, i.e reduction of the envisaged quantity of processes for maintenance and recurrent inspection. In order to extend savings to the organisational level, with respect to personnel expenditure, by DP supported maintenance planning, a suitable optimisation of the organisational structure and personnel employment is inevitable, because otherwise the rationalisation potentials will remain utopia. (orig.) [de

San Pablo Bay Tidal Marsh Enhancement and Water Quality Improvement Project

Science.gov (United States)

Information about the SFBWQP San Pablo Bay Tidal Marsh Enhancement and Water Quality Improvement Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

Enhancing quality of construction on nuclear facilities

International Nuclear Information System (INIS)

Buchert, K.P.

1984-01-01

From the author's viewpoint and the viewpoint of others, the quality of construction on both nuclear projects and many other non-nuclear projects has decreased. The trend toward recent QA and QC methods of contractors doing their own inspection has not only tended to reduce the quality of construction, but also has discouraged qualified inspectors from accepting positions where this type of QA and QC is practiced. In addition, the methods have decreased the desired interaction between design engineers and construction management. The paper contains detailed recommendations on how the quality of construction can be enhanced on nuclear projects. It is also shown that construction quality must be obtained by different methods than those used to obtain manufacturing quality

The practice of quality-associated costing: application to transfusion manufacturing processes.

Science.gov (United States)

Trenchard, P M; Dixon, R

1997-01-01

This article applies the new method of quality-associated costing (QAC) to the mixture of processes that create red cell and plasma products from whole blood donations. The article compares QAC with two commonly encountered but arbitrary models and illustrates the invalidity of clinical cost-benefit analysis based on these models. The first, an "isolated" cost model, seeks to allocate each whole process cost to only one product class. The other is a "shared" cost model, and it seeks to allocate an approximately equal share of all process costs to all associated products.

QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

NARCIS (Netherlands)

Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

2011-01-01

Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary

Positive attitude toward healthy eating predicts higher diet quality at all cost levels of supermarkets.

Science.gov (United States)

Aggarwal, Anju; Monsivais, Pablo; Cook, Andrea J; Drewnowski, Adam

2014-02-01

Shopping at low-cost supermarkets has been associated with higher obesity rates. This study examined whether attitudes toward healthy eating are independently associated with diet quality among shoppers at low-cost, medium-cost, and high-cost supermarkets. Data on socioeconomic status (SES), attitudes toward healthy eating, and supermarket choice were collected using a telephone survey of a representative sample of adult residents of King County, WA. Dietary intake data were based on a food frequency questionnaire. Thirteen supermarket chains were stratified into three categories: low, medium, and high cost, based on a market basket of 100 commonly eaten foods. Diet-quality measures were energy density, mean adequacy ratio, and total servings of fruits and vegetables. The analytical sample consisted of 963 adults. Multivariable regressions with robust standard error examined relations between diet quality, supermarket type, attitudes, and SES. Shopping at higher-cost supermarkets was associated with higher-quality diets. These associations persisted after adjusting for SES, but were eliminated after taking attitudinal measures into account. Supermarket shoppers with positive attitudes toward healthy eating had equally higher-quality diets, even if they shopped at low-, medium-, or high-cost supermarkets, independent of SES and other covariates. These findings imply that shopping at low-cost supermarkets does not prevent consumers from having high-quality diets, as long as they attach importance to good nutrition. Promoting nutrition-education strategies among supermarkets, particularly those catering to low-income groups, can help to improve diet quality. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Cost Quality Management Assessment for the Idaho Operations Office. Final report

International Nuclear Information System (INIS)

1995-06-01

The Office of Engineering and Cost Management (EM-24) conducted a Cost Quality Management Assessment of EM-30 and EM-40 activities at the Idaho National Engineering Laboratory on Feb. 3--19, 1992 (Round I). The CQMA team assessed the cost and cost-related management activities at INEL. The Round II CQMA, conducted at INEL Sept. 19--29, 1994, reviewed EM-30, EM-40, EM-50, and EM-60 cost and cost-related management practices against performance objectives and criteria. Round II did not address indirect cost analysis. INEL has made measurable progress since Round I

Research on goal-setting method of rock drivage based on the balance among period, cost and quality

Institute of Scientific and Technical Information of China (English)

SHAN Ren-liang; CAI Wei-ling; WANG Yu-bao; LI Dong-gang; CHEN Xiang

2012-01-01

On the basis of the analysis on the disadvantages of the original goal-serting about rock drivage,this paper defined the "life cycle quality".With project management theory and the Cobb-Douglas finction,"quality-cost and quality-price curve model" and the "total cost-period prediction model" were built.Then the goal-setting method of the balance among quality,cost and period of rock drivage was constructed by finding "life cycle cost" through "life cycle quality" using "quality-cost andquality-price curve model" and ensuring period through "life cycle cost" using "total cost-period prediction model" (hereinafter referred to as the "three goals balance method")."Value contribution" which is the value of the contribution to a mine because of rock drivage,was found in the process of constructing the "quality-cost and quality-price curve model".An industrial test was done in coal mine A with the research results,staff footage efficiency improved by 24.24％,the period shortened by 14.3％,the "life cycle cost" dropped by 2.09％,the "life cycle quality price" improved by 3.29％,and value contribution increased by 25.3％.The result shows that the new goal method setting on the basis of coal mine profit maximization can ensure construction period.At the same time,it can realize cost and quality objectives and the optimization and balance of relationship among them; rewarding excavation teams by "value contribution" can combine organizational goal with personal goal,it significantly raise the employee's work efficiency.

Monetary Diet Cost, Diet Quality, and Parental Socioeconomic Status in Spanish Youth.

Directory of Open Access Journals (Sweden)

Helmut Schröder

Full Text Available Using a food-based analysis, healthy dietary patterns in adults are more expensive than less healthy ones; studies are needed in youth. Therefore, the objective of the present study was to determine relationships between monetary daily diet cost, diet quality, and parental socioeconomic status.Data were obtained from a representative national sample of 3534 children and young people in Spain, aged 2 to 24 years. Dietary assessment was performed with a 24-hour recall. Mediterranean diet adherence was measured by the KIDMED questionnaire. Average food cost was calculated from official Spanish government data. Monetary daily diet cost was expressed as euros per day (€/d and euros per day standardized to a 1000kcal diet (€/1000kcal/d.Mean monetary daily diet cost was 3.16±1.57€/d (1.56±0.72€/1000kcal/d. Socioeconomic status was positively associated with monetary daily diet cost and diet quality measured by the KIDMED index (€/d and €/1000kcal/d, p<0.019. High Mediterranean diet adherence (KIDMED score 8-12 was 0.71 €/d (0.28€/1000kcal/d more expensive than low compliance (KIDMED score 0-3. Analysis for nonlinear association between the KIDMED index and monetary daily diet cost per1000kcal showed no further cost increases beyond a KIDMED score of 8 (linear p<0.001; nonlinear p = 0.010.Higher monetary daily diet cost is associated with healthy eating in Spanish youth. Higher socioeconomic status is a determinant for higher monetary daily diet cost and quality.

Monetary Diet Cost, Diet Quality, and Parental Socioeconomic Status in Spanish Youth

Science.gov (United States)

Ribas-Barba, Lourdes; Pérez-Rodrigo, Carmen; Bawaked, Rowaedh Ahmed; Fíto, Montserrat; Serra-Majem, Lluis

2016-01-01

Background Using a food-based analysis, healthy dietary patterns in adults are more expensive than less healthy ones; studies are needed in youth. Therefore, the objective of the present study was to determine relationships between monetary daily diet cost, diet quality, and parental socioeconomic status. Design and Methods Data were obtained from a representative national sample of 3534 children and young people in Spain, aged 2 to 24 years. Dietary assessment was performed with a 24-hour recall. Mediterranean diet adherence was measured by the KIDMED questionnaire. Average food cost was calculated from official Spanish government data. Monetary daily diet cost was expressed as euros per day (€/d) and euros per day standardized to a 1000kcal diet (€/1000kcal/d). Results Mean monetary daily diet cost was 3.16±1.57€/d (1.56±0.72€/1000kcal/d). Socioeconomic status was positively associated with monetary daily diet cost and diet quality measured by the KIDMED index (€/d and €/1000kcal/d, pdiet adherence (KIDMED score 8–12) was 0.71 €/d (0.28€/1000kcal/d) more expensive than low compliance (KIDMED score 0–3). Analysis for nonlinear association between the KIDMED index and monetary daily diet cost per1000kcal showed no further cost increases beyond a KIDMED score of 8 (linear pdiet cost is associated with healthy eating in Spanish youth. Higher socioeconomic status is a determinant for higher monetary daily diet cost and quality. PMID:27622518

Integration of quality improvement and cost-efficiency through industrial improvement techniques

Directory of Open Access Journals (Sweden)

Vink JP

2016-06-01

Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer.

Science.gov (United States)

Leung, Henry W C; Chan, Agnes L F; Leung, Matthew S H; Lu, Chin-Li

2013-04-01

To systematically review and assess the quality of cost-effectiveness analyses (CEAs) of pharmaceutical therapies for metastatic colorectal cancer (mCRC). The MEDLINE, EMBASE, Cochrane, and EconLit databases were searched for the Medical Subject Headings or text key words quality-adjusted, QALY, life-year gained (LYG), and cost-effectiveness (January 1, 1999-December 31, 2009). Original CEAs of mCRC pharmacotherapy published in English were included. CEAs that measured health effects in units other than quality-adjusted life years or LYG and letters to the editor, case reports, posters, and editorials were excluded. Each article was independently assessed by 2 trained reviewers according to a quality checklist created by the Panel on Cost-Effectiveness in Health and Medicine. Twenty-four CEA studies pertaining to pharmaceutical therapies for mCRC were identified. All studies showed a wide variation in methodologic approaches, which resulted in a different range of incremental cost-effectiveness ratios reported for each regimen. We found common methodologic flaws in a significant number of CEA studies, including lack of clear description for critique of data quality; lack of method for adjusting costs for inflation and methods for obtaining expert judgment; no results of model validation; wide differences in the types of perspective, time horizon, study design, cost categories, and effect outcomes; and no quality assessment of data (cost and effectiveness) for the interventions evaluation. This study has shown a wide variation in the methodology and quality of cost-effectiveness analysis for mCRC. Improving quality and harmonization of CEA for cancer treatment is needed. Further study is suggested to assess the quality of CEA methodology outside the mCRC disease state.

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.

2014-06-16

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.; Hussain, Aftab M.; Rojas, Jhonathan Prieto; Hussain, Muhammad Mustafa

2014-01-01

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

Quality and the academic library reviewing, assessing and enhancing service provision

CERN Document Server

2016-01-01

Quality and the Academic Library: Reviewing, Assessing and Enhancing Service Provision provides an in-depth review and analysis of quality management and service quality in academic libraries. All aspects of quality are considered in the book, including quality assessment, quality review, and quality enhancement. An overview of quality management and service quality concepts, principles, and methods leads to a detailed consideration of how they have been applied in universities and their libraries. A case study approach is used with different perspectives provided from the different stakeholders involved in the quality processes. All contributors adopt a critical reflection approach, reflecting on the implications, impact, and significance of the activities undertaken and the conclusions that can be drawn for future developments. The book concludes with an overall reflection on quality management and service quality in academic libraries with a final analysis of priorities for the future.

Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD patients in China.

Directory of Open Access Journals (Sweden)

Yaming Zheng

Full Text Available Hand, foot and mouth disease (HFMD is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China.A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012-2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication, direct non-medical costs (transportation, nutrition, accommodation and nursery, and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS were used to calculate associated loss in quality adjusted life years (QALYs.The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215, $1072 (95%CI $999, $1144, $3051 (95%CI $2905, $3197 and $2819 (95%CI $2068, $3571 respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9, 6.9 (95%CI 6.4, 7.4 and 13.7 (95%CI 12.9, 14.5 per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss.HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.

Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD) patients in China.

Science.gov (United States)

Zheng, Yaming; Jit, Mark; Wu, Joseph T; Yang, Juan; Leung, Kathy; Liao, Qiaohong; Yu, Hongjie

2017-01-01

Hand, foot and mouth disease (HFMD) is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China. A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012-2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication), direct non-medical costs (transportation, nutrition, accommodation and nursery), and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate associated loss in quality adjusted life years (QALYs). The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072 (95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571) respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and 13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss. HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.

Methods Reduce Cost, Enhance Quality of Nanotubes

Science.gov (United States)

2009-01-01

For all the challenges posed by the microgravity conditions of space, weight is actually one of the more significant problems NASA faces in the development of the next generation of U.S. space vehicles. For the Agency s Constellation Program, engineers at NASA centers are designing and testing new vessels as safe, practical, and cost-effective means of space travel following the eventual retirement of the space shuttle. Program components like the Orion Crew Exploration Vehicle, intended to carry astronauts to the International Space Station and the Moon, must be designed to specific weight requirements to manage fuel consumption and match launch rocket capabilities; Orion s gross liftoff weight target is about 63,789 pounds. Future space vehicles will require even greater attention to lightweight construction to help conserve fuel for long-range missions to Mars and beyond. In order to reduce spacecraft weight without sacrificing structural integrity, NASA is pursuing the development of materials that promise to revolutionize not only spacecraft construction, but also a host of potential applications on Earth. Single-walled carbon nanotubes are one material of particular interest. These tubular, single-layer carbon molecules - 100,000 of them braided together would be no thicker than a human hair - display a range of remarkable characteristics. Possessing greater tensile strength than steel at a fraction of the weight, the nanotubes are efficient heat conductors with metallic or semiconductor electrical properties depending on their diameter and chirality (the pattern of each nanotube s hexagonal lattice structure). All of these properties make the nanotubes an appealing material for spacecraft construction, with the potential for nanotube composites to reduce spacecraft weight by 50 percent or more. The nanotubes may also feature in a number of other space exploration applications, including life support, energy storage, and sensor technologies. NASA s various

Cost studies of thermally enhanced in situ soil remediation technologies

International Nuclear Information System (INIS)

Bremser, J.; Booth, S.R.

1996-05-01

This report describes five thermally enhanced technologies that may be used to remediate contaminated soil and water resources. The standard methods of treating these contaminated areas are Soil Vapor Extraction (SVE), Excavate ampersand Treat (E ampersand T), and Pump ampersand Treat (P ampersand T). Depending on the conditions at a given site, one or more of these conventional alternatives may be employed; however, several new thermally enhanced technologies for soil decontamination are emerging. These technologies are still in demonstration programs which generally are showing great success at achieving the expected remediation results. The cost savings reported in this work assume that the technologies will ultimately perform as anticipated by their developers in a normal environmental restoration work environment. The five technologies analyzed in this report are Low Frequency Heating (LF or Ohmic, both 3 and 6 phase AC), Dynamic Underground Stripping (DUS), Radio Frequency Heating (RF), Radio Frequency Heating using Dipole Antennae (RFD), and Thermally Enhanced Vapor Extraction System (TEVES). In all of these technologies the introduction of heat to the formation raises vapor pressures accelerating contaminant evaporation rates and increases soil permeability raising diffusion rates of contaminants. The physical process enhancements resulting from temperature elevations permit a greater percentage of volatile organic compound (VOC) or semi- volatile organic compound (SVOC) contaminants to be driven out of the soils for treatment or capture in a much shorter time period. This report presents the results of cost-comparative studies between these new thermally enhanced technologies and the conventional technologies, as applied to five specific scenarios

The trade-off between hospital cost and quality of care. An exploratory empirical analysis.

Science.gov (United States)

Morey, R C; Fine, D J; Loree, S W; Retzlaff-Roberts, D L; Tsubakitani, S

1992-08-01

The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital.

Balancing compliance and cost when implementing a Quality Assurance program

International Nuclear Information System (INIS)

Pickering, S.Y.

1997-12-01

When implementing a Quality Assurance (QA) program, compliance and cost must be balanced. A QA program must be developed that hits the mark in terms of adequate control and documentation, but does not unnecessarily expand resources. As the Waste Isolation Pilot Plant (WIPP) has moved towards certification, Sandia National Laboratories has learned much about balancing compliance and costs. Some of these lessons are summarized here

Low-Cost Air Quality Monitoring Tools: From Research to Practice (A Workshop Summary

Directory of Open Access Journals (Sweden)

Andrea L. Clements

2017-10-01

Full Text Available In May 2017, a two-day workshop was held in Los Angeles (California, U.S.A. to gather practitioners who work with low-cost sensors used to make air quality measurements. The community of practice included individuals from academia, industry, non-profit groups, community-based organizations, and regulatory agencies. The group gathered to share knowledge developed from a variety of pilot projects in hopes of advancing the collective knowledge about how best to use low-cost air quality sensors. Panel discussion topics included: (1 best practices for deployment and calibration of low-cost sensor systems, (2 data standardization efforts and database design, (3 advances in sensor calibration, data management, and data analysis and visualization, and (4 lessons learned from research/community partnerships to encourage purposeful use of sensors and create change/action. Panel discussions summarized knowledge advances and project successes while also highlighting the questions, unresolved issues, and technological limitations that still remain within the low-cost air quality sensor arena.

An improved set of standards for finding cost for cost-effectiveness analysis.

Science.gov (United States)

Barnett, Paul G

2009-07-01

Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.

Community Partnership to Address Snack Quality and Cost in Afterschool Programs

Science.gov (United States)

Tilley, Falon; Turner-McGrievy, Gabrielle; Weaver, Robert Glenn; Jones, Sonya

2014-01-01

Background Policies call on afterschool programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community-partnership between ASPs and local grocery stores. Methods Four large-scale ASPs (serving ∼500 children aged 6-12 years each day) and a single local grocery store chain participated in the study. The nutritional quality of snacks served was recorded pre-intervention (18 weeks spring/fall 2011) and post-intervention (7 weeks spring 2012) via direct observation, along with cost/child/snack/day. Results Pre-intervention snacks were low-nutrient-density salty snacks (eg, chips, 3.0 servings/week), sugar-sweetened beverages (eg, powdered-lemonade, 1.9 servings/week), and desserts (eg, cookies, 2.1servings/week), with only 0.4 servings/week of fruits and no vegetables. By post-intervention, fruits (3.5 servings/week) and vegetables (1.2 servings/week) increased, while sugar-sweetened beverages and desserts were eliminated. Snack expenditures were $0.26 versus $0.24 from pre-intervention to post-intervention. Partnership savings versus purchasing snacks at full retail cost was 24.5% or $0.25/serving versus $0.34/serving. Conclusions This innovative partnership can serve as a model in communities where ASPs seek to identify low-cost alternatives to providing nutritious snacks. PMID:25040123

Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes.

NARCIS (Netherlands)

Schouten, L.M.T.; Niessen, L.W.; Pas, J.W. van der; Grol, R.P.T.M.; Hulscher, M.E.J.L.

2010-01-01

OBJECTIVE: To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting. STUDY DESIGN AND METHODS: Economic evaluation from a healthcare perspective with lifetime horizon

Investigating the Effects of Consumer Innovativeness, Service Quality and Service Switching Costs on Service Loyalty in the Mobile Phone Service Context

Directory of Open Access Journals (Sweden)

Farzana Quoquab

2016-02-01

Full Text Available The objective of this study is to examine the effects of consumer innovativeness, service quality, service switching costs and service satisfaction on service loyalty among mobile phone service users. A cross sectional survey was employed which yielded 535 responses. Structural equation modelling using the AMOS version 2.0 was utilized to test study the hypotheses. Test results reveal that service satisfaction, service switching costs and service quality are the three antecedents that directly influence service loyalty. However, consumer innovativeness does not have any direct effect on service loyalty. Moreover, service satisfaction is found to be a partial mediator between ‘service quality’ and ‘service loyalty’. Findings from this study will develop insights to enable policy-makers, managers and marketers to better strategize and effectively implement loyalty programs and prevent their customers from switching. This will enhance value creation for both their users and for the industry.

A Framework for Better Understanding and Enhancing Direct Contact Membrane Distillation (DCMD) in Terms of Module Design, Cost Analysis and Energy Required

KAUST Repository

AbuHannoud, Ali

2011-07-01

Water is becoming scarcer and several authors have highlighted the upcoming problem of higher water salinity and the difficulty of treating and discharging water. Moreover, current discoveries of problems with chemicals that have been used for pretreating or post-treating water alerted scientists to research better solutions to treat water. Membrane distillation (MD) is a promising technology that might replace current processes as it has lower pretreatment requirements combined with a tremendous ability to treat a wide range of feed sources while producing very high product quality. If it enters the market, it will have a big influence on all products, from food industry to spaceflight. However, there are several problems which make MD a hot topic for research. One of them is the question about the real cost of MD in terms of heating feed and cooling distillate over time with respect to product quantity and quality. In this work, extensive heating and cooling analyses are covered to answer this question in order to enhance the MD process. Results show energy cost to produce water and the main source of energy loss for direct contact membrane distillation (DCMD), and several suggestions are made in order to better understand and hence enhance the process.

Quality and cost evaluation of bread produced from blends of wheat ...

African Journals Online (AJOL)

Background: This study was necessitated by the need to improve the nutritional quality of baked products, ensure their acceptability and the baker's profitability. Objective: The aim of the study therefore was to evaluate the quality and cost of bread produced from composite flours of wheat and partially defatted soy. Materials ...

Enhancing the quality and credibility of qualitative analysis.

OpenAIRE

Patton, M Q

1999-01-01

Varying philosophical and theoretical orientations to qualitative inquiry remind us that issues of quality and credibility intersect with audience and intended research purposes. This overview examines ways of enhancing the quality and credibility of qualitative analysis by dealing with three distinct but related inquiry concerns: rigorous techniques and methods for gathering and analyzing qualitative data, including attention to validity, reliability, and triangulation; the credibility, comp...

Cost to primary care practices of responding to payer requests for quality and performance data.

Science.gov (United States)

Halladay, Jacqueline R; Stearns, Sally C; Wroth, Thomas; Spragens, Lynn; Hofstetter, Sara; Zimmerman, Sheryl; Sloane, Philip D

2009-01-01

We wanted to determine how much it costs primary care practices to participate in programs that require them to gather and report data on care quality indicators. Using mixed quantitative-qualitative methods, we gathered data from 8 practices in North Carolina that were selected purposively to be diverse by size, ownership, type, location, and medical records. Formal practice visits occurred between January 2008 and May 2008. Four quality-reporting programs were studied: Medicare's Physician Quality Reporting Initiative (PQRI), Community Care of North Carolina (CCNC), Bridges to Excellence (BTE), and Improving Performance in Practice (IPIP). We estimated direct costs to the practice and on-site costs to the quality organization for implementation and maintenance phases of program participation. Major expenses included personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. Costs per full-time equivalent clinician ranged from less than $1,000 to $11,100 during program implementation phases and ranged from less than $100 to $4,300 annually during maintenance phases. Main sources of variation included program characteristics, amount of on-site assistance provided, experience and expertise of practice personnel, and the extent of data system problems encountered. The costs of a quality-reporting program vary greatly by program and are important to anticipate and understand when undertaking quality improvement work. Incentives that would likely improve practice participation include financial payment, quality improvement skills training, and technical assistance with electronic system troubleshooting.

Cost per QALY (quality-adjusted life year and lifetime cost of prolonged mechanical ventilation in Taiwan.

Directory of Open Access Journals (Sweden)

Mei-Chuan Hung

Full Text Available INTRODUCTION: Patients who require prolonged mechanical ventilation (PMV are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-adjusted life year, out-of-pocket expenses, and lifetime costs for PMV patients stratified by underlying diseases and cognition levels. METHODS: A nationwide sample of 50,481 patients with continual mechanical ventilation for more than 21 days was collected during 1997-2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA was performed to categorise PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted using an EQ-5D utility value derived from a convenience sample of 142 PMV patients to estimate quality-adjusted life expectancies (QALE. Another convenience sample of 165 patients was used to estimate the out-of-pocket expenses. The lifetime expenditures paid by the single-payer National Health Insurance (NHI system and patients' families were estimated by multiplying average monthly expenditures by the survival probabilities and summing the values over lifetime. RESULTS: PMV therapy costs more than 100,000 U.S. dollars (USD per QALY for all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 56,000 USD per QALY for those with liver cirrhosis, intracranial or spinal cord injuries, and 57,000-69,000 USD for patients with multiple co-morbidities under age of 65. The average lifetime cost of PMV was usually below 56,000 USD. The out-of-pocket expenses were often more than one-third of the total cost of treatment. CONCLUSIONS: PMV treatment for patients with poor cognition would cost more than 5 times Taiwan's GDP (gross domestic products, or less cost-effective. The out

Summary of strategies for planning Productivity Improvement and Quality Enhancement (PIQE)

Science.gov (United States)

1986-01-01

The Summary of NASA Strategies for Productivity Improvement and Quality Enhancement respond to NASA's eighth top goal: Establish NASA as a leader in the development and application of advanced technology and management practices which contribute to significant increases in both Agency and national productivity. The Strategies provide the framework for development of the agency-wide Productivity Improvement and Quality Enhancement (PIQE) Plans.

The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

Directory of Open Access Journals (Sweden)

Ali KURT

2016-03-01

Full Text Available Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between cost leadership strategy, total quality management applications and firms’ financial performance has been gathered. In addition, the relationship between TQM applications and financial performance has also been gathered.

Offset Printing Plate Quality Sensor on a Low-Cost Processor

Directory of Open Access Journals (Sweden)

Francisco Tirado

2013-10-01

Full Text Available The aim of this work is to develop a microprocessor-based sensor that measures the quality of the offset printing plate through the introduction of different image analysis applications. The main features of the presented system are the low cost, the low amount of power consumption, its modularity and easy integration with other industrial modules for printing plates, and its robustness against noise environments. For the sake of clarity, a viability analysis of previous software is presented through different strategies, based on dynamic histogram and Hough transform. This paper provides performance and scalability data compared with existing costly commercial devices. Furthermore, a general overview of quality control possibilities for printing plates is presented and could be useful to a system where such controls are regularly conducted.

A Rotational Blended Learning Model: Enhancement and Quality Assurance

Science.gov (United States)

Ghoul, Said

2013-01-01

Research on blended learning theory and practice is growing nowadays with a focus on the development, evaluation, and quality assurance of case studies. However, the enhancement of blended learning existing models, the specification of their online parts, and the quality assurance related specifically to them have not received enough attention.…

Builders' Perceptions of Lowest Cost Procurement and Its Impact on Quality

Directory of Open Access Journals (Sweden)

Mary Hardie

2012-11-01

Full Text Available to the degree to which it meets the customer’s needs andexpectations. Dissatisfaction with the quality of building projectshas been widely reported in recent times. There are indicationsthat there may be some relationship between the procurementmethod used and customer satisfaction with the delivered product.In particular, traditional competitive bid contracting may havean adverse impact on quality in some circumstances. To shedsome light on reported industry attitudes, a survey of constructionprofessionals in the Sydney metropolitan area was undertaken.The respondents demonstrate mixed views on the effectivenessof the competitive tender system on quality project outcomes. Tosome extent contractors’ attitudes may be determined by theirpreferred current mode of operation. However, some supportis expressed for the contention that quality of outcome can bereduced by an overly cost driven contractor selection process. Inparticular, when economic pressures cause bidders to reduce thetime allocated for the tender process, an inaccurate and unreliablebid may win. This makes it very diffi cult for the reliable contractorto remain profi table. A move to value-based rather than cost-basedprocurement may assist industry performance and customersatisfaction.

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

Science.gov (United States)

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The

Creating patient value in glaucoma care : applying quality costing and care delivery value chain approaches

NARCIS (Netherlands)

D.F. de Korne (Dirk); J.C.A. Sol (Kees); T. Custers (Thomas); E. van Sprundel (Esther); B.M. van Ineveld (Martin); H.G. Lemij (Hans); N.S. Klazinga (Niek)

2009-01-01

textabstractPurpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost model

Understanding coal quality and its relationship to power plant performance and costs

Energy Technology Data Exchange (ETDEWEB)

Jennison, K.D.; Stallard, G.S. [Black & Veatch International, Overland Park, KS (United States)

1995-12-01

The availability of reliable, reasonably priced energy is a necessary cornerstone for established and emerging economies. In addition to addressing coal quality issues strictly at a plant level, it is now prudent to consider long-term performance and economics of particular fuel sources to be selected in the light of system economics and reliability. In order to evaluate coal quality issues in a more comprehensive manner, it is important to develop both an approach and a set of tools which can support the various phases of the planning/analysis processes. The processes must consider the following: (1) Cost/availability of other potential coal supplies, including {open_quotes}raw{close_quotes} domestic sources, {open_quotes}cleaned {close_quotes} domestic sources, and other internationally marketed coals. (2) Power plant performance issues as function of plant design and fuel properties. (3) System expansion plans, candidate technologies, and associated capital and operating costs. (4) Projected load demand, for system and for individual units within the system. (5) Legislative issues such as environmental pressures, power purchase agreements, etc. which could alter the solution. (6) Economics of potential plans/strategies based on overall cost-effectiveness of the utility system, not just individual units. (7) Anticipated unit configuration, including addition of environmental control equipment or other repowering options. The Coal Quality Impact Model (CQIM{trademark}) is a PC-based computer program capable of predicting coal-related cost and performance impacts at electric power generating sites. The CQIM was developed for EPRI by Black & Veatch and represents over a decade of effort geared toward developing an extensible state-of-the-art coal quality assessment tool. This paper will introduce CQIM, its capabilities, and its application to Eastern European coal quality assessment needs.

Cost and quality implications of discrepancies between admitting and discharge diagnoses.

Science.gov (United States)

McNutt, Robert; Johnson, Tricia; Kane, Jason; Ackerman, Mariel; Odwazny, Richard; Bardhan, Jaydeep

2012-01-01

Presenting and discharge diagnoses of hospitalized patients may differ as a result of patient complexity, diagnostic dilemmas, or errors in clinical judgment at the time of primary assessment. When diagnoses at admission and discharge are not in agreement, this discrepancy may indicate more complex processes of care and resultant costs. It is unclear whether surrogate measures reflecting quality of care are impacted by discrepant diagnoses. To assess whether an association exists between admitting and discharge International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes and other quality markers including hospital length of stay, total cost of care, and 30-day readmission rate. This was a retrospective, cross-sectional analysis of general internal medicine patients aged 18 years and older. Diagnosis discrepancy was defined as a difference between the 3-digit ICD-9 diagnosis code at admission and the principal 3-digit ICD-9 diagnosis code at discharge. Sixty-eight percent of patients had a diagnosis discrepancy. Diagnosis discrepancy was associated with a 0.41-day increase in length of stay (P < .001), $663 increase in direct costs (P < .001), and a 1.55 times greater odds of readmission within 30 days (P < .001). Diagnosis discrepancy was associated with hospital quality outcome measures. This finding likely reflects variations in patients' diagnostic complexity.

Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

Science.gov (United States)

Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E

2017-10-24

Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced

Modelling the Cost and Quality of Preservation Imaging and Archiving

DEFF Research Database (Denmark)

Kejser, Ulla Bøgvad

2009-01-01

, fire and other risks. In this PhD thesis it is examined how one may evaluate the long‐term costs and benefits to cultural heritage institutions of different preservation strategies for digital copies. The investigated alternatives are preserving the copies in a digital repository, and printing...... the files out on microfilm and preserving them in a non‐digital repository. In order to obtain empirical data and to understand the decisive cost factors in preservation copying, a case study was set up in which degrading sheet‐film negatives were digitised. Requirements for image quality and metadata were...... systematic evaluation of the quality of repositories and the perceived benefits that different preservation strategies may bring. This also relates to a conducted investigation of preservation requirements for a shared bit preservation system, which describes how institutions with OAIS compliant repositories...

[Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy].

Science.gov (United States)

Machado, Flávia Mori Sarti; Simões, Arlete Naresse

2008-02-01

To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

Enhancement of quality in chemical inquiry by pre-university students.

NARCIS (Netherlands)

van Rens, L.; Pilot, A.; van Dijk, H.

2005-01-01

Our pre-university chemistry students face problems achieving sufficient quality in chemical inquiry. To try to enhance the quality of student performance in chemical inquiry, Dutch pre-university chemistry students (age 17) carried out an authentic research project on 'Diffusion of ions in

Enhancement of quality in chemical inquiry by pre-university students

NARCIS (Netherlands)

van Rens, L.; Pilot, A.; van Dijk, H.

2004-01-01

Our pre-university chemistry students face problems achieving sufficient quality in chemical inquiry. To try to enhance the quality of student performance in chemical inquiry, Dutch pre-university chemistry students (age 17) carried out an authentic research project on 'Diffusion of ions in

Reducing the length of postnatal hospital stay: implications for cost and quality of care.

Science.gov (United States)

Bowers, John; Cheyne, Helen

2016-01-15

UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care. We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women's experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care. Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality

Customer Focused Product Design Using Integrated Model of Target Costing, Quality Function Deployment and Value Engineering

Directory of Open Access Journals (Sweden)

Hossein Rezaei Dolatabadi

2013-01-01

Full Text Available Target costing by integrating customer requirements, technical attributes and cost information into the product design phase and eliminating the non-value added functions, plays a vital role in different phases of the product life cycle. Quality Function Deployment (QFD and Value Engineering (VE are two techniques which can be used for applying target costing, successfully. The purpose of this paper is to propose an integrated model of target costing, QFD and VE to explore the role of target costing in managing product costs while promoting quality specifications meeting customers’ needs. F indings indicate that the integration of target costing, QFD and VE is an essential technique in managing the costs of production process. Findings also imply that integration of the three techniques provides a competitive cost advantage to companies.

Power quality enhancement of renewable energy source power network using SMES system

International Nuclear Information System (INIS)

Seo, H.R.; Kim, A.R.; Park, M.; Yu, I.K.

2011-01-01

Power quality enhancement of a renewable energy source power network is performed by a real-toroidal-type SMES coil. SMES unit charges and discharges the HTS coil to mitigate the fluctuation of PV system output power. The grid connected PV and SMES system has been modeled and simulated using power-hard-in-the-loop simulation. The PHILS results demonstrated the effectiveness of the SMES system for enhancing power quality. This paper deals with power quality enhancement of renewable energy source power network using SMES system and describes the operation characteristics of HTS SMES system using real-toroidal-type SMES coil for smoothening the fluctuation of large-scale renewable energy source such as photovoltaic (PV) power generation system. It generates maximum power of PV array under various weather conditions. SMES unit charges and discharges the HTS coil to mitigate the fluctuation of PV system output power. The SMES unit is controlled according to the PV array output and the utility power quality conditions. The grid connected PV and SMES system has been modeled and simulated using power-hard-in-the-loop simulation (PHILS). The PHILS results demonstrated the effectiveness of the SMES system for enhancing power quality in power network including large-scale renewable energy source, especially PV power generation system.

Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial.

Science.gov (United States)

Murphy, J; Gray, A; Cooper, C; Cooper, D; Ramsay, C; Carr, A

2016-12-01

A trial-based comparison of the use of resources, costs and quality of life outcomes of arthroscopic and open surgical management for rotator cuff tears in the United Kingdom NHS was performed using data from the United Kingdom Rotator Cuff Study (UKUFF) randomised controlled trial. Using data from 273 patients, healthcare-related use of resources, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. There were no significant differences between the arthroscopic and open groups in terms of total mean use and cost of resources or QALYs at any time post-operatively. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared with open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%. There was no significant overall difference in the use or cost of resources or quality of life between arthroscopic and open management in the trial. There was uncertainty about which strategy was most cost-effective. Cite this article: Bone Joint J 2016;98-B:1648-55. ©2016 Gray et al.

Dynamics of Anthropomorphic Painting Robot: Quality Analysis and Cost Reduction

NARCIS (Netherlands)

Potkonjak, V.; Djordjevic, G.; Kostic, D.; Rasic, M.

2000-01-01

Application of robots in spray-painting tasks results in low-cost production, persistent quality and protects humans from a hostile working environment. Automated planning of applicator’s trajectory requires a model of paint deposition onto the treated surface and formulation of an appropriate

Oriented diffusion filtering for enhancing low-quality fingerprint images

KAUST Repository

Gottschlich, C.; Schönlieb, C.-B.

2012-01-01

To enhance low-quality fingerprint images, we present a novel method that first estimates the local orientation of the fingerprint ridge and valley flow and next performs oriented diffusion filtering, followed by a locally adaptive contrast enhancement step. By applying the authors' new approach to low-quality images of the FVC2004 fingerprint databases, the authors are able to show its competitiveness with other state-of-the-art enhancement methods for fingerprints like curved Gabor filtering. A major advantage of oriented diffusion filtering over those is its computational efficiency. Combining oriented diffusion filtering with curved Gabor filters led to additional improvements and, to the best of the authors' knowledge, the lowest equal error rates achieved so far using MINDTCT and BOZORTH3 on the FVC2004 databases. The recognition performance and the computational efficiency of the method suggest to include oriented diffusion filtering as a standard image enhancement add-on module for real-time fingerprint recognition systems. In order to facilitate the reproduction of these results, an implementation of the oriented diffusion filtering for Matlab and GNU Octave is made available for download. © 2012 The Institution of Engineering and Technology.

Oriented diffusion filtering for enhancing low-quality fingerprint images

KAUST Repository

Gottschlich, C.

2012-01-01

To enhance low-quality fingerprint images, we present a novel method that first estimates the local orientation of the fingerprint ridge and valley flow and next performs oriented diffusion filtering, followed by a locally adaptive contrast enhancement step. By applying the authors\\' new approach to low-quality images of the FVC2004 fingerprint databases, the authors are able to show its competitiveness with other state-of-the-art enhancement methods for fingerprints like curved Gabor filtering. A major advantage of oriented diffusion filtering over those is its computational efficiency. Combining oriented diffusion filtering with curved Gabor filters led to additional improvements and, to the best of the authors\\' knowledge, the lowest equal error rates achieved so far using MINDTCT and BOZORTH3 on the FVC2004 databases. The recognition performance and the computational efficiency of the method suggest to include oriented diffusion filtering as a standard image enhancement add-on module for real-time fingerprint recognition systems. In order to facilitate the reproduction of these results, an implementation of the oriented diffusion filtering for Matlab and GNU Octave is made available for download. © 2012 The Institution of Engineering and Technology.

Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas : Costs, local control, survival, quality of life, and voice quality

NARCIS (Netherlands)

Goor, Kim M.; Peeters, A. Jeanne G. E.; Mahieu, Hans F.; Langendijk, Johannes A.; Leemans, C. Rene; Verdonck-de Leeuw, Irma M.; van Agthoven, Michel

Background, The clinical results of radiotherapy and endoscopic cordectomy for T1a glottic carcinoma are reported to be similar, but costs of both treatments may differ. Therefore, we retrospectively evaluated the costs, voice quality, quality of life, and clinical results of both treatments.

The implementation of the Quality Costs Methodology in the Public Transport Enterprise in Macedonia

Directory of Open Access Journals (Sweden)

Elizabeta Mitreva

2017-02-01

Full Text Available The implementation of TQM (Total Quality Management strategy in the public transport enterprises in Macedonia means improving the quality of services through examination of business processes not just in terms of defining, improvement and design of the process, but also improvement of productivity and optimization of the costs of quality. The purpose of this study is to point out the importance of determining the quality of the transport services, its methods, and techniques for measurement of the optimization of business processes in particular. The analysis of the quality costs when providing transport services can help managers to understand the impact of poor quality on the financial results and the bad image it gives to the enterprise. In this study, we proposed and applied the model for better performance and higher efficiency of the transport enterprise, through the optimization of business processes, change in the corporate culture and use of the complete business potentials. The need for this methodology was imposed as a result of the analysis made in the company in terms of whether is it doing an analysis on the costs of quality or not. The benefits from the utilization of this model will not only lead to increasing the business performance of the transport enterprise, but this model will also serve as a driving force for continuous improvements to the satisfaction of all stakeholders.

The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres.

Science.gov (United States)

Simoens, Steven; Dunselman, Gerard; Dirksen, Carmen; Hummelshoj, Lone; Bokor, Attila; Brandes, Iris; Brodszky, Valentin; Canis, Michel; Colombo, Giorgio Lorenzo; DeLeire, Thomas; Falcone, Tommaso; Graham, Barbara; Halis, Gülden; Horne, Andrew; Kanj, Omar; Kjer, Jens Jørgen; Kristensen, Jens; Lebovic, Dan; Mueller, Michael; Vigano, Paola; Wullschleger, Marcel; D'Hooghe, Thomas

2012-05-01

This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.

Directing a Quality Enhancement Plan

Directory of Open Access Journals (Sweden)

Ronald A. Styron, Jr.

2015-08-01

Full Text Available This paper is drawn from a project aimed at enhancing the quality of instructional practice and improving studentlearning outcomes in classes across an urban university located in the southern region of the United States. The strategies, employed by the project leader, are discussed in detail as framed by a new problem-solving leadership design called the Alloy Improvement Model (AIM. Data collected at the end of the second full year and reported in this paper indicated all project goals were met and that the utilization of the AIM was central to project success.

Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

Science.gov (United States)

Bachman, Daniel; Nyland, John; Krupp, Ryan

2016-02-18

To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

Adoption of On-farm and Post-harvest Rice Quality Enhancing Technologies in Nigeria

Directory of Open Access Journals (Sweden)

Tiamiyu, SA.

2014-01-01

Full Text Available This paper examines the rate and determinants of adoption of improved rice quality enhancing technologies among a randomly selected sample of 150 farmers and 18 rice processors from six rice producing areas of Niger State. Data were collected through interview schedule using questionnaires. Descriptive statistics and regression model were adopted to analyze data. Results show that adoption of quality enhancing technologies was low among the selected sample of these rice value chain actors. The adoption indices of on-farm and post-harvest quality enhancing practices were 0.46 and 0.37 respectively. Some socioeconomic attributes including: Age, level of education, contact with extension, access to credit and level of commercialization were statistically significant determining factors (P≤0.05 influencing adoption at farm level, while post-harvest technology adoption was determined by level of education, access to credit and membership of cooperatives. Promotion of quality enhanced technologies among these actors in the rice value chain is recommended.

Supplier’s Joint Investments in Cost Reduction and Quality Improvement in a Decentralized Supply Chain

Directory of Open Access Journals (Sweden)

Hengyun Zhang

2017-01-01

Full Text Available We consider a decentralized supply chain with a downstream manufacturer and an upstream supplier. The upstream supplier sells a product to the manufacturer, who faces a quality and price sensitive demand. The supplier has a chance to invest in both cost reduction and quality improvement of its product. We derive the optimal investment and pricing decisions for the supply chain members. We do so in both the centralized and the decentralized supply chains. We show that the optimal investment and pricing decisions in the decentralized supply chain may deviate from that in the centralized supply chain. We develop a mechanism to coordinate the decentralized supply chain. The developed mechanism contains four policies: wholesale price, sharing of revenue, sharing of cost reduction investment cost, and sharing of quality improvement investment cost. We also show that the developed coordination mechanism can lead to Pareto improvement.

Quality in drilling operations

Energy Technology Data Exchange (ETDEWEB)

Duncan, E; Gervais, I [Sedco Forex Jacintoport Facility, Channelview, TX (United States); Le Moign, Y; Pangarkar, S; Stibbs, B [Sedco Forex, Montrouge (France); McMorran, P [Sedco Forex, Pau (France); Nordquist, E [Dubai Petroleum Company, Dubai (United Arab Emirates); Pittman, T [Sedco Forex, Perth (Australia); Schindler, H [Sedco Forex, Dubai (United Arab Emirates); Scott, P [Woodside Offshore Petroleum Pty. Ltd., Perth (Australia)

1997-12-31

Driven by cost and profitability pressures, quality has taken on new meaning and importance in the oil field during the past decade. In drilling operations, new initiatives have led to cooperative team efforts between operators and drilling contractors to enhance quality. In this article examples are given of how one drilling contractor, by adopting a quality culture, is reaping major benefits for its clients as well as its employees. 22 figs., 19 refs.

Quality in drilling operations

Energy Technology Data Exchange (ETDEWEB)

Duncan, E.; Gervais, I. [Sedco Forex Jacintoport Facility, Channelview, TX (United States); Le Moign, Y.; Pangarkar, S.; Stibbs, B. [Sedco Forex, Montrouge (France); McMorran, P. [Sedco Forex, Pau (France); Nordquist, E. [Dubai Petroleum Company, Dubai (United Arab Emirates); Pittman, T. [Sedco Forex, Perth (Australia); Schindler, H. [Sedco Forex, Dubai (United Arab Emirates); Scott, P. [Woodside Offshore Petroleum Pty. Ltd., Perth (Australia)

1996-12-31

Driven by cost and profitability pressures, quality has taken on new meaning and importance in the oil field during the past decade. In drilling operations, new initiatives have led to cooperative team efforts between operators and drilling contractors to enhance quality. In this article examples are given of how one drilling contractor, by adopting a quality culture, is reaping major benefits for its clients as well as its employees. 22 figs., 19 refs.

The Relationship between Costs and Quality in Veterans Health Administration Community Living Centers: An Analysis Using Longitudinal Data.

Science.gov (United States)

Burgess, James F; Shwartz, Michael; Stolzmann, Kelly; Sullivan, Jennifer L

2018-05-18

To examine the relationship between cost and quality in Veterans Health Administration (VA) nursing homes (called Community Living Centers, CLCs) using longitudinal data. One hundred and thirty CLCs over 13 quarters (from FY2009 to FY2012) were studied. Costs, resident days, and resident severity (RUGs score) were obtained from the VA Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident-centered care (RCC) was measured using the Artifacts of Culture Change Tool. We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days. With the exception of RCC, all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs. The relationship between cost and quality depends on facility size and current level of performance. © Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Contractor Selection for Enhancing the Quality of University ...

African Journals Online (AJOL)

Contractor Selection for Enhancing the Quality of University Education in Nigeria using the Hamming Distance. DEA Omorogbe, SO Aibieyi. Abstract. The need for contractor selection in our university education system cannot be over emphasized. And applying scientific techniques for appropriateness and accuracy in the ...

Quality, energy requirement and costs of drying tarragon (Artemisia dracunculus L.)

Energy Technology Data Exchange (ETDEWEB)

Hosseini, A.A.A.

2005-11-07

Tarragon (Artemisia dracunculus L.) is a favorite herbal and medicinal plant. Drying is necessary to achieve longer shelf life with high quality, preserving the original flavor. Essential oil content and color are the most important parameters that define the quality of herbal and medicinal plants. Hot air batch drying is the most common drying method for these plants but affects the essential oil content and color. The drying conditions affect essential oil content and color as well as the energy consumption and costs. Process engineers and farmers need to know how they have to dry to obtain the best quality. The objective of this work is to investigate the conditions for optimal drying in terms of quality, energy consumption and costs. Adsorption and desorption experiments were done to find the equilibrium moisture content and water exchange between the material and surrounding air during drying and storage at temperatures of 25C to 70C and relative humidities of 5% to 90%. Drying of tarragon leaves and chopped plants was investigated separately and the best model was selected from the drying equations in literature. The effect of drying temperature and relative humidity on the essential oil content and color change was studied. Experiments were done at temperatures of 40C to 90C and the optimal conditions were. Long-term effects of the drying conditions were also investigated during the storage time. Material dried at 45, 60 and 90C was stored and the essential oil content and color of the material was measured after 15, 30, 60 and 120 days of storage. Drying at 45C was found as the best condition based on the changes of essential oil and color during drying and storage. Optimization of drying of tarragon was studied based on the results of the sorption isotherms, drying equations and the changes of essential oil content and color during drying and storage. Models were made for the drying process, energy consumption and cost calculation. The current conditions

Between Cost Cheap Prices And Increasing High Quality Educational University In Pekanbaru City

Directory of Open Access Journals (Sweden)

Prama Widayat

2018-02-01

Full Text Available The need of higher education in the community has become the main thing for the future, not all can study at State Universities (PTN but some must enter in Private Universities (PTS. But the problem that arises is the problem of tuition fees in the PTS course higher than the state university, the tendency of prospective students in choosing Higher Education (PT based on cost and quality. While the problems from the PT side lies in the budget constraints in improving quality because of talk about the quality of course comprehensive from the means of lectures to the specialization of universities. Limitations of costs can at least be overcome by the synergy of universities, private companies and governments so it is not always student.

Community Partnership to Address Snack Quality and Cost in After-School Programs

Science.gov (United States)

Beets, Michael W.; Tilley, Falon; Turner-McGrievy, Gabrielle; Weaver, Robert G.; Jones, Sonya

2014-01-01

Background: Policies call on after-school programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community partnership between ASPs and local grocery stores. Methods: Four large-scale ASPs (serving ~500 children, aged 6-12?years,…

Value management: optimizing quality, service, and cost.

Science.gov (United States)

Makadon, Harvey J; Bharucha, Farzan; Gavin, Michael; Oliveira, Jason; Wietecha, Mark

2010-01-01

Hospitals have wrestled with balancing quality, service, and cost for years--and the visibility and urgency around measuring and communicating real metrics has grown exponentially in the last decade. However, even today, most hospital leaders cannot articulate or demonstrate the "value" they provide to patients and payers. Instead of developing a strategic direction that is based around a core value proposition, they focus their strategic efforts on tactical decisions like physician recruitment, facility expansion, and physician alignment. In the healthcare paradigm of the next decade, alignment of various tactical initiatives will require a more coherent understanding of the hospital's core value positioning. The authors draw on their experience in a variety of healthcare settings to suggest that for most hospitals, quality (i.e., clinical outcomes and patient safety) will become the most visible indicator of value, and introduce a framework to help healthcare providers influence their value positioning based on this variable.

Power quality enhancement at distribution level utilizing the unified power quality conditioner (UPQC)

Science.gov (United States)

Khadkikar, Vinod

The present doctoral work is based on the philosophy of optimal utilization of the available resources in a most effective and efficient way to improve the product efficiency and to reduce the overall cost. This work proposes a novel control philosophy termed as power angle control (PAC), in which both the series and shunt inverters share the load reactive power in co-ordination with each other without affecting the basic UPQC compensation capabilities. This eventually results in a better utilization of the series inverter, reduction in the shunt inverter rating to some extent and ultimately in the reduction of the overall cost of UPQC. Moreover, in this thesis work several other control approaches are also proposed, such as, unit vector template generation, quadrature voltage injection, generalized single-phase p-q theory and novel current unbalance compensation approach. All the developed concepts are successfully validated through digital simulation as well as extensive experimental investigations. Keywords. power quality, active power filter, unified power quality conditioner, reactive power compensation, harmonics compensation.

Enhancing quality using ISO 9001:2008 as a vehicle

International Nuclear Information System (INIS)

Hemantha Rao, G.V.S.; Rama Rao, B.S.

2009-01-01

Effectiveness of any function rests on three engines - technology, systems and people. Characterization and Quality Control of nuclear fuel is no an exception. Systems integrate people and technology. Technology without systems is creative chaos while systems without technology is mindless bureaucracy. People who man should bridge and blend these two proportionately. Systems provide both means and platform for continual improvement of quality. ISO 9001:2008, international standard for Quality Management System based on the eight principles of total quality management has been used as a driver for building and enhancing the quality of fuel fabricated at NFC. This paper brings out how this international standard has been used as a platform to continually upgrade the quality of fuel manufactured at NFC and its performance. Results thus far obtained are also discussed

Improving iris recognition performance using segmentation, quality enhancement, match score fusion, and indexing.

Science.gov (United States)

Vatsa, Mayank; Singh, Richa; Noore, Afzel

2008-08-01

This paper proposes algorithms for iris segmentation, quality enhancement, match score fusion, and indexing to improve both the accuracy and the speed of iris recognition. A curve evolution approach is proposed to effectively segment a nonideal iris image using the modified Mumford-Shah functional. Different enhancement algorithms are concurrently applied on the segmented iris image to produce multiple enhanced versions of the iris image. A support-vector-machine-based learning algorithm selects locally enhanced regions from each globally enhanced image and combines these good-quality regions to create a single high-quality iris image. Two distinct features are extracted from the high-quality iris image. The global textural feature is extracted using the 1-D log polar Gabor transform, and the local topological feature is extracted using Euler numbers. An intelligent fusion algorithm combines the textural and topological matching scores to further improve the iris recognition performance and reduce the false rejection rate, whereas an indexing algorithm enables fast and accurate iris identification. The verification and identification performance of the proposed algorithms is validated and compared with other algorithms using the CASIA Version 3, ICE 2005, and UBIRIS iris databases.

The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

DEFF Research Database (Denmark)

Meacock, R.; Kristensen, Søren Rud; Sutton, M.

2014-01-01

Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m...

Quality of life and cost factors in panic disorder.

Science.gov (United States)

Davidson, J R

1996-01-01

Quality of life encompasses domains of personal happiness, role fulfillment, and health status. Increasing attention has been paid to the relationship between quality of life and panic disorder, with accumulating evidence now available to suggest impairment in several domains among subjects with panic disorder. This review summarizes the results of community-based and treatment-seeking populations of subjects with panic disorder. Impaired personal happiness, restricted role functioning, and increased use of health services are all described. Evidence suggests that accurate diagnosis and effective treatment can significantly lessen health service utilization, resulting in substantial cost offset and also leading to increased work productivity and personal effectiveness.

[Preliminary analysis of total cost and life quality for elder patients with femoral neck fracture].

Science.gov (United States)

Liu, Haonan; He, Liang; Zhang, Guilin; Gong, Xiaofeng; Li, Ning

2015-09-01

To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture. One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics ＆ Traumatology, Beijing Jishuitan Hospital were admitted into our study from August 2013 to December. According to the type of surgery there were 52 and 53 cases in internal fixation (IF) group and hemiarthroplasty (HA) group respectively. At first we collected the medical expense of the patients before and during hospitalization. And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge. At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions (EQ-5D) and calculated the total cost. Outcome All the patients completed the operation successfully. No nonunion or delayed union cases in IF group, and no cases received revision surgery in both groups. The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost. The primary treatment cost accounts for 84.1% of the medical cost. The cost for home care accounts for 90.7% of the non-medical care. The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups (P>0.05). In addition the data of life quality and walking capability also showed no significant difference. The main cost for the femoral neck fracture is medical expense in 1-year follow-up. Both surgeries can provide satisfactory outcome, however IF may be more cost-effective compared to the HA because of the less total cost.

Cost effectiveness of medication adherence-enhancing interventions: a systematic review of trial-based economic evaluations

NARCIS (Netherlands)

Oberje, E.J.M.; Kinderen, de R.J.A.; Evers, S.M.A.A.; Woerkum, van C.M.J.; Bruin, de M.

2013-01-01

Background In light of the pressure to reduce unnecessary healthcare expenditure in the current economic climate, a systematic review that assesses evidence of cost effectiveness of adherence-enhancing interventions would be timely. Objective Our objective was to examine the cost effectiveness of

A cost-effectiveness analysis of shipboard telemedicine.

Science.gov (United States)

Stoloff, P H; Garcia, F E; Thomason, J E; Shia, D S

1998-01-01

The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost

Learning a No-Reference Quality Assessment Model of Enhanced Images With Big Data.

Science.gov (United States)

Gu, Ke; Tao, Dacheng; Qiao, Jun-Fei; Lin, Weisi

2018-04-01

In this paper, we investigate into the problem of image quality assessment (IQA) and enhancement via machine learning. This issue has long attracted a wide range of attention in computational intelligence and image processing communities, since, for many practical applications, e.g., object detection and recognition, raw images are usually needed to be appropriately enhanced to raise the visual quality (e.g., visibility and contrast). In fact, proper enhancement can noticeably improve the quality of input images, even better than originally captured images, which are generally thought to be of the best quality. In this paper, we present two most important contributions. The first contribution is to develop a new no-reference (NR) IQA model. Given an image, our quality measure first extracts 17 features through analysis of contrast, sharpness, brightness and more, and then yields a measure of visual quality using a regression module, which is learned with big-data training samples that are much bigger than the size of relevant image data sets. The results of experiments on nine data sets validate the superiority and efficiency of our blind metric compared with typical state-of-the-art full-reference, reduced-reference and NA IQA methods. The second contribution is that a robust image enhancement framework is established based on quality optimization. For an input image, by the guidance of the proposed NR-IQA measure, we conduct histogram modification to successively rectify image brightness and contrast to a proper level. Thorough tests demonstrate that our framework can well enhance natural images, low-contrast images, low-light images, and dehazed images. The source code will be released at https://sites.google.com/site/guke198701/publications.

Combining Water Quality and Cost-Benefit Analysis to Examine the Implications of Agricultural Best Management Practices

Science.gov (United States)

Rao, N. S.; Easton, Z. M.; Lee, D. R.; Steenhuis, T. S.

2007-12-01

Nutrient runoff from agricultural fields threatens water quality and can impair habitats in many watersheds. Agencies consider these potential risks as they determine acceptable levels of nutrient loading. For example, in the New York City (NYC) watershed, the Environmental Protection Agency's Total Maximum Daily Load (TMDL) for phosphorus (P) has been set at 15μg P L-1 to protect against eutrophication and bacterial outbreaks. In the NYC watersheds agricultural Best Management Practices (BMPs) are the primary means to control nonpoint source P loading. BMPs include riparian buffers, filter strips, manure storage facilities, crop rotation, stripcropping, tree planting and nutrient management plans (NMPs). Water quality research on BMPs to date has included studies on site-specificity of different BMPs, short and long term BMP efficacy, and placement of BMPs with respect to critical source areas. A necessary complement to studies addressing water quality aspects of different BMPs are studies examining the cost-benefit aspects of BMPs. In general, there are installment, maintenance and opportunity costs associated with each BMP, and there are benefits, including cost share agreements between farmers and farm agencies, and increased efficiency of farm production and maintenance. Combining water quality studies and related cost-benefit analyses would help planners and watershed managers determine how best improve water quality. Our research examines the costs-benefit structure associated with BMP scenarios on a one-farm headwater watershed in the Catskill Mountains of NY. The different scenarios include "with and without" BMPs, combinations of BMPs, and different BMP placements across agricultural fields. The costs associated with each BMP scenarios are determined using information from farm agencies and watershed planning agencies. With these data we perform a cost-benefit analysis for the different BMP scenarios and couple the water quality modeling using the

Cost and impact of a quality improvement programme in mental health services.

Science.gov (United States)

Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

2010-04-01

To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

Minimizing total costs of forest roads with computer-aided design ...

Indian Academy of Sciences (India)

imum total road costs, while conforming to design specifications, environmental ..... quality, and enhancing fish and wildlife habitat, an appropriate design ..... Soil, Water and Timber Management: Forest Engineering Solutions in Response to.

Social cost-efficient service quality. Integrating customer valuation in incentive regulation. Evidence from the case of Norway

Energy Technology Data Exchange (ETDEWEB)

Growitsch, Christian; Mueller, Christine; Wissner, Matthias [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany); Jamasb, Tooraj [University of Cambridge, Faculty of Economics (United Kingdom)

2010-05-15

In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities. (author)

Social cost-efficient service quality-Integrating customer valuation in incentive regulation: Evidence from the case of Norway

Energy Technology Data Exchange (ETDEWEB)

Growitsch, Christian, E-mail: c.growitsch@wik.or [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany); Jamasb, Tooraj [University of Cambridge, Faculty of Economics (United Kingdom); Mueller, Christine; Wissner, Matthias [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany)

2010-05-15

In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities.

Social cost-efficient service quality-Integrating customer valuation in incentive regulation: Evidence from the case of Norway

International Nuclear Information System (INIS)

Growitsch, Christian; Jamasb, Tooraj; Mueller, Christine; Wissner, Matthias

2010-01-01

In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities.

The Effect of Safety Costs on Productivity and Quality: A Case Study of Five Steel Companies in Ahvaz

Directory of Open Access Journals (Sweden)

Gholamabbas Shirali

2016-10-01

Full Text Available Background The implementation of a safety program is one of the most effective factors in increasing productivity. A look to safety from the perspective of efficiency can indicate necessary investment in safety for all, especially the managers of companies. Objectives The aim of this study was to evaluate the effect of safety costs on some indicators of productivity and quality in industrial companies. Methods This study was a retrospective analysis and was implemented in five steel companies in Ahvaz. The data relating to the safety costs such as staffing costs and total safety costs, and productivity and quality indicators were collected in five years. This information and data were collected according to statistics from documents and archives of safety, accounting, and production sectors of companies. Costs as well as numbers and figures of variables were expressed in the form of per capita and percentage to make the data comparable. Linear and generalized regression models and Wald Chi-Square test were used by the SPSS 22 software to determine the relationships between them. Results Safety costs such as capita labor safety costs and capita total safety costs or percentage safety labor costs to labor costs, showed a significant positive effect on labor productivity, labor competitiveness, total factor productivity, quality index and production rates (in some cases, P = 0.001. Conclusions The total safety cost and safety labor compensation generally, regardless of the nature and quality of the safety management system, can impact productivity, quality and quantity of production in addition to other factors of production. Surely if safety programs are targeted and codified, the effect of the investment will be doubled.

Association of increased monetary cost of dietary intake, diet quality and weight management in Spanish adults.

Science.gov (United States)

Schröder, Helmut; Serra-Majem, Luis; Subirana, Isaac; Izquierdo-Pulido, Maria; Fitó, Montserrat; Elosua, Roberto

2016-03-14

Higher monetary diet cost is associated with healthier food choices and better weight management. How changes in diet cost affect changes in diet quality and weight remains unknown. The aim of this study was to assess the impact of changes in individual monetary diet cost on changes in diet quality, measured by the modified Mediterranean diet score recommendations (MDS-rec) and by energy density (ED), as well as changes in weight and BMI. We conducted a prospective, population-based study of 2181 male and female Spaniards aged between 25 and 74 years, who were followed up to the 2009-2010 academic year. We measured weight and height and recorded dietary data using a validated FFQ. Average food cost was calculated from official Spanish government data. We fitted multivariate linear and logistic regression models. The average daily diet cost increased from 3·68(SD0.0·89)€/8·36 MJ to 4·97(SD1·16)€/8·36 MJ during the study period. This increase was significantly associated with improvement in diet quality (Δ ED and Δ MDS-rec; Pcost per 8·36 MJ was associated with a decrease of 0·3 kg in body weight (P=0·02) and 0·1 kg/m(2) in BMI (P=0·04). These associations were attenuated after adjusting for changes in diet quality indicators. An improvement in diet quality and better weight management were both associated with an increase in diet cost; this could be considered in food policy decisions.

Enhancing Nurses Access for Care Quality and Knowledge through ...

International Development Research Centre (IDRC) Digital Library (Canada)

Enhancing Nurses Access for Care Quality and Knowledge through ... Special journal issue highlights IDRC-supported findings on women's paid work ... New website will help record vital life events to improve access to services for all.

Quality assurance and accreditation.

Science.gov (United States)

1997-01-01

In 1996, the Joint Commission International (JCI), which is a partnership between the Joint Commission on Accreditation of Healthcare Organizations and Quality Healthcare Resources, Inc., became one of the contractors of the Quality Assurance Project (QAP). JCI recognizes the link between accreditation and quality, and uses a collaborative approach to help a country develop national quality standards that will improve patient care, satisfy patient-centered objectives, and serve the interest of all affected parties. The implementation of good standards provides support for the good performance of professionals, introduces new ideas for improvement, enhances the quality of patient care, reduces costs, increases efficiency, strengthens public confidence, improves management, and enhances the involvement of the medical staff. Such good standards are objective and measurable; achievable with current resources; adaptable to different institutions and cultures; and demonstrate autonomy, flexibility, and creativity. The QAP offers the opportunity to approach accreditation through research efforts, training programs, and regulatory processes. QAP work in the area of accreditation has been targeted for Zambia, where the goal is to provide equal access to cost-effective, quality health care; Jordan, where a consensus process for the development of standards, guidelines, and policies has been initiated; and Ecuador, where JCI has been asked to help plan an approach to the evaluation and monitoring of the health care delivery system.

Reducing costs while maintaining quality in endovascular neurosurgical procedures.

Science.gov (United States)

Kashlan, Osama N; Wilson, Thomas J; Chaudhary, Neeraj; Gemmete, Joseph J; Stetler, William R; Dunnick, N Reed; Thompson, B Gregory; Pandey, Aditya S

2014-11-01

extrapolation over a 1-year period, the 3 policy changes decreased costs by an estimated $323,561.34. Simple cost-saving policies can lead to substantial reductions in costs of neurointerventional procedures while maintaining high levels of quality and growth of services.

Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients

DEFF Research Database (Denmark)

Lundqvist, C.; Beiske, A. G.; Reiertsen, O.

2014-01-01

Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...... was the dominant cost during IDL (45 % of total costs), it represented only 6.4 % of the total for conventional treatment. IDL improves function but is not cost effective using recommended thresholds for cost/QALY in Norway.......Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...... to IDL were assessed at baseline, and subsequently at 3, 6, 9 and 12 months follow-up. We used the Unified PD Rating Scale (UPDRS) for function and 15D for Quality of Life (QoL). Costs were assessed using quarterly structured patient questionnaires and hospital registries. Costs per quality adjusted life...

How Much Will It Cost To Monitor Microbial Drinking Water Quality in Sub-Saharan Africa?

Science.gov (United States)

Delaire, Caroline; Peletz, Rachel; Kumpel, Emily; Kisiangani, Joyce; Bain, Robert; Khush, Ranjiv

2017-06-06

Microbial water quality monitoring is crucial for managing water resources and protecting public health. However, institutional testing activities in sub-Saharan Africa are currently limited. Because the economics of water quality testing are poorly understood, the extent to which cost may be a barrier to monitoring in different settings is unclear. This study used cost data from 18 African monitoring institutions (piped water suppliers and health surveillance agencies in six countries) and estimates of water supply type coverage from 15 countries to assess the annual financial requirements for microbial water testing at both national and regional levels, using World Health Organization recommendations for sampling frequency. We found that a microbial water quality test costs 21.0 ± 11.3 USD, on average, including consumables, equipment, labor, and logistics, which is higher than previously calculated. Our annual cost estimates for microbial monitoring of piped supplies and improved point sources ranged between 8 000 USD for Equatorial Guinea and 1.9 million USD for Ethiopia, depending primarily on the population served but also on the distribution of piped water system sizes. A comparison with current national water and sanitation budgets showed that the cost of implementing prescribed testing levels represents a relatively modest proportion of existing budgets (water sources in sub-Saharan Africa would cost 16.0 million USD per year, which is minimal in comparison to the projected annual capital costs of achieving Sustainable Development Goal 6.1 of safe water for all (14.8 billion USD).

Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

Science.gov (United States)

Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

2016-11-01

To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

Chemical drinking water quality in Ghana: Water costs and scope for advanced treatment

Energy Technology Data Exchange (ETDEWEB)

Rossiter, Helfrid M.A. [School of Engineering, The University of Edinburgh, Edinburgh, EH9 3JL (United Kingdom); Owusu, Peter A.; Awuah, Esi [Department of Civil Engineering, Kwame Nkrumah University of Science and Technology, Kumasi (Ghana); MacDonald, Alan M. [British Geological Survey, Murchison House, West Mains Road, Edinburgh, EH9 3LA (United Kingdom); Schaefer, Andrea I., E-mail: Andrea.Schaefer@ed.ac.uk [School of Engineering, The University of Edinburgh, Edinburgh, EH9 3JL (United Kingdom)

2010-05-01

To reduce child mortality and improve health in Ghana boreholes and wells are being installed across the country by the private sector, NGO's and the Ghanaian government. Water quality is not generally monitored once a water source has been improved. Water supplies were sampled across Ghana from mostly boreholes, wells and rivers as well as some piped water from the different regions and analysed for the chemical quality. Chemical water quality was found to exceed the WHO guidelines in 38% of samples, while pH varied from 3.7 to 8.9. Excess levels of nitrate (NO{sub 3}{sup -}) were found in 21% of the samples, manganese (Mn) and fluoride (F{sup -}) in 11% and 6.7%, respectively. Heavy metals such as lead (Pb), arsenic (As) and uranium (U) were localised to mining areas. Elements without health based guideline values such as aluminium (Al, 95%) and chloride (Cl, 5.7%) were found above the provisional guideline value. Economic information was gathered to identify water costs and ability to pay. Capital costs of wells and boreholes are about Pounds 1200 and Pounds 3800 respectively. The majority of installation costs are generally paid by the government or NGO's, while the maintenance is expected to be covered by the community. At least 58% of the communities had a water payment system in place, either an annual fee/one-off fee or 'pay-as-you-fetch'. The annual fee was between Pounds 0.3-21, while the boreholes had a water collection fee of Pounds 0.07-0.7/m{sup 3}, many wells were free. Interestingly, the most expensive water ( Pounds 2.9-3.5/m{sup 3}) was brought by truck. Many groundwater sources were not used due to poor chemical water quality. Considering the cost of unsuccessful borehole development, the potential for integrating suitable water treatment into the capital and maintenance costs of water sources is discussed. Additionally, many sources were not in use due to lack of water capacity, equipment malfunction or lack of economic

Chemical drinking water quality in Ghana: Water costs and scope for advanced treatment

International Nuclear Information System (INIS)

Rossiter, Helfrid M.A.; Owusu, Peter A.; Awuah, Esi; MacDonald, Alan M.; Schaefer, Andrea I.

2010-01-01

To reduce child mortality and improve health in Ghana boreholes and wells are being installed across the country by the private sector, NGO's and the Ghanaian government. Water quality is not generally monitored once a water source has been improved. Water supplies were sampled across Ghana from mostly boreholes, wells and rivers as well as some piped water from the different regions and analysed for the chemical quality. Chemical water quality was found to exceed the WHO guidelines in 38% of samples, while pH varied from 3.7 to 8.9. Excess levels of nitrate (NO 3 - ) were found in 21% of the samples, manganese (Mn) and fluoride (F - ) in 11% and 6.7%, respectively. Heavy metals such as lead (Pb), arsenic (As) and uranium (U) were localised to mining areas. Elements without health based guideline values such as aluminium (Al, 95%) and chloride (Cl, 5.7%) were found above the provisional guideline value. Economic information was gathered to identify water costs and ability to pay. Capital costs of wells and boreholes are about Pounds 1200 and Pounds 3800 respectively. The majority of installation costs are generally paid by the government or NGO's, while the maintenance is expected to be covered by the community. At least 58% of the communities had a water payment system in place, either an annual fee/one-off fee or 'pay-as-you-fetch'. The annual fee was between Pounds 0.3-21, while the boreholes had a water collection fee of Pounds 0.07-0.7/m 3 , many wells were free. Interestingly, the most expensive water ( Pounds 2.9-3.5/m 3 ) was brought by truck. Many groundwater sources were not used due to poor chemical water quality. Considering the cost of unsuccessful borehole development, the potential for integrating suitable water treatment into the capital and maintenance costs of water sources is discussed. Additionally, many sources were not in use due to lack of water capacity, equipment malfunction or lack of economic resources to repair and maintain equipment

Chemical drinking water quality in Ghana: water costs and scope for advanced treatment.

Science.gov (United States)

Rossiter, Helfrid M A; Owusu, Peter A; Awuah, Esi; Macdonald, Alan M; Schäfer, Andrea I

2010-05-01

To reduce child mortality and improve health in Ghana boreholes and wells are being installed across the country by the private sector, NGO's and the Ghanaian government. Water quality is not generally monitored once a water source has been improved. Water supplies were sampled across Ghana from mostly boreholes, wells and rivers as well as some piped water from the different regions and analysed for the chemical quality. Chemical water quality was found to exceed the WHO guidelines in 38% of samples, while pH varied from 3.7 to 8.9. Excess levels of nitrate (NO(3)(-)) were found in 21% of the samples, manganese (Mn) and fluoride (F(-)) in 11% and 6.7%, respectively. Heavy metals such as lead (Pb), arsenic (As) and uranium (U) were localised to mining areas. Elements without health based guideline values such as aluminium (Al, 95%) and chloride (Cl, 5.7%) were found above the provisional guideline value. Economic information was gathered to identify water costs and ability to pay. Capital costs of wells and boreholes are about pound1200 and pound3800 respectively. The majority of installation costs are generally paid by the government or NGO's, while the maintenance is expected to be covered by the community. At least 58% of the communities had a water payment system in place, either an annual fee/one-off fee or "pay-as-you-fetch". The annual fee was between pound0.3-21, while the boreholes had a water collection fee of pound0.07-0.7/m(3), many wells were free. Interestingly, the most expensive water ( pound2.9-3.5/m(3)) was brought by truck. Many groundwater sources were not used due to poor chemical water quality. Considering the cost of unsuccessful borehole development, the potential for integrating suitable water treatment into the capital and maintenance costs of water sources is discussed. Additionally, many sources were not in use due to lack of water capacity, equipment malfunction or lack of economic resources to repair and maintain equipment. Those

Effect of enhanced UV-B radiation on yield and quality of rice

International Nuclear Information System (INIS)

Yin Hong; Guo Wei; Mao Xiaoyan

2009-01-01

The effects of enhanced UV-B radiation on yield and quality of two rice cuhivars(ShenNong 6014 and ShenNong 265) are studied in potted method. There were three treatments including natural light (TCK), enhanced 5% UV-B radiation (T) and enhanced 10% (T). The results showed that enhanced UV-B radiation decreases yield components, the percentage of brown rice (0.66%-7.06%), head rice rate (5.65%-18.88%), the rate of white rice (22.17%-40.16%), grain area (2.61%-6.25%), fatty acid contents (1.23%-54.19%) and eating quality (1.07%-16.78%) but increasea protein content (4.65%-10.71%) and amylose content of rice (0.56%-4.81%). The effects of T2 was stronger than T1

Targeting Environmental Quality to Improve Population Health and Lower Healthcare Costs

Science.gov (United States)

Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Ye...

Quality improvement in hospitals: how much does it reduce healthcare costs?

Science.gov (United States)

Jones, S B

1995-01-01

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

Individual quality and age but not environmental or social conditions modulate costs of reproduction in a capital breeder.

Science.gov (United States)

Debeffe, Lucie; Poissant, Jocelyn; McLoughlin, Philip D

2017-08-01

Costs associated with reproduction are widely known to play a role in the evolution of reproductive tactics with consequences to population and eco-evolutionary dynamics. Evaluating these costs as they pertain to species in the wild remains an important goal of evolutionary ecology. Individual heterogeneity, including differences in individual quality (i.e., among-individual differences in traits associated with survival and reproduction) or state, and variation in environmental and social conditions can modulate the costs of reproduction; however, few studies have considered effects of these factors simultaneously. Taking advantage of a detailed, long-term dataset for a population of feral horses (Sable Island, Nova Scotia, Canada), we address the question of how intrinsic (quality, age), environmental (winter severity, location), and social conditions (group size, composition, sex ratio, density) influence the costs of reproduction on subsequent reproduction. Individual quality was measured using a multivariate analysis on a combination of four static and dynamic traits expected to depict heterogeneity in individual performance. Female quality and age interacted with reproductive status of the previous year to determine current reproductive effort, while no effect of social or environmental covariates was found. High-quality females showed higher probabilities of giving birth and weaning their foal regardless of their reproductive status the previous year, while those of lower quality showed lower probabilities of producing foals in successive years. Middle-aged (prime) females had the highest probability of giving birth when they had not reproduced the year before, but no such relationship with age was found among females that had reproduced the previous year, indicating that prime-aged females bear higher costs of reproduction. We show that individual quality and age were key factors modulating the costs of reproduction in a capital breeder but that

Cost prediction model for various payloads and instruments for the Space Shuttle Orbiter

Science.gov (United States)

Hoffman, F. E.

1984-01-01

The following cost parameters of the space shuttle were undertaken: (1) to develop a cost prediction model for various payload classes of instruments and experiments for the Space Shuttle Orbiter; and (2) to show the implications of various payload classes on the cost of: reliability analysis, quality assurance, environmental design requirements, documentation, parts selection, and other reliability enhancing activities.

Cost and quality of fuels for electric utility plants, 1994

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-07-14

This document presents an annual summary of statistics at the national, Census division, State, electric utility, and plant levels regarding the quantity, quality, and cost of fossil fuels used to produce electricity. Purpose of this publication is to provide energy decision-makers with accurate, timely information that may be used in forming various perspectives on issues regarding electric power.

Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study)

DEFF Research Database (Denmark)

Mastenbroek, Mirjam H.; Pedersen, Susanne S.; van der Tweel, Ingeborg

2016-01-01

-reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients...... programming strategy, unnecessary ICD therapy was prevented in 10% of ENHANCED-ICD patients during a median follow-up period of 1.3 years. With respect to patient-reported outcomes, levels of distress were highest and perceived health status lowest at the time of implantation, which both gradually improved...... during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life....

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

Science.gov (United States)

Yildiz, M Said; Khan, M Mahmud

2016-08-12

The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF services

Directory of Open Access Journals (Sweden)

M. Said Yildiz

2016-08-01

Full Text Available Abstract Background The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. Methods This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Results Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Conclusions Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

Integrated cost-effectiveness analysis of agri-environmental measures for water quality.

Science.gov (United States)

Balana, Bedru B; Jackson-Blake, Leah; Martin-Ortega, Julia; Dunn, Sarah

2015-09-15

This paper presents an application of integrated methodological approach for identifying cost-effective combinations of agri-environmental measures to achieve water quality targets. The methodological approach involves linking hydro-chemical modelling with economic costs of mitigation measures. The utility of the approach was explored for the River Dee catchment in North East Scotland, examining the cost-effectiveness of mitigation measures for nitrogen (N) and phosphorus (P) pollutants. In-stream nitrate concentration was modelled using the STREAM-N and phosphorus using INCA-P model. Both models were first run for baseline conditions and then their effectiveness for changes in land management was simulated. Costs were based on farm income foregone, capital and operational expenditures. The costs and effects data were integrated using 'Risk Solver Platform' optimization in excel to produce the most cost-effective combination of measures by which target nutrient reductions could be attained at a minimum economic cost. The analysis identified different combination of measures as most cost-effective for the two pollutants. An important aspect of this paper is integration of model-based effectiveness estimates with economic cost of measures for cost-effectiveness analysis of land and water management options. The methodological approach developed is not limited to the two pollutants and the selected agri-environmental measures considered in the paper; the approach can be adapted to the cost-effectiveness analysis of any catchment-scale environmental management options. Copyright © 2015 Elsevier Ltd. All rights reserved.

Standard values of quality and ore mining costs in management of multi-plant mining company

Energy Technology Data Exchange (ETDEWEB)

Kudelko, Jan [KGHM CUPRUM Research and Development Center, Wroclaw (Poland); Wirth, Herbert [KGHM Polska Miedz S.A., Lubin (Poland)

2010-03-15

Profitability of copper deposit mining depends on three basic variables, electrolytic copper price, manufacturing and selling costs of copper and company property involved in production process. If the company property is adjusted to its tasks then the mining profiability depends on costs of copper mining and selling, because the price is the external variable defined by the market. We can shape the costs in two (complementary) ways, traditionally, reducing the labor, material and power consumption, and by adjusting the quality of mined ore (copper content) to the level required by the current copper prices. Required quality of copper ore in the whole company we determine according to the accepted profitability criteria and then we determine quality standard for individual mines. Algorithms determining the ore quality standard resulting from current market price of copper are presented in the paper. Calculation models for the mined ore quality standards, unit mining costs per one ton of copper, electrolytic copper production and ore output are given. Standards were established for one variable assuming that the other variables are determined in this calculation. Innovative solution, presented in the paper, is the method of decomposition of the company controllable variables into the tasks for individual mines providing reaching the targets to the whole technological circuit. Using the models, having relatively few data, it will be possible to calculate quickly the values which are interesting for managers such as for example the prognosis of rate of return (economic or operational), required copper content in the mined ore for the whole company and individual mines at given rate of return or boundary level of copper content in comparison with cost and production level. Examples of calculation are provided. (orig.)

A Low-Cost Sensing System for Cooperative Air Quality Monitoring in Urban Areas

Directory of Open Access Journals (Sweden)

Simone Brienza

2015-05-01

Full Text Available Air quality in urban areas is a very important topic as it closely affects the health of citizens. Recent studies highlight that the exposure to polluted air can increase the incidence of diseases and deteriorate the quality of life. Hence, it is necessary to develop tools for real-time air quality monitoring, so as to allow appropriate and timely decisions. In this paper, we present uSense, a low-cost cooperative monitoring tool that allows knowing, in real-time, the concentrations of polluting gases in various areas of the city. Specifically, users monitor the areas of their interest by deploying low-cost and low-power sensor nodes. In addition, they can share the collected data following a social networking approach. uSense has been tested through an in-field experimentation performed in different areas of a city. The obtained results are in line with those provided by the local environmental control authority and show that uSense can be profitably used for air quality monitoring.

Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial.

Science.gov (United States)

Coulton, Simon; Clift, Stephen; Skingley, Ann; Rodriguez, John

2015-09-01

As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people. To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England. A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more. A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06-4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53-7.01), anxiety (mean difference = -1.78; -2.5 to -1.06) and depression (mean difference = -1.52; -2.13 to -0.92). Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people. © The Royal College of Psychiatrists 2015.

[Software for illustrating a cost-quality balance carried out by clinical laboratory practice].

Science.gov (United States)

Nishibori, Masahiro; Asayama, Hitoshi; Kimura, Satoshi; Takagi, Yasushi; Hagihara, Michio; Fujiwara, Mutsunori; Yoneyama, Akiko; Watanabe, Takashi

2010-09-01

We have no proper reference indicating the quality of clinical laboratory practice, which should clearly illustrates that better medical tests require more expenses. Japanese Society of Laboratory Medicine was concerned about recent difficult medical economy and issued a committee report proposing a guideline to evaluate the good laboratory practice. According to the guideline, we developed software that illustrate a cost-quality balance carried out by clinical laboratory practice. We encountered a number of controversial problems, for example, how to measure and weight each quality-related factor, how to calculate costs of a laboratory test and how to consider characteristics of a clinical laboratory. Consequently we finished only prototype software within the given period and the budget. In this paper, software implementation of the guideline and the above-mentioned problems are summarized. Aiming to stimulate these discussions, the operative software will be put on the Society's homepage for trial

Cost and quality gains from diversification and vertical integration in the electricity industry: A DEA approach

International Nuclear Information System (INIS)

Arocena, Pablo

2008-01-01

This paper analyzes the degree of economies of vertical integration, diversification and scale in the electricity industry by means of Data Envelopment Analysis. We estimate the impact that alternative forms of unbundling would have on the cost and quality of supply, measured as the number and duration of supply interruptions, in a group of Spanish electric utilities. We find evidence of the existence of cost and quality gains from integrating power generation and distribution in the range of 1.1 to 4.9%, whereas diversifying the source of power generation saves between 1.3 and 4.3% of costs and quality. Finally, the scale efficiency of the largest utilities could be improved by dividing them into smaller units, provided that their current vertical scope and generation-mix are preserved. (author)

Cost and quality gains from diversification and vertical integration in the electricity industry: A DEA approach

Energy Technology Data Exchange (ETDEWEB)

Arocena, Pablo [Universidad Publica de Navarra, Dpto. Gestion de Empresas, Campus de Arrosadia, 31006 Pamplona (Spain)

2008-01-15

This paper analyzes the degree of economies of vertical integration, diversification and scale in the electricity industry by means of Data Envelopment Analysis. We estimate the impact that alternative forms of unbundling would have on the cost and quality of supply, measured as the number and duration of supply interruptions, in a group of Spanish electric utilities. We find evidence of the existence of cost and quality gains from integrating power generation and distribution in the range of 1.1 to 4.9%, whereas diversifying the source of power generation saves between 1.3 and 4.3% of costs and quality. Finally, the scale efficiency of the largest utilities could be improved by dividing them into smaller units, provided that their current vertical scope and generation-mix are preserved. (author)

Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost.

Science.gov (United States)

Avants, S K; Margolin, A; Sindelar, J L; Rounsaville, B J; Schottenfeld, R; Stine, S; Cooney, N L; Rosenheck, R A; Li, S H; Kosten, T R

1999-01-01

This study examined the differential efficacy and relative costs of two intensities of adjunctive psychosocial services--a day treatment program and enhanced standard care--for the treatment of opioid-dependent patients maintained on methadone hydrochloride. A 12-week randomized clinical trial with 6-month follow-up was conducted in a community-based methadone maintenance program. Of the 308 patients who met inclusion criteria, 291 began treatment (day treatment program: N=145; enhanced standard care: N=146), and 237 completed treatment (82% of those assigned to the day treatment program and 81% of those receiving enhanced standard care). Two hundred twenty of the patients participated in the 6-month follow-up (75% of those in the day treatment program and 73% of those in enhanced standard care provided a follow-up urine sample for screening). Both interventions were 12 weeks in duration, manual-guided, and provided by master's-level clinicians. The day treatment was an intensive, 25-hour-per-week program. The enhanced standard care was standard methadone maintenance plus a weekly skills training group and referral to on- and off-site services. Outcome measures included twice weekly urine toxicology screens, severity of addiction-related problems, prevalence of HIV risk behaviors, and program costs. Although the cost of the day treatment program was significantly higher, there was no significant difference in the two groups' use of either opiates or cocaine. Over the course of treatment, drug use, drug-related problems, and HIV risk behaviors decreased significantly for patients assigned to both treatment intensities. Improvements were maintained at follow-up. Providing an intensive day treatment program to unemployed, inner-city methadone patients was not cost-effective relative to a program of enhanced methadone maintenance services, which produced comparable outcomes at less than half the cost.

Summarized Costs, Placement Of Quality Stars, And Other Online Displays Can Help Consumers Select High-Value Health Plans.

Science.gov (United States)

Greene, Jessica; Hibbard, Judith H; Sacks, Rebecca M

2016-04-01

Starting in 2017, all state and federal health insurance exchanges will present quality data on health plans in addition to cost information. We analyzed variations in the current design of information on state exchanges to identify presentation approaches that encourage consumers to take quality as well as cost into account when selecting a health plan. Using an online sample of 1,025 adults, we randomly assigned participants to view the same comparative information on health plans, displayed in different ways. We found that consumers were much more likely to select a high-value plan when cost information was summarized instead of detailed, when quality stars were displayed adjacent to cost information, when consumers understood that quality stars signified the quality of medical care, and when high-value plans were highlighted with a check mark or blue ribbon. These approaches, which were equally effective for participants with higher and lower numeracy, can inform the development of future displays of plan information in the exchanges. Project HOPE—The People-to-People Health Foundation, Inc.

Performance, Process, and Costs: Managing Service Quality with the Balanced Scorecard.

Science.gov (United States)

Poll, Roswitha

2001-01-01

Describes a cooperative project among three German libraries that used the Balanced Scorecard as a concept for an integrated quality management system. Considers performance indicators across four perspectives that will help academic libraries establish an integrated controlling system and to collect and evaluate performance as well as cost data…

Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

Science.gov (United States)

Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

2018-06-01

Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

Cost of living dictates what whales, dolphins and porpoises eat: the importance of prey quality on predator foraging strategies.

Directory of Open Access Journals (Sweden)

Jérôme Spitz

Full Text Available Understanding the mechanisms that drive prey selection is a major challenge in foraging ecology. Most studies of foraging strategies have focused on behavioural costs, and have generally failed to recognize that differences in the quality of prey may be as important to predators as the costs of acquisition. Here, we tested whether there is a relationship between the quality of diets (kJ · g(-1 consumed by cetaceans in the North Atlantic and their metabolic costs of living as estimated by indicators of muscle performance (mitochondrial density, n = 60, and lipid content, n = 37. We found that the cost of living of 11 cetacean species is tightly coupled with the quality of prey they consume. This relationship between diet quality and cost of living appears to be independent of phylogeny and body size, and runs counter to predictions that stem from the well-known scaling relationships between mass and metabolic rates. Our finding suggests that the quality of prey rather than the sheer quantity of food is a major determinant of foraging strategies employed by predators to meet their specific energy requirements. This predator-specific dependence on food quality appears to reflect the evolution of ecological strategies at a species level, and has implications for risk assessment associated with the consequences of changing the quality and quantities of prey available to top predators in marine ecosystems.

Quality-based financial incentives in health care: can we improve quality by paying for it?

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Conrad, Douglas A; Perry, Lisa

2009-01-01

This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

Cost and quality of life of overlooked eye care needs of children

Directory of Open Access Journals (Sweden)

Malvankar-Mehta MS

2018-02-01

Full Text Available Monali S Malvankar-Mehta,1,2 Ryan Wilson,3 Erik Leci,3 Kelly Hatch,4 Sapna Sharan1 1Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Hospital, 2Department of Epidemiology and Biostatistics, 3Schulich School of Medicine and Dentistry, 4Allyn & Betty Taylor Library, Natural Sciences Centre, The University of Western Ontario, London, ON, Canada Background: The objective of this research was to conduct a systematic review and cost analysis to summarize, from the Ministry of Health perspective, the costs families might incur because of their child’s prescription for refractive errors and amblyopia correction.Methods: Databases including MEDLINE, Embase, BIOSIS, CINAHL, HEED, ISI Web of Science, and the Cochrane Library as well as the gray literature were searched. Systematic review was conducted using EPPI-Reviewer 4. Percentage difference in cost of glasses and patches per patient per various diagnoses were computed. The cost of glasses and patches was projected over a 5-year time horizon. Cost-utility analysis was performed.Results: In total, 302 records were retrieved from multiple databases and an additional 48 records were identified through gray literature search. From these, a total of 14 studies (10,388 subjects were eligible for quantitative analysis. The cost of glasses increased significantly for congenital cataract patients to US$1,820, esotropia patients to US$840, myopes to US$411, amblyopes (mixed to US$916, anisometropes to US$521, and patients with strabismus to US$728 over a 5-year period making them unaffordable for low-income families. Incremental cost of glasses of congenital cataract patients with delayed treatment was computed to be US$1,690 per health utility gained. Incremental cost of glasses for high refractive error was US$93 per health utility gained in non-compliant children. For amblyopia patients, incremental cost of glasses per quality-adjusted life years gained was US$3,638.Conclusion: Cost of

The interaction between reproductive cost and individual quality is mediated by oceanic conditions in a long-lived bird.

Science.gov (United States)

Robert, Alexandre; Paiva, Vitor H; Bolton, Mark; Jiguet, Frédéric; Bried, Joël

2012-08-01

Environmental variability, costs of reproduction, and heterogeneity in individual quality are three important sources of the temporal and interindividual variations in vital rates of wild populations. Based on an 18-year monitoring of an endangered, recently described, long-lived seabird, Monteiro's Storm-Petrel (Oceanodroma monteiroi), we designed multistate survival models to separate the effects of the reproductive cost (breeders vs. nonbreeders) and individual quality (successful vs. unsuccessful breeders) in relation to temporally variable demographic and oceanographic properties. The analysis revealed a gradient of individual quality from nonbreeders, to unsuccessful breeders, to successful breeders. The survival rates of unsuccessful breeders (0.90 +/- 0.023, mean +/- SE) tended to decrease in years of high average breeding success and were more sensitive to oceanographic variation than those of both (high-quality) successful breeders (0.97 +/- 0.015) and (low-quality) nonbreeders (0.83 +/- 0.028). Overall, our results indicate that reproductive costs act on individuals of intermediate quality and are mediated by environmental harshness.

Carmel River Lagoon Enhancement Project: Water Quality and Aquatic Wildlife Monitoring, 2006-7

OpenAIRE

Perry, William; Watson, Fred; Casagrande, Joel; Hanley, Charles

2007-01-01

This is a report to the California Department of Parks and Recreation. It describes water quality and aquatic invertebrate monitoring after the construction of the Carmel River Lagoon Enhancement Project. Included are data that have been collected for two years and preliminary assessment of the enhanced ecosystem. This report marks the completion of 3-years of monitoring water quality and aquatic habitat. The report adopts the same format and certain background text from previous ...

Cost benefit of investment on quality in pharmaceutical manufacturing: WHO GMP pre- and post-certification of a Nigerian pharmaceutical manufacturer.

Science.gov (United States)

Anyakora, Chimezie; Ekwunife, Obinna; Alozie, Faith; Esuga, Mopa; Ukwuru, Jonathan; Onya, Steve; Nwokike, Jude

2017-09-18

Pharmaceutical companies in Africa need to invest in both facilities and quality management systems to achieve good manufacturing practice (GMP) compliance. Compliance to international GMP standards is important to the attainment of World Health Organization (WHO) prequalification. However, most of the local pharmaceutical manufacturing companies may be deterred from investing in quality because of many reasons, ranging from financial constraints to technical capacity. This paper primarily evaluates benefits against the cost of investing in GMP, using a Nigerian pharmaceutical company, Chi Pharmaceuticals Limited, as a case study. This paper also discusses how to drive more local manufacturers to invest in quality to attain GMP compliance; and proffers practical recommendations for local manufacturers who would want to invest in quality to meet ethical and regulatory obligations. The cost benefit of improving the quality of Chi Pharmaceuticals Limited's facilities and system to attain WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was calculated by dividing the annual benefits derived from quality improvement interventions by the annual costs of implementing quality improvement interventions, referred to as a benefit-cost ratio (BCR). Cost benefit of obtaining WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was 5.3 (95% confidence interval of 5.0-5.5). Investment in quality improvement intervention is cost-beneficial for local manufacturing companies. Governments and regulators in African countries should support pharmaceutical companies striving to invest in quality. Collaboration of local manufacturing companies with global companies will further improve quality. Local pharmaceutical companies should be encouraged to key into development opportunities available for pharmaceutical companies in Africa.

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Directory of Open Access Journals (Sweden)

Jeffrey J. Guterman

2016-09-01

Full Text Available Introduction: Attending physician judgment is the traditional standard of care for emergency department (ED admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods: We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days, and quality indicators (15- and 30-day ED returns; delayed hospital admissions. We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results: Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0% and correlated with Medicaid denied-payment day rates (p=0.038. There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission. There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion: Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.

A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

Science.gov (United States)

Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

2006-09-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

Strategies to control costs and quality: a focus on outcomes research for disease management.

Science.gov (United States)

Villagra, Victor

2004-04-01

Rapid adoption of disease management has outpaced systematic evaluation of its net value in improving health outcomes and mitigating healthcare cost. This article identifies areas in which outcomes research in disease management is needed to demonstrate its value or to enhance its performance. Patient identification for disease management relies on administrative database queries but the trade-offs in sensitivity, specificity, and predictive value of alternative queries are not well known. Large-scale deployment, rapid patient engagement, and repeated interactions between patients and nurses could be important attributes for attaining measurable improvements in quality and cost reduction over short periods of time, but these hypothesis need to be tested. There is a trend toward integration of multiple chronic disease management programs onto a single platform. To support this trend, there is a need for a corresponding set of integrated clinical guidelines or "meta-guidelines" that combine the contents of individual practice guidelines. The relative contribution of various disease management interventions in improving clinical results, lowering costs, and their respective ease of implementation is not known. Research leading to a better understanding of tradeoffs could lead to more rational resource allocation and better overall outcomes. Coordination between disease management programs and physician practices is lacking. Research aimed at defining operational and technical interfaces and cultural and behavioral professional adjustments necessary to achieve integration and coordination is needed. The lack of a consistent analytical framework for evaluating clinical and financial outcomes has made comparisons of reported results impossible and has rendered many reports unreliable. Theoretical work on a standard methodology that integrates clinical and financial outcomes and empiric validation is needed.

The Academic Quality Handbook: Enhancing Higher Education in Universities and Further Education Colleges.

Science.gov (United States)

McGhee, Patrick

This book is intended as an introduction to the management of quality assurance and enhancement in higher education, particularly in England. The text focuses on the relationship between institutional quality assurance and the auditing authority of the British Quality Assurance Agency for Higher Education. The chapters of part 1, "The Quality…

Monitoring Indoor Air Quality for Enhanced Occupational Health.

Science.gov (United States)

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

2017-02-01

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

Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

Energy Technology Data Exchange (ETDEWEB)

Chae, Yeora, E-mail: yrchae@kei.re.kr [Korea Environment Institute, 290 Jinheungno, Eunpyeong-Gu, Seoul 122-706 (Korea, Republic of); Park, Jeongim [Department of Environmental Health Science, Soonchunhyang University, Asan, Chungnam 336-745 (Korea, Republic of)

2011-09-15

This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: > The costs and benefits of Integrated Environmental Strategies (IES) are quantified.> Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.> Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.> Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.> Benefits of IES are greater than those obtained by each measure individually.

Current enhancement in crystalline silicon photovoltaic by low-cost nickel silicide back contact

KAUST Repository

Bahabry, R. R.; Gumus, A.; Kutbee, A. T.; Wehbe, N.; Ahmed, S. M.; Ghoneim, M. T.; Lee, K. -T.; Rogers, J. A.; Hussain, M. M.

2016-01-01

We report short circuit current (Jsc) enhancement in crystalline silicon (C-Si) photovoltaic (PV) using low-cost Ohmic contact engineering by integration of Nickel mono-silicide (NiSi) for back contact metallization as an alternative to the status quo of using expensive screen printed silver (Ag). We show 2.6 mA/cm2 enhancement in the short circuit current (Jsc) and 1.2 % increment in the efficiency by improving the current collection due to the low specific contact resistance of the NiSi on the heavily Boron (B) doped Silicon (Si) interface.

Current enhancement in crystalline silicon photovoltaic by low-cost nickel silicide back contact

KAUST Repository

Bahabry, R. R.

2016-11-30

We report short circuit current (Jsc) enhancement in crystalline silicon (C-Si) photovoltaic (PV) using low-cost Ohmic contact engineering by integration of Nickel mono-silicide (NiSi) for back contact metallization as an alternative to the status quo of using expensive screen printed silver (Ag). We show 2.6 mA/cm2 enhancement in the short circuit current (Jsc) and 1.2 % increment in the efficiency by improving the current collection due to the low specific contact resistance of the NiSi on the heavily Boron (B) doped Silicon (Si) interface.

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

Science.gov (United States)

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with

Simulation modeling for stratified breast cancer screening - a systematic review of cost and quality of life assumptions.

Science.gov (United States)

Arnold, Matthias

2017-12-02

The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters.

The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

OpenAIRE

Ali KURT; Cemal ZEHİR

2016-01-01

Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between ...

Inkjet printable nanosilver suspensions for enhanced sintering quality in rapid manufacturing

International Nuclear Information System (INIS)

Bai, John G; Creehan, Kevin D; Kuhn, Howard A

2007-01-01

Inkjet printable nanosilver suspensions were prepared by dispersing 30 nm silver particles into a water-based binder system to enhance the sintering quality in rapid manufacturing. During three-dimensional printing (3DP), the nanosilver suspensions were inkjet printed onto repetitively spread microsilver powder for selective joining. Since the nanosilver particles in the suspensions can be sintered at relatively low temperatures to bond the neighbouring microsilver powder, they were used to provide the continuous bonding strength of the manufacturing parts during the heat-up procedure of the sintering operation. Comparative study shows that the silver parts printed using the nanosilver suspension were significantly enhanced in sintering quality than those printed using the binder system, especially when the silver parts had thin or small features with high aspect ratios

Image quality enhancement for skin cancer optical diagnostics

Science.gov (United States)

Bliznuks, Dmitrijs; Kuzmina, Ilona; Bolocko, Katrina; Lihachev, Alexey

2017-12-01

The research presents image quality analysis and enhancement proposals in biophotonic area. The sources of image problems are reviewed and analyzed. The problems with most impact in biophotonic area are analyzed in terms of specific biophotonic task - skin cancer diagnostics. The results point out that main problem for skin cancer analysis is the skin illumination problems. Since it is often not possible to prevent illumination problems, the paper proposes image post processing algorithm - low frequency filtering. Practical results show diagnostic results improvement after using proposed filter. Along that, filter do not reduces diagnostic results' quality for images without illumination defects. Current filtering algorithm requires empirical tuning of filter parameters. Further work needed to test the algorithm in other biophotonic applications and propose automatic filter parameter selection.

Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States: The quality-adjusted cost of care.

Science.gov (United States)

Younossi, Zobair M; Park, Haesuk; Dieterich, Douglas; Saab, Sammy; Ahmed, Aijaz; Gordon, Stuart C

2016-10-01

New direct-acting antiviral (DAA) therapy has dramatically increased cure rates for patients infected with hepatitis C virus (HCV), but has also substantially raised treatment costs. The aim of this analysis was to evaluate the therapeutic benefit and net costs (i.e. efficiency frontier) and the quality-adjusted cost of care associated with the evolution of treatment regimens for patients with HCV genotype 1 in the United States. A decision-analytic Markov model. Published literature and clinical trial data. Life Time. Third-party payer. This study compared four approved regimens in treatment-naïve genotype 1 chronic hepatitis C patients, including pegylated interferon and ribavirin (PR), first generation triple therapy (boceprevir + PR and telaprevir + PR), second generation triple therapy (sofosbuvir + PR and simeprevir + PR) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir + paritaprevir/ritonavir + dasabuvir ± ribavirin). Quality-adjusted cost of care (QACC). QACC was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY. All-oral therapy improved the average sustained virologic response (SVR) rate to 96%, thereby offsetting the high drug acquisition cost of $85,714, which resulted in the highest benefit based on the efficiency frontier. Furthermore, while oral therapies increased HCV drug costs by $48,350, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy. When the value of a QALY was varied from $100,000 to $300,000, the quality adjusted cost of care compared to dual therapy ranged from - $21,234 to - $107,861, - $89,007 to - $293,130, - $176,280 to - $500,599 for first generation triple, second generation triple, and all-oral therapies, respectively. Primary efficacy and safety measurements for drug regimens were sourced from clinical trials data rather than a real

Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

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Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

2013-01-01

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

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Barasa, Edwine W; Ayieko, Philip; Cleary, Susan; English, Mike

2012-01-01

To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

Directory of Open Access Journals (Sweden)

Edwine W Barasa

Full Text Available To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+ strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals with a partial intervention (n = 4 hospitals. Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$. Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06 in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18 in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31 per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY averted by scaling up would vary between US$39.8 and US$398.3.Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be

Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

International Nuclear Information System (INIS)

Chae, Yeora; Park, Jeongim

2011-01-01

This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: → The costs and benefits of Integrated Environmental Strategies (IES) are quantified.→ Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.→ Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.→ Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.→ Benefits of IES are greater than those obtained by each measure individually.

Total cost of ownership: Getting past the 10% solution

International Nuclear Information System (INIS)

Anderson, R.F.

1996-01-01

As the refining industry strives to succeed in a more-competitive world, some fresh ideas are needed to counter the headlines of plant closings, layoffs, and corporate restructurings. Other industries facing the same pressures have discovered opportunities to reduce cost in a more human and effective manner by using some tools borrowed from the Total Quality process to enhance the procurement process. Experience suggests that the purchase cost is a small fraction of the actual cost of a commodity and is often dwarfed by hidden costs. Discovering and eliminating the hidden costs of variation, nonoptimal operations, and poorly aligned vendor relations is vital to economic survival. The purpose of this paper is to suggest some fresh approaches to vendor-customer relations that can dramatically reduce undesired costs

The use of databases and registries to enhance colonoscopy quality.

Science.gov (United States)

Logan, Judith R; Lieberman, David A

2010-10-01

Administrative databases, registries, and clinical databases are designed for different purposes and therefore have different advantages and disadvantages in providing data for enhancing quality. Administrative databases provide the advantages of size, availability, and generalizability, but are subject to constraints inherent in the coding systems used and from data collection methods optimized for billing. Registries are designed for research and quality reporting but require significant investment from participants for secondary data collection and quality control. Electronic health records contain all of the data needed for quality research and measurement, but that data is too often locked in narrative text and unavailable for analysis. National mandates for electronic health record implementation and functionality will likely change this landscape in the near future. Copyright © 2010 Elsevier Inc. All rights reserved.

Electron beam irradiation: a novel technology to enhance the quality of soybean seeds

International Nuclear Information System (INIS)

Bhalla, Shashi; Srinivasan, K.; Singh, Subadas; Thakur, Manju; Sharma, S.K.; Pramod, R.; Dwivedi, J.; Bapna, S.C.

2010-01-01

Soybean seeds, rich in protein and oil, maintain their germinability only for short durations under ambient conditions. Loss of viability of stored seeds often hampers soybean production in harsh environments worldwide. Physiological factors favored by high temperature and high moisture content accelerate the seed deterioration in the tropics. Several chemical and physical treatments are being used to enhance quality. Irradiation is a novel technology for food preservation and is gaining importance all over the world. Low doses of irradiation bring about improvement in quality of food/seeds, which can be beneficial in several ways. Electron Beam (EB) irradiation is a new approach in this area. The objective of present study was to investigate the effect of EB irradiation in enhancing the quality of low vigour soybean seeds

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

Science.gov (United States)

Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

2008-09-01

To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

Enhancing board oversight on quality of hospital care: an agency theory perspective.

Science.gov (United States)

Jiang, H Joanna; Lockee, Carlin; Fraser, Irene

2012-01-01

Community hospitals in the United States are almost all governed by a governing board that is legally accountable for the quality of care provided. Increasing pressures for better quality and safety are prompting boards to strengthen their oversight function on quality. In this study, we aimed to provide an update to prior research by exploring the role and practices of governing boards in quality oversight through the lens of agency theory and comparing hospital quality performance in relation to the adoption of those practices. Data on board practices from a survey conducted by The Governance Institute in 2007 were merged with data on hospital quality drawn from two federal sources that measured processes of care and mortality. The study sample includes 445 public and private not-for-profit hospitals. We used factor analysis to explore the underlying dimensions of board practices. We further compared hospital quality performance by the adoption of each individual board practice. Consistent with the agency theory, the 13 board practices included in the survey appear to center around enhancing accountability of the board, management, and the medical staff. Reviewing the hospital's quality performance on a regular basis was the most common practice. A number of board practices, not examined in prior research, showed significant association with better performance on process of care and/or risk-adjusted mortality: requiring major new clinical programs to meet quality-related criteria, setting some quality goals at the "theoretical ideal" level, requiring both the board and the medical staff to be as involved as management in setting the agenda for discussion on quality, and requiring the hospital to report its quality/safety performance to the general public. Hospital governing boards should examine their current practices and consider adopting those that would enhance the accountability of the board itself, management, and the medical staff.

HDR Image Quality Enhancement Based on Spatially Variant Retinal Response

Directory of Open Access Journals (Sweden)

Horiuchi Takahiko

2010-01-01

Full Text Available There is a growing demand for being able to display high dynamic range (HDR images on low dynamic range (LDR devices. Tone mapping is a process for enhancing HDR image quality on an LDR device by converting the tonal values of the original image from HDR to LDR. This paper proposes a new tone mapping algorithm for enhancing image quality by deriving a spatially-variant operator for imitating S-potential response in human retina, which efficiently improves local contrasts while conserving good global appearance. The proposed tone mapping operator is studied from a system construction point of view. It is found that the operator is regarded as a natural extension of the Retinex algorithm by adding a global adaptation process to the local adaptation. The feasibility of the proposed algorithm is examined in detail on experiments using standard HDR images and real HDR scene images, comparing with conventional tone mapping algorithms.

78 FR 16474 - Extension of the Period for Comments on the Enhancement of Quality of Software-Related Patents

Science.gov (United States)

2013-03-15

...] Extension of the Period for Comments on the Enhancement of Quality of Software-Related Patents AGENCY... announcing the formation of a partnership with the software community to enhance the quality of software... quality of software-related patents and the preparation of software-related patent applications including...

Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care.

Science.gov (United States)

Brooten, Dorothy; Naylor, Mary D; York, Ruth; Brown, Linda P; Munro, Barbara Hazard; Hollingsworth, Andrea O; Cohen, Susan M; Finkler, Steven; Deatrick, Janet; Youngblut, JoAnne M

2002-01-01

To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. The Quality Cost Model of APN Transitional Care. Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

Science.gov (United States)

Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (Pinitiative practices relative to comparison practices (P=0.006 and Pinitiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after

Make or buy analysis model based on tolerance allocation to minimize manufacturing cost and fuzzy quality loss

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Rosyidi, C. N.; Puspitoingrum, W.; Jauhari, W. A.; Suhardi, B.; Hamada, K.

2016-02-01

The specification of tolerances has a significant impact on the quality of product and final production cost. The company should carefully pay attention to the component or product tolerance so they can produce a good quality product at the lowest cost. Tolerance allocation has been widely used to solve problem in selecting particular process or supplier. But before merely getting into the selection process, the company must first make a plan to analyse whether the component must be made in house (make), to be purchased from a supplier (buy), or used the combination of both. This paper discusses an optimization model of process and supplier selection in order to minimize the manufacturing costs and the fuzzy quality loss. This model can also be used to determine the allocation of components to the selected processes or suppliers. Tolerance, process capability and production capacity are three important constraints that affect the decision. Fuzzy quality loss function is used in this paper to describe the semantic of the quality, in which the product quality level is divided into several grades. The implementation of the proposed model has been demonstrated by solving a numerical example problem that used a simple assembly product which consists of three components. The metaheuristic approach were implemented to OptQuest software from Oracle Crystal Ball in order to obtain the optimal solution of the numerical example.

[Costs of health. Costs-effectiveness in case of lifestyle changes].

Science.gov (United States)

Apor, Péter

2010-05-09

Economical burden for the individuals and for the national budgets of chronic cardio-vasculo-metabolic diseases is high and is rapidly increasing. Costs of treatments and prevention are very different in countries of diverse culture, ethnicity, social-economical situations, but prevention with healthy foods and with adequate physical activity are cheaper than medicines anywhere in the world. A great couple of studies approved cost-effectiveness of interventions directed to the change of life style factors. Cheaper is to influence the whole, yet healthy population, but interventions on people with high risk are more target-specific and usually more expensive. Enhanced physical activity (minimum 30 minutes five times per week with low-medium intensity, plus resistance exercises for maintain the muscle mass and force, plus stretching and calisthenics to maintain joints motility) can be promoted by few hundred-few ten hundred euros or dollars. Price of gain in Quality/Disability-Adjusted Life Years expressed as Incremental Cost Effectiveness/Utility Ratio is known, estimated or modelled, and offers a good value of money.

Quality, the Enhancement of a University's Teaching and Learning and the Role of Quality Officers

Science.gov (United States)

Hodgson, Kath; Whalley, Gordon

2006-01-01

There has been, and remains, much criticism of the external monitoring of the quality of universities' learning and teaching by bodies such as the QAA largely on the grounds that it is essentially a bureaucratic collection of data that does little, if anything, to help in improving or enhancing the learning and teaching. In this article, while…

A Software Reuse Approach and Its Effect On Software Quality, An Empirical Study for The Software Industry

OpenAIRE

Mateen, Ahmed; Kausar, Samina; Sattar, Ahsan Raza

2017-01-01

Software reusability has become much interesting because of increased quality and reduce cost. A good process of software reuse leads to enhance the reliability, productivity, quality and the reduction of time and cost. Current reuse techniques focuses on the reuse of software artifact which grounded on anticipated functionality whereas, the non-functional (quality) aspect are also important. So, Software reusability used here to expand quality and productivity of software. It improves overal...

Impact of transaction costs on healthcare outcomes.

Science.gov (United States)

Stiles, Renée A; So, Stephanie A

2003-06-01

This article reviews transaction cost economics to frame a discussion of how inefficiencies in healthcare delivery processes affect clinical outcomes and differentiate between inefficiencies that are tractable from those that are transitional or intractable. Recognizing and quantifying these effects improves the ability of organizations to calculate returns on investment in quality improvement, research and development and related value enhancing, but it is subject to high-risk undertakings.

Enhancing the quality and credibility of qualitative analysis.

Science.gov (United States)

Patton, M Q

1999-12-01

Varying philosophical and theoretical orientations to qualitative inquiry remind us that issues of quality and credibility intersect with audience and intended research purposes. This overview examines ways of enhancing the quality and credibility of qualitative analysis by dealing with three distinct but related inquiry concerns: rigorous techniques and methods for gathering and analyzing qualitative data, including attention to validity, reliability, and triangulation; the credibility, competence, and perceived trustworthiness of the qualitative researcher; and the philosophical beliefs of evaluation users about such paradigm-based preferences as objectivity versus subjectivity, truth versus perspective, and generalizations versus extrapolations. Although this overview examines some general approaches to issues of credibility and data quality in qualitative analysis, it is important to acknowledge that particular philosophical underpinnings, specific paradigms, and special purposes for qualitative inquiry will typically include additional or substitute criteria for assuring and judging quality, validity, and credibility. Moreover, the context for these considerations has evolved. In early literature on evaluation methods the debate between qualitative and quantitative methodologists was often strident. In recent years the debate has softened. A consensus has gradually emerged that the important challenge is to match appropriately the methods to empirical questions and issues, and not to universally advocate any single methodological approach for all problems.

Challenges of healthcare administration: optimizing quality and value at an affordable cost in pediatric cardiology.

Science.gov (United States)

Cohen, Mitchell I; Frias, Patricio A

2018-01-01

The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient. Physicians and hospitals need to align in a team-based approach that allows physicians to understand current costs and how to strive toward a focus on healthcare outcomes. Pediatric cardiology is a unique discipline that cares for patients with complex congenital conditions that will span their lifetime and also involves not just cardiology but surgery, intensive care, anesthesia, nursing, and a host of inpatient and ambulatory services. Understanding what matters to the patient and his/her family and presenting quality outcomes in a transparent fashion will gradually allow a shift to take place away from physician visits, tests ordered, and procedures performed. This can only be achieved with physicians, given the appropriate tools to understand costs, value, and outcomes and models where the hospitals and physicians are aligned. The transformation to a value-based healthcare system is beginning and pediatric cardiologists need to be educated, given the appropriate resources, receive appropriate feedback, and patients need to be part of the solution so that care providers can understand what matters most to them.

Analysis of the costs and quality of cardiovascular care in oncological monitoring

Directory of Open Access Journals (Sweden)

Élide Sbardellotto Mariano da Costa

Full Text Available Summary Objective: To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. Method: We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. Results: 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%, followed by complementary exams (37%, consultations (8% and emergency care (4%. Conclusion: The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

Science.gov (United States)

Drewnowski, Adam

2015-01-01

Context: It is well established in the literature that healthier diets cost more than unhealthy diets. Objective: The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. Data Sources: A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Study Selection: Publications linking food prices, dietary quality, and socioeconomic status were selected. Data Extraction: Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Data Synthesis: Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Conclusions: Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health. PMID:26307238

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis.

Science.gov (United States)

Darmon, Nicole; Drewnowski, Adam

2015-10-01

It is well established in the literature that healthier diets cost more than unhealthy diets. The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Publications linking food prices, dietary quality, and socioeconomic status were selected. Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute.

Collaborative Network Management for Enhancing Quality Education of Primary Schools

Science.gov (United States)

Chaikoed, Wisithsak; Sirisuthi, Chaiyuth; Numnaphol, Kochaporn

2017-01-01

This research aims to study the network and collaborative factors that enhance quality education of primary schools. Different methods were used in this research work: (1) Related approaches, theories, and research literatures and (2) Scholars were interviewed on 871 issues in the form of questionnaire, and the collaborative network factors were…

Enhancing Cellular Coverage Quality by Virtual Access Point and Wireless Power Transfer

Directory of Open Access Journals (Sweden)

Jinsong Gui

2018-01-01

Full Text Available The ultradensification deploying for cellular networks is a direct and effective method for the improvement of network capacity. However, the benefit is achieved at the cost of network infrastructure investment and operating overheads, especially when there is big gap between peak-hour Internet traffic and average one. Therefore, we put forward the concept of virtual cellular coverage area, where wireless terminals with high-end configuration are motivated to enhance cellular coverage quality by both providing RF energy compensation and rewarding free traffic access to Internet. This problem is formulated as the Stackelberg game based on three-party circular decision, where a Macro BS (MBS acts as the leader to offer a charging power to Energy Transferring Relays (ETRs, and the ETRs and their associating Virtual Access Points (VAPs act as the followers to make their decisions, respectively. According to the feedback from the followers, the leader may readjust its strategy. The circular decision is repeated until the powers converge. Also, the better response algorithm for each game player is proposed to iteratively achieve the Stackelberg-Nash Equilibrium (SNE. Theoretical analysis proves the convergence of the proposed game scheme, and simulation results demonstrate its effectiveness.

Revised cost savings estimate with uncertainty for enhanced sludge washing of underground storage tank waste

International Nuclear Information System (INIS)

DeMuth, S.

1998-01-01

Enhanced Sludge Washing (ESW) has been selected to reduce the amount of sludge-based underground storage tank (UST) high-level waste at the Hanford site. During the past several years, studies have been conducted to determine the cost savings derived from the implementation of ESW. The tank waste inventory and ESW performance continues to be revised as characterization and development efforts advance. This study provides a new cost savings estimate based upon the most recent inventory and ESW performance revisions, and includes an estimate of the associated cost uncertainty. Whereas the author's previous cost savings estimates for ESW were compared against no sludge washing, this study assumes the baseline to be simple water washing which more accurately reflects the retrieval activity along. The revised ESW cost savings estimate for all UST waste at Hanford is $6.1 B ± $1.3 B within 95% confidence. This is based upon capital and operating cost savings, but does not include development costs. The development costs are assumed negligible since they should be at least an order of magnitude less than the savings. The overall cost savings uncertainty was derived from process performance uncertainties and baseline remediation cost uncertainties, as determined by the author's engineering judgment

Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low- and middle-income countries.

Science.gov (United States)

Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

2014-01-01

Many define an equitable health care system as one that provides logistical and financial access to "quality" care to the population. Realizing that fact, many low- and middle-income countries started investing in enhancing the quality of care in their health care systems, recently in primary health care. Unfortunately, in many instance, these investments have been exclusively focused on accreditation due to available guidelines and existing accrediting structures. A multi-track quality-enhancing strategy (MTQES) is proposed that includes, in addition to promoting resource-sensitive accreditation, other quality initiatives such as clinical guidelines, performance indicators, benchmarking activities, annual quality-enhancing projects, and annual quality summit/meeting. These complementary approaches are presented to synergistically enhance a continuous quality improvement culture in the primary health care sector, taking into consideration limited resources available, especially in low- and middle-income countries. In addition, an implementation framework depicting MTQES in three-phase interlinked packages is presented; each matches existing resources and quality infrastructure. Health care policymakers and managers need to think about accreditation as a beginning rather than an end to their quest for quality. Improvements in the structure of a health delivery organization or in the processes of care have little value if they do not translate to reduced disparities in access to "quality" care, and not merely access to care.

Comparing data quality and cost from three modes of on-board transit passenger surveys.

Science.gov (United States)

2015-06-01

This report presents the findings from a research project investigating the relative data quality and administration costs for three : different modes of surveying bus passengers that produce results generalizable to the full passenger population. Th...

External tank program productivity and quality enhancements - A case study

Science.gov (United States)

Locke, S. R.

1988-01-01

The optimization of the Manned Space Systems productivity and quality enhancement program is described. The guidelines and standards of the program and the roles played in it by various employee groups are addressed. Aspects of the program involving job/organization redefinition, production and planning in automation, and artificial intelligence and robotics are examined.

Species integrity enhanced by a predation cost to hybrids in the wild

DEFF Research Database (Denmark)

Nilsson, P. A.; Hulthén, Kaj; Chapman, Ben B.

2017-01-01

Species integrity can be challenged, and even eroded, if closely related species can hybridize and produce fertile offspring of comparable fitness to that of parental species. The maintenance of newly diverged or closely related species therefore hinges on the establishment and effectiveness of pre...... barrier to gene flow in the wild. Cyprinid fishes commonly produce fertile, viable hybrid offspring and therefore make excellent study organisms to investigate ecological costs to hybrids. We electronically tagged two freshwater cyprinid fish species (roach Rutilus rutilus and bream Abramis brama...... to directly test for a predation cost to hybrids in the wild. Hybrid individuals were found significantly more susceptible to cormorant predation than individuals from either parental species. Such ecological selection against hybrids contributes to species integrity, and can enhance species diversification....

Template matching for auditing hospital cost and quality.

Science.gov (United States)

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Mukherjee, Nabanita; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-10-01

Develop an improved method for auditing hospital cost and quality. Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006. A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period. From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching. The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes. The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring. © Health Research and Educational Trust.

Modelo PEF de costes de la calidad como herramienta de gestión en empresas constructoras: una visión actual Quality costs PEF model as a management tool in construction firms: a present vision

Directory of Open Access Journals (Sweden)

Santos Gracia Villar

2007-04-01

Full Text Available Los costes de la calidad representan una herramienta de planificación de la calidad, que permite la medición de la mejora continua. Se realizó una revisión bibliográfica y discusión de las publicaciones actuales sobre los modelos genéricos de costes de la calidad. Se observó que el modelo genérico empleado con mayor frecuencia, sigue siendo el enfoque tradicional PEF (prevención, evaluación y fallos. De esta manera, se plantea este modelo en el contexto de las empresas constructoras, como herramienta de gestión de la calidad, destacando la forma en que la gestión eficaz de estos, puede reflejarse en las utilidades y productividad de dicha empresa. De igual manera, se sugiere que los costes de la calidad pueden calcularse y ser expresados en forma contable, proporcionando un parámetro en el que podemos decidir sobre los beneficios que trae su control. El objetivo de un sistema de costes de la calidad es encontrar el nivel de calidad requerido para minimizar los costes de la calidad totales, esto dará la seguridad que dicha empresa constructora esta funcionando de manera óptima con relación a sus procesos y productosThe quality costs are a quality management tool to measure the continual improvement. It was made a bibliographical revision and discussion of present publications on the generic models of quality costs. It was observed that the most frequently used generic model, continues being traditional approach PAF (prevention, appraisal and failures. So, this model was established in a construction firm context as a quality management tool, pointing out the form in that the effective management of these can be reflected in the utilities and productivity of a construction firm. Also, is suggested that quality costs can be calculated and be recorded in a countable form, providing a parameter to decide on the benefits that its control brings. The objective of a quality costs system is to find the level of quality that minimizes

Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease.

Science.gov (United States)

Mundt, Marlon P; Gilchrist, Valerie J; Fleming, Michael F; Zakletskaia, Larissa I; Tuan, Wen-Jan; Beasley, John W

2015-03-01

Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50-0.77) and lower medical care costs (-$556; 95% CI, -$781 to -$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09-1.94) and greater costs ($506; 95% CI, $202-$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver high-quality cardiovascular disease care at a lower cost. © 2015 Annals of Family Medicine, Inc.

Enhancing Tomo-PIV reconstruction quality by reducing ghost particles

International Nuclear Information System (INIS)

De Silva, C M; Baidya, R; Marusic, I

2013-01-01

A technique to enhance the reconstruction quality and consequently the accuracy of the velocity vector field obtained in Tomo-PIV experiments is presented here. The methodology involves detecting and eliminating spurious outliers in the reconstructed intensity field (ghost particles). A simulacrum matching-based reconstruction enhancement (SMRE) technique is proposed, which utilizes the characteristic shape and size of actual particles to remove ghost particles in the reconstructed intensity field. An assessment of SMRE is performed by a quantitative comparison of Tomo-PIV simulation results and DNS data, together with a comparison to Tomo-PIV experimental data measured in a turbulent channel flow at a matched Reynolds number (Re τ = 937) to the DNS study. For the simulation data, a comparative study is performed on the reconstruction quality based on an ideal reconstruction determined from known particle positions. The results suggest that a significant improvement in the reconstruction quality and flow statistics is achievable at typical seeding densities used in Tomo-PIV experiments. This improvement is further amplified at higher seeding densities, enabling the use of up to twice the typical seeding densities currently used in Tomo-PIV experiments. A reduction of spurious vectors present in the velocity field is also observed based on a median outlier detection criterion. The application of SMRE to Tomo-PIV experimental data shows an improvement in flow statistics, comparable to the improvement seen in simulations. Finally, due to the non-iterative nature of SMRE, the increase in processing time is marginal since only a single pass of the reconstruction algorithm is required. (paper)

A comparison between the cost curves in the RAINS-model and the Swedish environmental quality objectives

International Nuclear Information System (INIS)

Sternhufvud, C.; Grennfelt, P.

2001-06-01

The Swedish Parliament has adopted fifteen environmental quality objectives. To be able to attain these goals in a cost-efficient way, cost curves have been created for sulphur dioxide (SO 2 ), nitrogen oxides (NO x ), and volatile organic compounds (VOC). These pollutants are also restricted in international protocols under the Convention on Long-Range Transboundary Air Pollution (CLRTAP). Most of the analyses underlying the protocols have been performed by the Regional Acidification Information and Simulation model (RAINS) developed at the International Institute for Applied Systems Analysis (IIASA) in Austria. This study compare the cost-effectiveness principles used in the RAINS model with the principles used in the proposal to meet the Swedish environmental quality objectives. The two approaches use different methodologies to solve the problem with air pollution and do therefore receive different results. The advantages and disadvantages are discussed in this report

Socioeconomic differences in the cost, availability and quality of healthy food in Sydney.

Science.gov (United States)

Crawford, Belinda; Byun, Roy; Mitchell, Emily; Thompson, Susan; Jalaludin, Bin; Torvaldsen, Siranda

2017-12-01

To compare the cost of a basket of staple foods, together with the availability and quality of fresh fruit and vegetables, by supermarket store type in high and low socioeconomic suburbs of Sydney. A food basket survey was undertaken in 100 supermarkets in the 20 highest and 20 lowest socioeconomic suburbs of Sydney. We assessed the cost of 46 foods, the range of 30 fresh fruit and vegetables and the quality of ten fresh fruit and vegetables. Two major supermarket retailers, a discount supermarket chain and independent grocery stores were surveyed. The food basket was significantly cheaper in low compared to high socioeconomic suburbs ($177 vs $189, ptype and socioeconomic status of suburb. Implications for public health: A nationwide food and nutrition surveillance system is required to inform public health policy and practice initiatives. In addition to the food retail environment, these initiatives must address the underlying contributors to inequity and food insecurity for disadvantaged groups. © 2017 The Authors.

Cost effectiveness analysis in radiopharmacy

International Nuclear Information System (INIS)

Carpentier, N.; Verbeke, S.; Ducloux, T.

1999-01-01

Objective: to evaluate the cost effectiveness of radiopharmaceuticals and their quality control. Materials and methods: this retrospective study was made in the Nuclear Medicine Department of the University Hospital of Limoges. Radiopharmaceutical costs were obtained with adding the price of the radiotracer, the materials, the equipments, the labour, the running expenses and the radioisotope. The costs of quality control were obtained with adding the price of labour, materials, equipments, running expenses and the cost of the quality control of 99m Tc eluate. Results: during 1998, 2106 radiopharmaceuticals were prepared in the Nuclear Medicine Department. The mean cost effectiveness of radiopharmaceutical was 1430 francs (846 to 4260). The mean cost effectiveness of quality control was 163 francs (84 to 343). The rise of the radiopharmaceutical cost induced by quality control was 11%. Conclusion: the technical methodology of quality control must be mastered to optimize the cost of this operation. (author)

A design technique of low cost but high quality peak stretcher

Energy Technology Data Exchange (ETDEWEB)

Lo, H Y; Su, C S; Hsu, J Y; Wang, L

1981-03-01

This paper presents the design of low cost but high quality pulse peak stretcher incorporated with a LSI of 12 bit ADC and SKD-85 microcomputer. The conflict between the capacitor high charging speed and longer holding time for realizing a high quality stretcher is discussed and solved. For a lager number of channels available in a dual ramp Wilkinson-type ADC, two-stage stretchers connected in series are designed. The first stage is a fast-discharge to keep the output stretched pulse follow-up the input quickly and the second-stage (main stretcher) is a slow-discharge to keep the transient of the circuit minimum. Both of these two peak stretchers are described and the experiment results are photographically recorded.

Evaluating quality of life and cost implications of prophylactic radiotherapy in mesothelioma: Health economic analysis of the SMART trial.

Science.gov (United States)

Stewart, Samuel Alan; Clive, Amelia O; Maskell, Nick A; Penz, Erika

2018-01-01

The SMART trial is a UK-based, multicentre RCT comparing prophylactic radiotherapy and symptom-based (deferred) radiotherapy in 203 patients with Malignant Pleural Mesothelioma who had undergone large bore pleural interventions. Using costs and quality of life data collected alongside the clinical trial, we will estimate the cost-effectiveness of prophylactic radiotherapy compared to deferred radiotherapy over a 1-year period. Healthcare utilization and costs were captured during the trial. Utility weights produced by the EQ-5D questionnaire were used to determine quality-adjusted life-years (QALY) gained. The incremental cost-effectiveness ratio was calculated over the one-year trial period. Costs were similar in the immediate and deferred radiotherapy groups: £5480.40 (SD = £7040; n = 102) and £5461.40 (SD = £7770; n = 101) respectively. There was also no difference in QALY: 0.498 (95% CI: [0.45, 0.547]) in the prophylactic radiotherapy group versus 0.525 (95% CI: [0.471, 0.580]) in the deferred group. At a willingness to pay threshold of £30,000/QALY there was only a 24% chance that prophylactic radiotherapy was cost-effective compared to deferred radiotherapy. There was no significant effect of prophylactic radiotherapy on quality of life in the intervention group, nor was there any discernable decrease in healthcare costs. There is little evidence to suggest that prophylactic radiotherapy is a cost-effective intervention in this population. ISRCTN72767336 with ISRCTN.

Evaluating quality of life and cost implications of prophylactic radiotherapy in mesothelioma: Health economic analysis of the SMART trial.

Directory of Open Access Journals (Sweden)

Samuel Alan Stewart

Full Text Available The SMART trial is a UK-based, multicentre RCT comparing prophylactic radiotherapy and symptom-based (deferred radiotherapy in 203 patients with Malignant Pleural Mesothelioma who had undergone large bore pleural interventions. Using costs and quality of life data collected alongside the clinical trial, we will estimate the cost-effectiveness of prophylactic radiotherapy compared to deferred radiotherapy over a 1-year period.Healthcare utilization and costs were captured during the trial. Utility weights produced by the EQ-5D questionnaire were used to determine quality-adjusted life-years (QALY gained. The incremental cost-effectiveness ratio was calculated over the one-year trial period.Costs were similar in the immediate and deferred radiotherapy groups: £5480.40 (SD = £7040; n = 102 and £5461.40 (SD = £7770; n = 101 respectively. There was also no difference in QALY: 0.498 (95% CI: [0.45, 0.547] in the prophylactic radiotherapy group versus 0.525 (95% CI: [0.471, 0.580] in the deferred group. At a willingness to pay threshold of £30,000/QALY there was only a 24% chance that prophylactic radiotherapy was cost-effective compared to deferred radiotherapy.There was no significant effect of prophylactic radiotherapy on quality of life in the intervention group, nor was there any discernable decrease in healthcare costs. There is little evidence to suggest that prophylactic radiotherapy is a cost-effective intervention in this population.ISRCTN72767336 with ISRCTN.

A Novel Approach To Mineral Carbonation: Enhancing Carbonation While Avoiding Mineral Pretreatment Process Cost

Energy Technology Data Exchange (ETDEWEB)

Michael J. McKelvy; Andrew V. G. Chizmeshya; Kyle Squires; Ray W. Carpenter; Hamdallah Bearat

2006-06-21

Known fossil fuel reserves, especially coal, can support global energy demands for centuries to come, if the environmental problems associated with CO{sub 2} emissions can be overcome. Unlike other CO{sub 2} sequestration candidate technologies that propose long-term storage, mineral sequestration provides permanent disposal by forming geologically stable mineral carbonates. Carbonation of the widely occurring mineral olivine (e.g., forsterite, Mg{sub 2}SiO{sub 4}) is a large-scale sequestration process candidate for regional implementation, which converts CO{sub 2} into the environmentally benign mineral magnesite (MgCO{sub 3}). The primary goal is cost-competitive process development. As the process is exothermic, it inherently offers low-cost potential. Enhancing carbonation reactivity is key to economic viability. Recent studies at the U.S. DOE Albany Research Center have established that aqueous-solution carbonation using supercritical CO{sub 2} is a promising process; even without olivine activation, 30-50% carbonation has been achieved in an hour. Mechanical activation (e.g., attrition) has accelerated the carbonation process to an industrial timescale (i.e., near completion in less than an hour), at reduced pressure and temperature. However, the activation cost is too high to be economical and lower cost pretreatment options are needed. Herein, we report our second year progress in exploring a novel approach that offers the potential to substantially enhance carbonation reactivity while bypassing pretreatment activation. As our second year progress is intimately related to our earlier work, the report is presented in that context to provide better overall understanding of the progress made. We have discovered that robust silica-rich passivating layers form on the olivine surface during carbonation. As carbonation proceeds, these passivating layers thicken, fracture and eventually exfoliate, exposing fresh olivine surfaces during rapidly

A cost-effectiveness analysis of hormone replacement therapy in the menopause.

Science.gov (United States)

Cheung, A P; Wren, B G

1992-03-02

To evaluate the cost-effectiveness of hormone replacement therapy in the menopause with particular reference to osteoporotic fracture and myocardial infarction. The multiple-decrement form of the life table was the mathematical model used to follow women of age 50 through their lifetime under the "no hormone replacement" and "hormone replacement" assumptions. Standard demographic and health economic techniques were used to calculate the corresponding lifetime differences in direct health care costs (net costs in dollars) and health effects ("net effectiveness" in terms of life expectancy and quality, in "quality-adjusted life-years"). This was then expressed as a cost-effectiveness ratio or the cost ($) per quality-adjusted life-year (QALY) for each of the chosen hormone replacement regimens. All women of age 50 in New South Wales, Australia (n = 27,021). The analysis showed that the lifetime net increments in direct medical care costs were largely contributed by hormone drug and consultation costs. Hormone replacement was associated with increased quality-adjusted life expectancy, a large percentage of which was attributed to a relief of menopausal symptoms. Cost-effectiveness ratios ranged from under 10,000 to over a million dollars per QALY. Factors associated with improved cost-effectiveness were prolonged treatment duration, the presence of menopausal symptoms, minimum progestogen side effects (in the case of oestrogen with progestogen regimens), oestrogen use after hysterectomy and the inclusion of cardiac benefits in addition to fracture prevention. Hormone replacement therapy for symptomatic women is cost-effective when factors that enhance its efficiency are considered. Short-term treatment of asymptomatic women for prevention of osteoporotic fractures and myocardial infarction is an inefficient use of health resources. Cost-effectiveness of hormone replacement in asymptomatic women is dependent on the magnitude of cardiac benefits associated with hormone

Efficacy of Flaxseed Flour as Bind Enhancing Agent on the Quality of Extended Restructured Mutton Chops

Directory of Open Access Journals (Sweden)

Heena Sharma

2014-02-01

Full Text Available Consumers have become very conscious about their nutrition and well being due to changes in their socio-economic lifestyle and rapid urbanization. Therefore, development of technology for production of low cost and functional meat products is urgently required. One such approach is innovative restructuring technology in which binding of meat pieces still remains the main challenge and extension of product is generally associated with poor binding and texture. Thus, the present study was envisaged as an attempt to solve this problem by the incorporation of flaxseed flour (FF as bind enhancing agent. The FF was used at three different levels viz., 0.5%, 1%, and 1.5% to replace lean meat in pre-standardized restructured mutton chops formulation. The products were subjected to analysis for physico-chemical, sensory and textural properties. Cooking yield, moisture percentage and fat percentage increased with increase in the level of incorporation of FF, however, protein percent and pH decreased with increase in the level of incorporation. Shear force value of product incorporated with 1.5% FF was significantly higher (p<0.01 than control and product containing 0.5% FF level. Among the sensory attributes, product with 1% flaxseed flour showed significantly higher values (p<0.05 for general appearance, binding, texture and overall acceptability. Hardness showed significant increasing (p<0.01 values with increasing levels of incorporation of flaxseed flour, however all other parameters of texture profile analysis showed a decreasing trend. On the basis of sensory scores and physico-chemical properties, the optimum incorporation level of FF was adjudged as 1%. Products incorporated with optimum level of flaxseed flour (1% were also assessed for water activity and microbiological quality during the storage period of 15 days. It was found that the extended restructured product could be safely stored under refrigeration (4°C±1°C in low density

Low-Cost Quality Control and Nondestructive Evaluation Technologies for General Aviation Structures

Science.gov (United States)

Cramer, K. Elliott; Gavinsky, Bob; Semanskee, Grant

1998-01-01

NASA's Advanced General Aviation Transport Experiments (AGATE) Program has as a goal to reduce the overall cost of producing private aviation aircraft while maintaining the safety of these aircraft. In order to successfully meet this goal, it is necessary to develop nondestructive inspection techniques which will facilitate the production of the materials used in these aircraft and assure the quality necessary to maintain airworthiness. This paper will discuss a particular class of general aviation materials and several nondestructive inspection techniques that have proven effective for making these inspections. Additionally, this paper will discuss the investigation and application of other commercially available quality control techniques applicable to these structures.

Ownership, competition, and the adoption of new technologies and cost-saving practices in a fixed-price environment.

Science.gov (United States)

Hirth, R A; Chernew, M E; Orzol, S M

2000-01-01

Advances in medical technology have been implicated as the primary cause of rising health care expenditures. It is not yet known whether the increasing prevalence of managed care mechanisms, particularly capitation, will change substantially incentives for acquiring and using cost-increasing innovations. We examined the decisions of dialysis units (a set of providers that has faced capitation and real decreases in payment for several decades) with respect to use of cost-increasing technologies that enhance quality of care, cost-cutting practices that reduce quality of care, and amenities desired by patients that are unrelated to quality of care. We found that the dialysis payment system does not appear to have blocked access to a number of new, quality-enhancing technologies that were developed in the 1980s. However, facilities made adjustments along other valuable margins to facilitate adoption of these technologies; use of new technologies varied with numerous facility, regulatory, and case-mix characteristics including ownership, chain membership, size, market competition, and certificate of need programs. Interestingly, the trade-offs made by for-profit and nonprofit facilities when faced with fixed prices appeared quite different. For-profits tended to deliver lower technical quality of care but more amenities, while nonprofits favored technical quality of care over amenities. Our findings may have implications for the response of other types of health care providers to capitation and increasing economic constraints.

Using complaints to enhance quality improvement: developing an analytical tool.

Science.gov (United States)

Hsieh, Sophie Yahui

2012-01-01

This study aims to construct an instrument for identifying certain attributes or capabilities that might enable healthcare staff to use complaints to improve service quality. PubMed and ProQuest were searched, which in turn expanded access to other literature. Three paramount dimensions emerged for healthcare quality management systems: managerial, operational, and technical (MOT). The paper reveals that the managerial dimension relates to quality improvement program infrastructure. It contains strategy, structure, leadership, people and culture. The operational dimension relates to implementation processes: organizational changes and barriers when using complaints to enhance quality. The technical dimension emphasizes the skills, techniques or information systems required to achieve successfully continuous quality improvement. The MOT model was developed by drawing from the relevant literature. However, individuals have different training, interests and experiences and, therefore, there will be variance between researchers when generating the MOT model. The MOT components can be the guidelines for examining whether patient complaints are used to improve service quality. However, the model needs testing and validating by conducting further research before becoming a theory. Empirical studies on patient complaints did not identify any analytical tool that could be used to explore how complaints can drive quality improvement. This study developed an instrument for identifying certain attributes or capabilities that might enable healthcare professionals to use complaints and improve service quality.

The two (quality) faces of HCHP (Harvard Community Health Plan).

Science.gov (United States)

Burda, D

1991-03-18

When it comes to total quality management, Harvard Community Health Plan has two personalities. It's using the principles espoused by such TQM gurus as Joseph Juran to reduce costs and improve quality in its clinics and offices. But HCHP also is enhancing its image in the healthcare industry by teaching TQM principles to others for big bucks.

The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital.

Science.gov (United States)

Wang, Hsiu-Ling; Huang, Jun-Ying; Howng, Shen-Long

2011-02-01

The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician-patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.

Delivery system characteristics and their association with quality and costs of care: implications for accountable care organizations.

Science.gov (United States)

Chukmaitov, Askar; Harless, David W; Bazzoli, Gloria J; Carretta, Henry J; Siangphoe, Umaporn

2015-01-01

Implementation of accountable care organizations (ACOs) is currently underway, but there is limited empirical evidence on the merits of the ACO model. The aim was to study the associations between delivery system characteristics and ACO competencies, including centralization strategies to manage organizations, hospital integration with physicians and outpatient facilities, health information technology, infrastructure to monitor community health and report quality, and risk-adjusted 30-day all-cause mortality and case-mixed-adjusted inpatient costs for the Medicare population. Panel data (2006-2009) were assembled from Florida and multiple sources: inpatient hospital discharge, vital statistics, the American Hospital Association, the Healthcare Information and Management Systems Society, and other databases. We applied a panel study design, controlling for hospital and market characteristics. Hospitals that were in centralized health systems or became more centralized over the study period had significantly larger reductions in mortality compared with hospitals that remained freestanding. Surprisingly, tightly integrated hospital-physician arrangements were associated with increased mortality; as such, hospitals may wish to proceed cautiously when developing specific types of alignment with local physician organizations. We observed no statistically significant differences in the growth rate of costs across hospitals in any of the health systems studied relative to freestanding hospitals. Although we observed quality improvement in some organizational types, these outcome improvements were not coupled with the additional desired objective of lower cost growth. This implies that additional changes not present during our study period, potentially changes in provider payment approaches, are essential for achieving the ACO objectives of higher quality of care at lower costs. Provider organizations implementing ACOs should consider centralizing service delivery as a

Quality of Context Enhancements and Cost Effective Radio over Fiber Network Planning

DEFF Research Database (Denmark)

Shawky, Ahmed Sherif Mahmoud

In Communication networks today there is an endless quest for increased capacity and improved quality. With wireless systems being now popular worldwide for allowing users and devices to communicate and share information with each other irrespective of their location, the development of sustainable...... into dynamic context information reliability by developing models and online algorithms that ensure increased reliability for context information exchange. Eventually, the PhD looks into improving network planning by implementing an automated network planning model that takes advantage of both Radio over Fiber...... services. The increased number of mobile users puts a demand on today's networks in terms of application sensitivity, mobility and reliability. Mobile operators are offering various context-aware services and applications to the user. Today, mobile users are demanding access to dynamic context information...

A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

Science.gov (United States)

Harris, G T; Olukoga, I A

2005-04-01

To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.

Cost effectiveness of novel oral anticoagulants for stroke prevention in atrial fibrillation depending on the quality of warfarin anticoagulation control.

Science.gov (United States)

Janzic, Andrej; Kos, Mitja

2015-04-01

Vitamin K antagonists, such as warfarin, are standard treatments for stroke prophylaxis in patients with atrial fibrillation. Patient outcomes depend on quality of warfarin management, which includes regular monitoring and dose adjustments. Recently, novel oral anticoagulants (NOACs) that do not require regular monitoring offer an alternative to warfarin. The aim of this study was to evaluate whether cost effectiveness of NOACs for stroke prevention in atrial fibrillation depends on the quality of warfarin control. We developed a Markov decision model to simulate warfarin treatment outcomes in relation to the quality of anticoagulation control, expressed as percentage of time in the therapeutic range (TTR). Standard treatment with adjusted-dose warfarin and improved anticoagulation control by genotype-guided dosing were compared with dabigatran, rivaroxaban, apixaban and edoxaban. The analysis was performed from the Slovenian healthcare payer perspective using 2014 costs. In the base case, the incremental cost-effectiveness ratio for apixaban, dabigatran and edoxaban was below the threshold of €25,000 per quality-adjusted life-years compared with adjusted-dose warfarin with a TTR of 60%. The probability that warfarin was a cost-effective option was around 1%. This percentage rises as the quality of anticoagulation control improves. At a TTR of 70%, warfarin was the preferred treatment in half the iterations. The cost effectiveness of NOACs for stroke prevention in patients with nonvalvular atrial fibrillation who are at increased risk for stroke is highly sensitive to warfarin anticoagulation control. NOACs are more likely to be cost-effective options in settings with poor warfarin management than in settings with better anticoagulation control, where they may not represent good value for money.

Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis.

Science.gov (United States)

Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Sullivan, Patrick W

2011-04-01

In October 2008, Centers for Medicare and Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus placing stress on hospitals to prevent incidence of this costly condition. To evaluate whether prevention methods are cost-effective compared with standard care in the management of HAPUs. A semi-Markov model simulated the admission of patients to an acute care hospital from the time of admission through 1 year using the societal perspective. The model simulated health states that could potentially lead to an HAPU through either the practice of "prevention" or "standard care." Univariate sensitivity analyses, threshold analyses, and Bayesian multivariate probabilistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted. Cost per quality-adjusted life-years (QALYs) gained for the prevention of HAPUs. Prevention was cost saving and resulted in greater expected effectiveness compared with the standard care approach per hospitalization. The expected cost of prevention was $7276.35, and the expected effectiveness was 11.241 QALYs. The expected cost for standard care was $10,053.95, and the expected effectiveness was 9.342 QALYs. The multivariate probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.99% of the simulations. The threshold cost of prevention was $821.53 per day per person, whereas the cost of prevention was estimated to be $54.66 per day per person. This study suggests that it is more cost effective to pay for prevention of HAPUs compared with standard care. Continuous preventive care of HAPUs in acutely ill patients could potentially reduce incidence and prevalence, as well as lead to lower expenditures.

Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: A systematic review of systematic reviews and meta-analyses

NARCIS (Netherlands)

N.J. Elbert (Niels); H. van Os-Medendorp (Harmieke); W. van Renselaar (Wilco); A.G. Ekeland (Anne G); L. van Hakkaart-van Roijen (Leona); H. Raat (Hein); T.E.C. Nijsten (Tamar); S.G.M.A. Pasmans (Suzanne)

2014-01-01

textabstractEHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. Objective: We conducted a systematic review of

Enhancement of radiological protection through an internal quality assessment cycle

International Nuclear Information System (INIS)

Figueiredo, Filipe Morais de; Gama, Zenewton Andre da Silva

2012-01-01

Objective: To determine the level of quality in radiation protection of patients during radiological examination, evaluating the effectiveness of an intervention aimed at enhancing the quality of such a protection. Materials and Methods: A quality improvement cycle was implemented in a radiology service of the Regional Health Administration, in Algarve, Portugal. Based on six quality criteria, an initial evaluation was performed and followed by an intervention focused on the most problematic points (over an eight-month period) and a subsequent quality reassessment. A random sampling (n = 60) has allowed the authors to infer the point estimates and confidence intervals for each criterion, as well as calculating the statistical significance of the results by means of the Z-test. Results: Initially, deficiencies were observed in relation to all the quality criteria. After the intervention, a minimum relative improvement of 33% was observed in five of the six criteria, with statistical significance (p < 0.05) in two of them. The absolute frequency of noncompliance decreased from 38 (first evaluation) to 21 (second evaluation), corresponding to a 44.7% improvement. Conclusion: The first institutional evaluation cycle showed a seemingly incipient improvement margin. However, the implemented intervention was effective in stimulating good practices and improving the level of radiological protection of patients. (author)

[Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis].

Science.gov (United States)

García-Ruiz, A J; Quintano Jiménez, J A; García-Agua Soler, N; Ginel Mendoza, L; Hidalgo Requena, A; Del Moral, F

2016-01-01

To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Conceptualizing how group singing may enhance quality of life with Parkinson's disease.

Science.gov (United States)

Buetow, Stephen A; Talmage, Alison; McCann, Clare; Fogg, Laura; Purdy, Suzanne

2014-01-01

Abstract Purpose: Group singing could be a promising component of neurorehabilitative care. This article aims to conceptualize how group singing may enable people with Parkinson's disease (PD) to synchronize their movement patterns to musical rhythm and enhance quality of life. Spanning the medical and social sciences, the article draws conceptually on literature on PD, group singing and rhythm in music; personal experience; and reasoning. Conceptualizing PD in terms of disruptions to social and biological rhythms, we hypothesize how group singing may produce two socio-psychological states - connectedness and flow - that may entrain rhythm in people with PD. The states connect during group singing to elicit and enhance motor processes but may also reawaken after the group singing, through the recall and reactivation of the musical rhythms encoded during group singing. In people with PD, this continuity of flow is hypothesized to be conducive to rhythmic entrainment during and after group singing and in turn to reduced deficits in motor timing and emotional processing, and improvements in quality of life. Empirical studies are needed to test this hypothesis in people with movement disorders such as PD. Implications for Rehabilitation Musical rhythm in group singing may enhance quality of life, and rehabilitation, in people with PD. Use group singing to produce two socio-psychological states - connectedness and flow - that may yield these health benefits. Include people with PD in singing groups to facilitate perceptual exposure to familiar music with melodic distinctiveness and a regular beat.

Solitary pulmonary nodules: Impact of quantitative contrast-enhanced CT on the cost-effectiveness of FDG-PET

International Nuclear Information System (INIS)

Comber, L.A.; Keith, C.J.; Griffiths, M.; Miles, K.A.

2003-01-01

AIM: To determine the impact of quantitative contrast-enhanced computed tomography (QECT) on the cost-effectiveness of diagnostic strategies for the assessment of solitary pulmonary nodules (SPNs). MATERIALS AND METHODS: Four diagnostic strategies were evaluated using decision tree analysis: conventional CT alone; conventional CT followed by QECT; conventional CT followed positron emission tomography (PET); and conventional CT followed by QECT and PET (QECT+PET). The average cost per patient, accuracy of management and incremental cost:accuracy ratio (ICAR) were determined for each strategy. Although baseline assumptions reflected the Australian setting, sensitivity analysis was used to extrapolate the results to the UK. RESULTS: At the baseline prevalence of malignancy (54%) and cost of PET relative to surgery (16%), the QECT strategy incurs the least cost ($5560/patient) but the QECT+PET strategy is the most cost-effective (ICAR $12059/patient). At reported levels of disease prevalence (68.5%) and cost of PET relative to surgery (29.9%) in the UK, the QECT strategy is the most cost-effective. CONCLUSION: QECT offers a cost-effective approach to evaluation of SPNs. Whether QECT is used alone or in combination with PET will depend upon local availability and regional values for prior probability of malignancy within SPNs and the cost of PET relative to surgery

IMPROVING BIOMASS LOGISTICS COST WITHIN AGRONOMIC SUSTAINABILITY CONSTRAINTS AND BIOMASS QUALITY TARGETS

Energy Technology Data Exchange (ETDEWEB)

J. Richard Hess; Kevin L. Kenney; Christopher T. Wright; David J. Muth; William Smith

2012-10-01

Equipment manufacturers have made rapid improvements in biomass harvesting and handling equipment. These improvements have increased transportation and handling efficiencies due to higher biomass densities and reduced losses. Improvements in grinder efficiencies and capacity have reduced biomass grinding costs. Biomass collection efficiencies (the ratio of biomass collected to the amount available in the field) as high as 75% for crop residues and greater than 90% for perennial energy crops have also been demonstrated. However, as collection rates increase, the fraction of entrained soil in the biomass increases, and high biomass residue removal rates can violate agronomic sustainability limits. Advancements in quantifying multi-factor sustainability limits to increase removal rate as guided by sustainable residue removal plans, and mitigating soil contamination through targeted removal rates based on soil type and residue type/fraction is allowing the use of new high efficiency harvesting equipment and methods. As another consideration, single pass harvesting and other technologies that improve harvesting costs cause biomass storage moisture management challenges, which challenges are further perturbed by annual variability in biomass moisture content. Monitoring, sampling, simulation, and analysis provide basis for moisture, time, and quality relationships in storage, which has allowed the development of moisture tolerant storage systems and best management processes that combine moisture content and time to accommodate baled storage of wet material based upon “shelf-life.” The key to improving biomass supply logistics costs has been developing the associated agronomic sustainability and biomass quality technologies and processes that allow the implementation of equipment engineering solutions.

Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

Science.gov (United States)

West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

2012-01-01

Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

Directory of Open Access Journals (Sweden)

Geoffrey K Spurling

2010-10-01

Full Text Available BACKGROUND: Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing. METHODS AND FINDINGS: We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise. Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008, International Pharmaceutical Abstracts (1970 to February 2008, Embase (1997 to February 2008, Current Contents (2001 to 2008, and Central (The Cochrane Library Issue 3, 2007 using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies and other sources (138 studies. Articles were then excluded because they did not fulfil inclusion criteria (179 or quality appraisal criteria (18, leaving 58 included studies with 87 distinct

Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

Science.gov (United States)

Hunt, Priscillia; Hunter, Sarah B; Levan, Deborah

2017-06-01

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. Copyright © 2017. Published by Elsevier Inc.

Full cost accounting for decision making at Ontario Hydro

International Nuclear Information System (INIS)

Plagiannakos, T.

1996-01-01

Ontario Hydro's approach to full cost accounting (FCA) was outlined in response to questions raised earlier, in another forum, regarding Ontario Hydro's views on FCA. FCA was defined as an evaluation framework (as opposed to an accounting system) which tries to account for the internal (private) as well as the external (environment and human health) costs and benefits and integrate them into business decisions. When the external impacts cannot be monetized, qualitative evaluations are used based on the damage costing approach, which Ontario Hydro prefers to the cost of control method recommended by its critics. In general, however, Ontario Hydro is not opposed to FCA in so far as it puts the Utility in a better position to make more informed decisions, improve environmental cost management, avoid future costs, enhance revenue, improve environmental quality, contribute to environmental policy, and contribute to sustainable development. 1 fig

Comparison and cost analysis of drinking water quality monitoring requirements versus practice in seven developing countries.

Science.gov (United States)

Crocker, Jonny; Bartram, Jamie

2014-07-18

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country's ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries.

A conceptual framework for cost management training in the Limpopo Province of South Africa.

Science.gov (United States)

Jooste, Karien; Mothiba, Tebogo Maria

2014-10-01

This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres. The tertiary hospital in the Limpopo province is the first institution to appoint nurse managers with a dual role in cost centres. The development of a conceptual framework for a context-specific programme for Cost Centre Managers is the first of its nature in South Africa. A qualitative, exploratory, descriptive design was followed. The target population included nurse managers (n = 35) formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A focus group and individual interviews were conducted until data saturation occurred. Personal and professional distress, an empowering potential of being a cost centre manager, and the need for decentralized cost centre management were indicated as barriers for nurse managers that led to a framework for a context-specific training programme. There is a need for a context-specific training programme for cost centre managers in a hospital with cost centres. The training of cost centre managers for their dual role in cost centres could enhance cost effectiveness, quality care and staff satisfaction. © 2013 John Wiley & Sons Ltd.

The Cost Effectiveness of the U.S. Export Enhancement Program Bonus Allocation Mechanism

OpenAIRE

Humei Wang; Richard J. Sexton

2004-01-01

The U.S. Export Enhancement Program is evaluated from the perspective of the cost effectiveness of its bonus allocation mechanism. The current mechanism resembles a discriminatory-price, common-value auction. However, auction theory suggests that a discriminatory auction may not be optimal in this setting for several reasons. This article evaluates the current format relative to an alternative, uniform-price auction. Estimation results reveal evidence of strategic bidder behavior under the cu...

Enhancing e-waste estimates: Improving data quality by multivariate Input–Output Analysis

Energy Technology Data Exchange (ETDEWEB)

Wang, Feng, E-mail: fwang@unu.edu [Institute for Sustainability and Peace, United Nations University, Hermann-Ehler-Str. 10, 53113 Bonn (Germany); Design for Sustainability Lab, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628CE Delft (Netherlands); Huisman, Jaco [Institute for Sustainability and Peace, United Nations University, Hermann-Ehler-Str. 10, 53113 Bonn (Germany); Design for Sustainability Lab, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628CE Delft (Netherlands); Stevels, Ab [Design for Sustainability Lab, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628CE Delft (Netherlands); Baldé, Cornelis Peter [Institute for Sustainability and Peace, United Nations University, Hermann-Ehler-Str. 10, 53113 Bonn (Germany); Statistics Netherlands, Henri Faasdreef 312, 2492 JP Den Haag (Netherlands)

2013-11-15

Highlights: • A multivariate Input–Output Analysis method for e-waste estimates is proposed. • Applying multivariate analysis to consolidate data can enhance e-waste estimates. • We examine the influence of model selection and data quality on e-waste estimates. • Datasets of all e-waste related variables in a Dutch case study have been provided. • Accurate modeling of time-variant lifespan distributions is critical for estimate. - Abstract: Waste electrical and electronic equipment (or e-waste) is one of the fastest growing waste streams, which encompasses a wide and increasing spectrum of products. Accurate estimation of e-waste generation is difficult, mainly due to lack of high quality data referred to market and socio-economic dynamics. This paper addresses how to enhance e-waste estimates by providing techniques to increase data quality. An advanced, flexible and multivariate Input–Output Analysis (IOA) method is proposed. It links all three pillars in IOA (product sales, stock and lifespan profiles) to construct mathematical relationships between various data points. By applying this method, the data consolidation steps can generate more accurate time-series datasets from available data pool. This can consequently increase the reliability of e-waste estimates compared to the approach without data processing. A case study in the Netherlands is used to apply the advanced IOA model. As a result, for the first time ever, complete datasets of all three variables for estimating all types of e-waste have been obtained. The result of this study also demonstrates significant disparity between various estimation models, arising from the use of data under different conditions. It shows the importance of applying multivariate approach and multiple sources to improve data quality for modelling, specifically using appropriate time-varying lifespan parameters. Following the case study, a roadmap with a procedural guideline is provided to enhance e

Enhancing e-waste estimates: Improving data quality by multivariate Input–Output Analysis

International Nuclear Information System (INIS)

Wang, Feng; Huisman, Jaco; Stevels, Ab; Baldé, Cornelis Peter

2013-01-01

Highlights: • A multivariate Input–Output Analysis method for e-waste estimates is proposed. • Applying multivariate analysis to consolidate data can enhance e-waste estimates. • We examine the influence of model selection and data quality on e-waste estimates. • Datasets of all e-waste related variables in a Dutch case study have been provided. • Accurate modeling of time-variant lifespan distributions is critical for estimate. - Abstract: Waste electrical and electronic equipment (or e-waste) is one of the fastest growing waste streams, which encompasses a wide and increasing spectrum of products. Accurate estimation of e-waste generation is difficult, mainly due to lack of high quality data referred to market and socio-economic dynamics. This paper addresses how to enhance e-waste estimates by providing techniques to increase data quality. An advanced, flexible and multivariate Input–Output Analysis (IOA) method is proposed. It links all three pillars in IOA (product sales, stock and lifespan profiles) to construct mathematical relationships between various data points. By applying this method, the data consolidation steps can generate more accurate time-series datasets from available data pool. This can consequently increase the reliability of e-waste estimates compared to the approach without data processing. A case study in the Netherlands is used to apply the advanced IOA model. As a result, for the first time ever, complete datasets of all three variables for estimating all types of e-waste have been obtained. The result of this study also demonstrates significant disparity between various estimation models, arising from the use of data under different conditions. It shows the importance of applying multivariate approach and multiple sources to improve data quality for modelling, specifically using appropriate time-varying lifespan parameters. Following the case study, a roadmap with a procedural guideline is provided to enhance e

Use of biosolids to enhance rangeland forage quality.

Science.gov (United States)

McFarland, Michael J; Vasquez, Issaak Romero; Vutran, MaiAnh; Schmitz, Mark; Brobst, Robert B

2010-05-01

Biosolids land application was demonstrated to be a potentially cost-effective means for restoring forage productivity and enhancing soil-moisture-holding capacity on disturbed rangelands. By land-applying aerobically digested, anaerobically digested, composted, and lime-stabilized biosolids on rangeland test plots at rates of up to 20 times (20X) the estimated nitrogen-based agronomic rate, forage yields were found to increase from 132.8 kg/ha (118.2 lb/ac) (control plots) to 1182.3 kg/ha (1052.8 lb/ac). Despite the environmental benefits associated with increased forage yield (e.g., reduced soil erosion, improved drainage, and enhanced terrestrial carbon sequestration), the type of forage generated both before and after biosolids land application was found to be dominated by invasive weeds, all of which were characterized as having fair to poor nutritional value. Opportunistic and shallow rooting invasive weeds not only have marginal nutritional value, they also limit the establishment of native perennial grasses and thus biodiversity. Many of the identified invasive species (e.g., Cheatgrass) mature early, a characteristic that significantly increases the fuel loads that support the increased frequency and extent of western wildfires.

Cost-benefit evaluation in a quality control programme for conventional radiodiagnosis

International Nuclear Information System (INIS)

Gallini, R.; Belletti, S.; Giugni, U.

1985-01-01

A comparison is being made between the cost of the staff and equipment in a quality control programme of conventional radiodiagnosis and the benefit obtained in the reduction of spoilt films and in the reduction of dose to patients and workers. For over two years the programme has followed a protocol verified on about 50 X-ray tubes, 25 radiological devices and four automatic processors. The present research, based on previous data, works on a limited but representative sample of radiological X-ray tubes and accessories. The control procedures are carried out periodically to improve and make constant the efficiency of the radiological devices. An evaluation of the cost of these procedures is made. In the meantime the dose to the patients undergoing radiodiagnostic examinations is evaluated by a transmission chamber. Comparison between the values obtained before and after the control enables the benefits to be evaluated. Rejection of radiographic films is evaluated before and after the control to obtain the cost reduction. During the one year control period, there were no variations in the technical characteristics of the personnel, in the operational procedures or in the work-load. (author)

Effects of Soil Quality Enhancement on Pollinator-Plant Interactions

Directory of Open Access Journals (Sweden)

Yasmin J. Cardoza

2012-01-01

Full Text Available Both biotic and abiotic factors can affect soil quality, which can significantly impact plant growth, productivity, and resistance to pests. However, the effects of soil quality on the interactions of plants with beneficial arthropods, such as pollinators, have not been extensively examined. We studied the effects of vermicompost (earthworm compost, VC soil amendment on behavioral and physiological responses of pollinators to flowers and floral resources, using cucumbers, Cucumis sativus, as our model system. Results from experiments conducted over three field seasons demonstrated that, in at least two out of three years, VC amendment significantly increased visit length, while reducing the time to first discovery. Bumblebee (Bombus impatiens workers that fed on flowers from VC-amended plants had significantly larger and more active ovaries, a measure of nutritional quality. Pollen fractions of flowers from VC-grown plants had higher protein compared to those of plants grown in chemically fertilized potting soil. Nectar sugar content also tended to be higher in flowers from VC-grown plants, but differences were not statistically significant. In conclusion, soil quality enhancement, as achieved with VC amendment in this study, can significantly affect plant-pollinator interactions and directly influences pollinator nutrition and overall performance.

An empirical analysis of the relationship between cost of control activities and project management success

Directory of Open Access Journals (Sweden)

Al-Tmeemy Samiaah

2018-01-01

Full Text Available To achieve the objectives of continuous improvement programs, construction managers must link the achievement of quality with cost. This paper aims to associate project management success (PMS with cost of control (COC activities in an empirical manner. Thus, the purpose is to determine the extent to which COC activities impact PMS. Quantitative method was adopted to collect data from Malaysian building companies using postal and email surveys. Hypothesis is tested using correlation and simple linear regression analysis. The findings of this study indicate that COC activities are positively associated with the PMS. The empirical evidences obtained from this research, provides financial justification for all quality improvement efforts. This can assist building contractors to enhance the success of project management by reducing the level of business failures due to poor quality, cost overruns, and delays.

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services

OpenAIRE

Yildiz, M. Said; Khan, M. Mahmud

2016-01-01

Abstract Background The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. Methods This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Packa...

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

Science.gov (United States)

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The impact of scale, complexity, and service quality on the administrative costs of pension funds: A cross-country comparison

OpenAIRE

J.A. Bikker; O.W. Steenbeek; F. Torracchi

2010-01-01

Administrative costs per participant appear to vary widely across pension funds in different countries. These costs are important because they reduce the rate of return on the investments of pension funds, and consequently raise the cost of retirement security. Using unique data on 90 pension funds over the period 2004-2008, this paper examines the impact of scale, the complexity of pension plans, and service quality on the administrative costs of pension funds, and compares those costs acros...

A possibilistic model to determine the cost of environmental quality in mid/short term planning of an electricity distribution system

International Nuclear Information System (INIS)

Schweickardt, Gustavo Alejandro; Gimenez Alvarez, Juan Manuel

2012-01-01

This work presents a Possibilistic Optimization Model to determine the Dynamic Environmental Quality Cost, applied on an Electricity Distribution System and measured as Network System Visual Impact. The Mid/Short Term Planning is the Regulatory Control Period. A multicriteria optimization approach is proposed, and for each criterion, non-stochastic uncertainties are recognized and represented by mean the introduction of Fuzzy Sets. In this way, a possibility in the occurrence of criteria variables values is established. In addition, as consequence of uncertainties of criteria preference ranking, a Model to obtain criteria Priority Vector is introduced. The Environmental Quality Cost determination is based in the relationship between the Investment Cost and an Impact Index of Network System Environmental Quality, proposed in this work. Finally, a simulation on a real system and the most important conclusions are presented.

The impact of horizontal mergers and acquisitions on cost and quality in health care.

Science.gov (United States)

Taylor, M J; Porper, R W; Manji, S

1995-12-01

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs.

The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

OpenAIRE

Bishai, David; LeFevre, Amnesty; Theuss, Marc; Boxshall, Matt; Hetherington, John D; Zaw, Min; Montagu, Dominic

2013-01-01

Abstract Introduction This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Methods The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were g...

Study on measuring social cost of water pollution: concentrated on Han River water system

Energy Technology Data Exchange (ETDEWEB)

Kim, Kwang Im; Min, Dong Gee; Chung, Hoe Seong; Lim, Hyun Jeong; Kim, Mee Sook [Korea Environment Institute, Seoul (Korea)

1999-12-01

Following the economic development and the progress of urbanization, the damage on water pollution has been more serious but a social cost caused by water pollution cannot be measured. Although the need of water quality preservation is emphasized, a base material for public investment on enhancing water quality preservation is not equipped yet due to the absence of economic values of water resource. Therefore it measured a cost generated by leaving pollution not treated water quality in this study. To measure the usable value of water resource or the cost of water pollution all over the country should include a national water system, but this study is limited on the mainstream of Han River water system from North Han River through Paldang to Chamsil sluice gates. Further study on Nakdong River and Keum River water systems should be done. 74 refs., 4 figs., 51 tabs.

Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement.

Science.gov (United States)

Harris, D C

1994-01-01

performed much more cheaply. Amongst the various potential benefits of epoetin, the one with the greatest potential to save money for society is improved productivity. To date, productivity improvements with epoetin have been demonstrated only in small studies. If the acquisition costs of epoetin are reduced by low dosage therapy, these potential benefits can cover a large proportion of the total cost of epoetin. Epoetin undoubtedly improves quality of life and activity, but it is not clear which level of haematocrit gives optimum improvement.(ABSTRACT TRUNCATED AT 400 WORDS)

Achieving quality excellence at the Diablo Canyon Nuclear Power Plant

International Nuclear Information System (INIS)

Skidmore, S.M.; Taggart, D.A.

1988-01-01

Quality assurance methods at the Diablo Canyon plant were transformed from the then typical industry practices that often alienated professional and technical people, as well as craftsmen and their foremen, to a cooperative method that allowed plant personnel to work together as a team. It has created an attitude to do it right the first time. The roles of quality professionals were expanded to include teaching and coaching to facilitate enhanced communication between and within functional organizations. This included regular presentations to managers and line personnel in an informal group participative atmosphere. These presentations have become widely known at the plant as quality awareness tailboard sessions. These presentations are intended to increase personnel sensitivity to the subject of quality and quality management. Economic achievement of excellence in quality is essential to remain competitive in today's marketplace. The proactive team-oriented approach of quality assurance achieves the bottom line of high quality with concurrently enhanced productivity and cost-effectiveness

Health-Related Quality of Life Impairment and Indirect Cost of Crohn’s Disease: A Self-Report Study in Poland

Science.gov (United States)

Kawalec, Paweł; Mossakowska, Małgorzata; Pilc, Andrzej

2016-01-01

Background and Aims Evidence on indirect cost of Crohn’s disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity). Methods A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients’ characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient’s version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients’ productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients’ productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders. Results The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (pabsenteeism, 41% (p = 0.030) for presenteeism, 76% (pproductivity loss at unpaid work, and 75% (p<0.001) for informal care. Conclusions Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland. PMID:27992531

Quality audit in the fastener industry

Science.gov (United States)

Reagan, John R.

1995-09-01

Both the financial and quality communities rely on audits to verify customers records. The financial community is highly structured around three categories of risk, INHERENT RISK, CONTROL RISK, and DETECTION RISK. Combined, the product of these three categories constitute the AUDIT RISK. The financial community establishes CONTROL RISK based in large part on a systems level understanding of the process flow. This system level understanding is best expressed in a flowchart. The quality community may be able to adopt this structure and thereby reduce cost while maintaining and enhancing quality. The quality community should attempt to flowchart the systems level quality process before beginning substantive testing. This theory needs to be applied in several trial cases to prove or disprove this hypothesis

Underwater image quality enhancement of sea cucumbers based on improved histogram equalization and wavelet transform

Directory of Open Access Journals (Sweden)

Xi Qiao

2017-09-01

Full Text Available Sea cucumbers usually live in an environment where lighting and visibility are generally not controllable, which cause the underwater image of sea cucumbers to be distorted, blurred, and severely attenuated. Therefore, the valuable information from such an image cannot be fully extracted for further processing. To solve the problems mentioned above and improve the quality of the underwater images of sea cucumbers, pre-processing of a sea cucumber image is attracting increasing interest. This paper presents a new method based on contrast limited adaptive histogram equalization and wavelet transform (CLAHE-WT to enhance the sea cucumber image quality. CLAHE was used to process the underwater image for increasing contrast based on the Rayleigh distribution, and WT was used for de-noising based on a soft threshold. Qualitative analysis indicated that the proposed method exhibited better performance in enhancing the quality and retaining the image details. For quantitative analysis, the test with 120 underwater images showed that for the proposed method, the mean square error (MSE, peak signal to noise ratio (PSNR, and entropy were 49.2098, 13.3909, and 6.6815, respectively. The proposed method outperformed three established methods in enhancing the visual quality of sea cucumber underwater gray image.

What cost quality assurance

International Nuclear Information System (INIS)

Tikkanen, M.W.; Starek, R.; Liddel, P.R.; Grey, R.G.; Peile, R.C.

1991-01-01

This paper reports that the increased awareness of global environmental pollution has meant that analytical laboratories are faced with an increasing number of samples to analyze and a greater demand for quality control for their applications. In answer to these demands, more laboratory managers are turning to automation for analytical procedures and automated routines to perform quality control on individual samples. Atomic Absorption analysis, particularly by graphite furnace and hydride generation technique has proved to be adaptable to automated analysis to determine low concentrations of elements such as As, Co, Cd, Hg, Ag, Ba, Cr and Pb. Although highly sensitive, both techniques are time consuming and highly matrix dependent. They may also require extensive sample preparation prior to analysis. Additionally, government imposed methodologies e.g. those used for the USA EPA, Contract Laboratory Program, RCRA and SDWA programs, require very specific time consuming quality control measures

Internet pharmacy: issues of access, quality, costs, and regulation.

Science.gov (United States)

Crawford, Stephanie Y

2003-02-01

Internet pharmacy has been the focus of heightened interest over the past 3 years since the first major Web site was introduced in the United States. This paper addresses issues pertaining to Internet pharmacies that sell prescriptions and other products to consumers at the retail level. The Internet pharmacy industry has shifted rapidly in the short time span. This paper begins with a summary of historical considerations and the shifting organization of Internet pharmacy. The advantages and disadvantages of online pharmacy practice are listed. Issues of access, quality, and cost are described. The challenges in regulation at the state and federal levels are presented. Advice to consumers is offered regarding the use of Internet pharmacy sites for purchasing prescription drug products.

Water quality audits can improve availability and reduce costs

International Nuclear Information System (INIS)

Dvorin, R.S.; Schlesinger, H.A.

1984-01-01

The Water Quality Audit (WQA) is an independent, detailed review and thorough analysis of an operating plant's water technology control systems and operator education (as distinguished from operator training). The need for such an audit and its role in improving the reliability and availability of both nuclear and fossil-fueled power plants is discussed. Instances of how the failure of either system hardware or operational control has caused injection of seawater, acid, caustic, or ion exchange resin into the condensate-feedwater system and steam generator are revealed. The systems to be audited are described, and the stage-wise nature of the audit explained. The potential savings of an audit are outlined and the timing and range of costs of a WQA are given

Student Organizations and Their Contribution to Quality Assurance and Enhancement in Higher Education Institutions – Case Study: Romania

Directory of Open Access Journals (Sweden)

Andreea Mirică

2014-12-01

Full Text Available The purpose of this paper is to analyze the involvement of student organizations toward quality assurance and enhancement in higher education institutions in Romania. In order to achieve this purpose, a survey among student organizations from the main university cities in Romania has been conducted between December 2013 and May 2014. In order to analyze the results we used the frequency distribution method. One of the main findings of this paper is that there is a strong desire of a high quality education among student organizations, yet some of them do not become involved in activities contributing to quality assurance and enhancement. This paper can become a valuable tool for policy makers of the Romanian national students federations in order to design the best policies meant to encourage all the organizations participate in the quality assurance and enhancement process.

Localized real-time information on outdoor air quality at kindergartens in Oslo, Norway using low-cost sensor nodes.

Science.gov (United States)

Castell, Nuria; Schneider, Philipp; Grossberndt, Sonja; Fredriksen, Mirjam F; Sousa-Santos, Gabriela; Vogt, Mathias; Bartonova, Alena

2018-08-01

In Norway, children in kindergartens spend significant time outdoors under all weather conditions, and there is thus a natural concern about the quality of outdoor air. It is well known that air pollution is associated with a wide variety of adverse health impacts for children, with greater impact on children with asthma. Especially during winter and spring, kindergartens in Oslo that are situated close to streets with busy traffic, or in areas where wood burning is used for house heating, can experience many days with bad air quality. During these periods, updated information on air quality levels can help the kindergarten teachers to plan appropriate outdoor activities and thus protect children's health. We have installed 17 low-cost air quality nodes in kindergartens in Oslo. These nodes are smaller, cheaper and less complex to use than traditional equipment. Performance evaluation shows that while they are less accurate and suffer from higher uncertainty than reference equipment, they still can provide reliable coarse information about local pollution. The main challenge when using this technology is that calibration parameters might change with time depending on the atmospheric conditions. Thus, even if the sensors are calibrated a priori, once deployed, and especially if they are deployed for a long time, it is not possible to determine if a node is over- or under-estimating the concentration levels. To enhance the data from the sensors, we employed a data fusion technique that allows generating a detailed air quality map merging the data from the sensors and the data from an urban model, thus being able to offer air quality information to any location within Oslo. We arranged a focus group with the participation of local administration, kindergarten staff and parents to understand their opinion and needs related to the air quality information that was provided to the participant kindergartens. They expressed concern about the data quality but agree that

A Logistic Life Cycle Cost-Benefit Analysis of Power Quality Management in the Avionics Repair Facility

National Research Council Canada - National Science Library

Kennedy, Christopher

1998-01-01

.... The implementation of power quality management can result in wide scale logistical support changes in regards to the life cycle costs of maintaining the DoD's current inventory of sensitive electronic equipment...

Small Steps Lead to Quality Assurance and Enhancement in Qatar University

Science.gov (United States)

Al Attiyah, Asma; Khalifa, Batoul

2009-01-01

This paper presents a brief overview of Qatar University's history since it was started in 1973. Its primary focus is on the various small, but important, steps taken by the University to address the needs of quality assurance and enhancement. The Qatar University Reform Plan is described in detail. Its aims are to continually improve the quality…

Cost-Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery.

Science.gov (United States)

Joliat, Gaëtan-Romain; Labgaa, Ismaïl; Hübner, Martin; Blanc, Catherine; Griesser, Anne-Claude; Schäfer, Markus; Demartines, Nicolas

2016-10-01

Enhanced recovery after surgery (ERAS) programs have been shown to ease the postoperative recovery and improve clinical outcomes for various surgery types. ERAS cost-effectiveness was demonstrated for colorectal surgery but not for liver surgery. The present study aim was to analyze the implementation costs and benefits of a specific ERAS program in liver surgery. A dedicated ERAS protocol for liver surgery was implemented in our department in July 2013. The subsequent year all consecutive patients undergoing liver surgery were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital costs with a patient series before ERAS implementation (pre-ERAS group). Mean costs per patient were compared with a bootstrap T test. A cost-minimization analysis was performed. Seventy-four ERAS patients were compared with 100 pre-ERAS patients. There were no significant pre- and intraoperative differences between the two groups, except for the laparoscopy number (n = 18 ERAS, n = 9 pre-ERAS, p = 0.010). Overall postoperative complications were observed in 36 (49 %) and 64 patients (64 %) in the ERAS and pre-ERAS groups, respectively (p = 0.046). The median length of stay was significantly shorter for the ERAS group (8 vs. 10 days, p = 0.006). The total mean costs per patient were €38,726 and €42,356 for ERAS and pre-ERAS (p = 0.467). The cost-minimization analysis showed a total mean cost reduction of €3080 per patient after ERAS implementation. ERAS implementation for liver surgery induced a non-significant decrease in cost compared to standard care. Significant decreased complication rate and hospital stay were observed in the ERAS group.

Dietary strategies for reduced phosphorus excretion and improved water quality

NARCIS (Netherlands)

Maguire, R.O.; Dou, Z.; Sims, J.T.; Brake, J.; Joern, B.C.

2005-01-01

Received for publication October 29, 2004. Cost effective feeding strategies are essential to deal with P surpluses associated with intensive animal agriculture and the consequent impact on water quality. Reduction of P overfeeding, use of feed additives to enhance dietary P utilization, and

Comparison and Cost Analysis of Drinking Water Quality Monitoring Requirements versus Practice in Seven Developing Countries

Directory of Open Access Journals (Sweden)

Jonny Crocker

2014-07-01

Full Text Available Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country’s ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states, Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries.

The determinants of hospital cost: a cost-volume-profit analysis of health services in the occupied territories: Palestine.

Science.gov (United States)

Younis, Mustafa Z; Jaber, Samer; Smith, Pamela C; Hartmann, Michael; Bongyu, Moye

2010-06-01

The purpose of this study is to examine the unit costs of a multi-service hospital in Palestine for the period 2005-2007. We investigate the cost structure of the Rafidya Hospital located in Nablus city, for both inpatient and outpatient departments. This study uses cost-volume-profit (CVP) analysis, also known as breakeven analysis. CVP analysis requires examining total costs, along with fixed and variable costs. CVP analysis illuminates how changes in assumptions about cost behaviour and the relevant range in which those assumptions are valid affect the relationships among revenues, variable costs and fixed costs at various production levels. For the hospital of interest, we find that fixed costs account for 70% of total costs, and variable costs were 30% of total costs. Inpatient departments accounted for 86% of total costs, and outpatient departments were 14% of total costs. Results of the breakeven analysis illustrate that several departments charge sufficient fees to cover all unit costs. Results provide useful information about unit cost based on four categories: (1) unit cost per admission of each department, (2) unit cost per patient day of each department, (3) unit cost per admission with annual capital cost of each department and (4) unit cost per patient day with annual capital cost. Our results provide hospital cost information that can be used by decision-makers to provide and expand healthcare services, in an effort to increase sustainability and profitability. The use of cost analysis by administrators and regulators will improve the quality of financial information, as well as enhance the efficient use of scarce resources.

Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study.

Science.gov (United States)

Soekarjo, Damayanti; Zehner, Elizabeth

2011-10-01

It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.

Impact of extreme load requirements and quality assurance on nuclear power plant costs

International Nuclear Information System (INIS)

Stevenson, J.D.

1993-01-01

Definitive costs, applicable to nuclear power plant concrete structures, as a function of National Regulatory Requirements, standardization, the effect of extreme load design associated with both design basis accidents and extreme external events and quality assurance are difficult to develop since such effects are interrelated and not only differ widely from country to country, project to project but also vary in time. Table 1 shows an estimate of the of the overall plant cost effects of external event extreme load design on nuclear power plant design for the U.S -and selected foreign countries for which experience with LWRs exist- Germany is the most expensive primarily due to a military aircraft crash resistance. However, the German requirement for 4 safeguards trains rather than 2 and the containment design requirement to consider one Steam Generator blowdown concurrent with a RCS blowdown. This presentation will concentrate on the direct current impact extreme load design and quality assurance have on concrete structures, systems and components for nuclear plants. This presentation is considered timely due to the increased interest in the c potential backfit of Eastern European nuclear power stations of the WWER 440 and WWER 1000 types which typically did not consider the extreme loads identified in Table 1 and accident loads in Table 3 and quality assurance in Table 5 in their original design. Concrete structures in particular are highlighted because they typically form the last barrier to radioactive release from the containment and other Safety Related Structures

The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

Science.gov (United States)

2013-01-01

Introduction This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Methods The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies. Results In 2009 PSI Myanmar’s social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities. Conclusion In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO’s, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers’ cost structures as well as strategic objectives in maintaining the network and its portfolio of services. PMID:23826743

The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar.

Science.gov (United States)

Bishai, David; LeFevre, Amnesty; Theuss, Marc; Boxshall, Matt; Hetherington, John D; Zaw, Min; Montagu, Dominic

2013-01-01

This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar's social franchise operations from 2007 to 2009. The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies. In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities. In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO's, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

[Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people].

Science.gov (United States)

Lutomski, Jennifer E; Baars, Maria A E; Boter, Han; Buurman, Bianca M; den Elzen, Wendy P J; Jansen, Aaltje P D; Kempen, Gertrudis I J M; Steunenberg, Bas; Steyerberg, Ewout W; Olde Rikkert, Marcel G M; Melis, René J F

2014-01-01

To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

PET/CT and contrast enhanced CT in single vs. two separate sessions: a cost analysis study.

Science.gov (United States)

Picchio, M; Mansueto, M; Crivellaro, C; Guerra, L; Marcelli, S; Arosio, M; Sironi, S; Gianolli, L; Grimaldi, A; Messa, C

2012-06-01

Aim of the study was to quantify the economic impact of PET/CT and contrast enhanced (c.e.) CT performed in a single session examination vs. stand-alone modalities in oncological patients. One-hundred-forty-five cancer patients referred to both PET/CT and c.e. CT, to either stage (N.=46) or re-stage (N.=99) the disease, were included. Seventy-two/145 performed both studies in a single session (innovative method) and 73/145 in two different sessions (traditional method). The cost-minimization analysis was performed by evaluating: 1) institutional costs, data obtained by hospital accountability (staff, medical materials, equipment maintenance and depreciation, departments utilities); 2) patients costs, data obtained by a specific survey provided to patients (travel, food, accommodation costs, productivity loss). Economic data analysis showed that the costs for innovative method was lower than those of traditional method, both for Institution (106 € less per test) and for patient (21 € less per patient). The loss of productivity for patient and caregivers resulted lower for the innovative method than the traditional method (3 work-hour less per person). PET/CT and c.e. CT performed in a single session is more cost-effective than stand-alone modalities, by reducing both Institutional and patients costs. These advantages are mainly due to lower Institutional cost (single procedure) and to lower cost related to travel and housing.

Switching benefits and costs in competitive health insurance markets: A conceptual framework and empirical evidence from the Netherlands.

Science.gov (United States)

Duijmelinck, Daniëlle M I D; Mosca, Ilaria; van de Ven, Wynand P M M

2015-05-01

Competitive health insurance markets will only enhance cost-containment, efficiency, quality, and consumer responsiveness if all consumers feel free to easily switch insurer. Consumers will switch insurer if their perceived switching benefits outweigh their perceived switching costs. We developed a conceptual framework with potential switching benefits and costs in competitive health insurance markets. Moreover, we used a questionnaire among Dutch consumers (1091 respondents) to empirically examine the relevance of the different switching benefits and costs in consumers' decision to (not) switch insurer. Price, insurers' service quality, insurers' contracted provider network, the benefits of supplementary insurance, and welcome gifts are potential switching benefits. Transaction costs, learning costs, 'benefit loss' costs, uncertainty costs, the costs of (not) switching provider, and sunk costs are potential switching costs. In 2013 most Dutch consumers switched insurer because of (1) price and (2) benefits of supplementary insurance. Nearly half of the non-switchers - and particularly unhealthy consumers - mentioned one of the switching costs as their main reason for not switching. Because unhealthy consumers feel not free to easily switch insurer, insurers have reduced incentives to invest in high-quality care for them. Therefore, policymakers should develop strategies to increase consumer choice. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Improvement in cost-effectiveness and customer satisfaction by a quality management system according to EN ISO 9001:2000.

Science.gov (United States)

Beholz, Sven; Konertz, Wolfgang

2005-12-01

The implementation of a quality management system (QMS) according to EN ISO 9001:2000 has proven to be possible for cardiac surgery departments. However, it remains unclear if a QMS can help to improve quality as indicated by cost-effectiveness and customer satisfaction. To control costs for medical goods and laboratory investigations an internal control system for the allocation of resources was implemented. Laboratory costs and medical goods per open heart procedure were investigated in the years 2000 to 2003. In terms of customer satisfaction, repeated questionnaire-based evaluation of referring physicians was obtained from 2001 to 2003 and the influence of repeated interventions on various aspects of communications was investigated. Costs of medical goods could be reduced by 6.1%, and for laboratory investigations by 35% per operation. Additionally, customer satisfaction could be increased efficiently with respect to accessibility and postoperative communication. By the introduction of a process based QMS, efficient control of the costs of medical goods and laboratory investigations could be achieved. Once a year repeat evaluation of satisfaction of advising physicians has proven to be a valuable tool in the process of continuous improvement.

Cost effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT).

Science.gov (United States)

2005-09-10

To compare the cost effectiveness of social behaviour and network therapy, a new treatment for alcohol problems, with that of the proved motivational enhancement therapy. Cost effectiveness analysis alongside a pragmatic randomised trial. Seven treatment sites around Birmingham, Cardiff, and Leeds. 742 clients with alcohol problems; 617 (83.2%) were interviewed at 12 months and full economic data were obtained on 608 (98.5% of 617). Main economic measures Quality adjusted life years (QALYs), costs of trial treatments, and consequences for public sector resources (health care, other alcohol treatment, social services, and criminal justice services). Both therapies saved about five times as much in expenditure on health, social, and criminal justice services as they cost. Neither net savings nor cost effectiveness differed significantly between the therapies, despite the average cost of social behaviour and network therapy (221 pounds sterling; 385 dollars; 320 euros) being significantly more than that of motivational enhancement therapy (129 pounds sterling). If a QALY were worth 30,000 pounds sterling, then the motivational therapy would have 58% chance of being more cost effective than the social therapy, and the social therapy would have 42% chance of being more cost effective than the motivational therapy. Participants reported highly significant reductions in drinking and associated problems and costs. The novel social behaviour and network therapy did not differ significantly in cost effectiveness from the proved motivational enhancement therapy.

Higher Dietary Cost Is Associated with Higher Diet Quality: A Cross-Sectional Study among Selected Malaysian Adults

OpenAIRE

Ibnteesam Pondor; Wan Ying Gan; Geeta Appannah

2017-01-01

Food price is a determining factor of food choices; however its relationship with diet quality is unclear in Malaysia. This study aimed to examine socio-economic characteristics and daily dietary cost (DDC) in relation to diet quality in the state of Selangor, Malaysia. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and diet quality was estimated using a Malaysian Healthy Eating Index (M-HEI). DDC in Malaysian Ringgit (RM) was calculated from dietary intake and nationa...

Enhancement of Edge-based Image Quality Measures Using Entropy for Histogram Equalization-based Contrast Enhancement Techniques

Directory of Open Access Journals (Sweden)

H. T. R. Kurmasha

2017-12-01

Full Text Available An Edge-based image quality measure (IQM technique for the assessment of histogram equalization (HE-based contrast enhancement techniques has been proposed that outperforms the Absolute Mean Brightness Error (AMBE and Entropy which are the most commonly used IQMs to evaluate Histogram Equalization based techniques, and also the two prominent fidelity-based IQMs which are Multi-Scale Structural Similarity (MSSIM and Information Fidelity Criterion-based (IFC measures. The statistical evaluation results show that the Edge-based IQM, which was designed for detecting noise artifacts distortion, has a Person Correlation Coefficient (PCC > 0.86 while the others have poor or fair correlation to human opinion, considering the Human Visual Perception (HVP. Based on HVP, this paper propose an enhancement to classic Edge-based IQM by taking into account the brightness saturation distortion which is the most prominent distortion in HE-based contrast enhancement techniques. It is tested and found to have significantly well correlation (PCC > 0.87, Spearman rank order correlation coefficient (SROCC > 0.92, Root Mean Squared Error (RMSE < 0.1054, and Outlier Ratio (OR = 0%.

Neonatal chest image quality addressed through training to enhance radiographer awareness

Directory of Open Access Journals (Sweden)

Hesta Friedrich-Nel

2018-03-01

Full Text Available Background: Diagnostic radiographers working in the neonatal intensive care unit primarily aim to produce an image of optimal quality using optimal exposure techniques without repeating exposures, to keep neonatal radiation dose to a minimum.   Objectives: The aim of the study was to determine whether radiographers were producing optimal quality chest images and, if not, whether additional training could contribute to reaching this goal in the Free State Province of South Africa.   Methods: Neonatal chest image quality was determined in the Neonatal Intensive Care Unit by using a checklist based on and compiled from published guidelines to evaluate the quality of 450 randomly-selected images. Thereafter, a training programme was designed, based on the evaluation criteria of the checklist and image quality areas identified. The training also referred to positioning techniques that should be applied to ensure optimal image quality. After presentation of the training, 450 newly-produced neonatal chest images were evaluated. These images were selected through purposive sampling as this evaluation only included images of participating radiographers who completed the training.   Results: Image quality that showed significant improvement included a reduction in electrocardiogram lines superimposed on chest anatomy, a tendency to centre closer to thoracic vertebra four, and visible four-sided collimation on images. Image quality areas with no significant enhancement were the absence of lead markers and radiation shielding.   Conclusion: The study has shown that a training programme has the potential to improve neonatal chest image quality.

Calibration of low-cost gas sensors for an urban air quality monitoring network

Science.gov (United States)

Scott, A.; Kelley, C.; He, C.; Ghugare, P.; Lehman, A.; Benish, S.; Stratton, P.; Dickerson, R. R.; Zuidema, C.; Azdoud, Y.; Ren, X.

2017-12-01

In a warming world, environmental pollution may be exacerbated by anthropogenic activities, such as climate change and the urban heat island effect, as well as natural phenomena such as heat waves. However, monitoring air pollution at federal reference standards (approximately 1 part per billion or ppb for ambient ozone) is cost-prohibitive in heterogeneous urban areas as many expensive devices are required to fully capture a region's geo-spatial variability. Innovation in low-cost sensors provide a potential solution, yet technical challenges remain to overcome possible imprecision in the data. We present the calibrations of ozone and nitrous dioxide from a low-cost air quality monitoring device designed for the Baltimore Open Air Project. The sensors used in this study are commercially available thin film electrochemical sensors from SPEC Sensor, which are amperometric, meaning they generate current proportional to volumetric fraction of gas. The results of sensor calibrations in the laboratory and field are presented.

Multi-Functional Distributed Generation Unit for Power Quality Enhancement

DEFF Research Database (Denmark)

Zeng, Zheng; Yang, Huan; Guerrero, Josep M.

2015-01-01

A multi-functional distributed generation unit (MFDGU) and its control strategy are proposed in this paper for the purpose of enhancing power quality in low-voltage networks. By using the 3H-bridge converter structure, an MFDGU can be applied in 3-phase 4-wire low-voltage distribution networks...... reference of the MFDGU, which can be easily implemented in three-phase networks. A 15kVA prototype consisting of three full bridge converters has been built and tested. Experimental results show the feasibility of the proposed topology and control strategy....

75 FR 22120 - Notice of Roundtables and Request for Comments on Enhancement in the Quality of Patents and on...

Science.gov (United States)

2010-04-27

... the public on means to enhance quality of the patent process with particular emphasis on the search... DEPARTMENT OF COMMERCE Patent and Trademark Office [Docket No.: PTO-P-2010-0038] Notice of Roundtables and Request for Comments on Enhancement in the Quality of Patents and on United States Patent and...

The role and relevance of quality assurance to quality control

International Nuclear Information System (INIS)

Churchill, G.F.

1989-01-01

The paper describes the development of Quality Assurance as a total management technique, incorporating manufacturing and construction Quality Control, to give confidence of satisfactory in-service performance. The application of QA to the Heysham 2 and Torness AGR projects design and construction is defined with particular reference to the development of a QA requirements specification, delegation of QA responsibility through the hierarchy of purchasers and suppliers of plant and material, the role of the QA organization and QA auditing. The paper discusses the effectiveness and benefits of QA and the problems identified in its application and implementation. The problems, their solutions and longer term improvements to reduce the costs of QA as well as enhancing confidence in the satisfactory performance of future nuclear projects, are described. (author)

Cost-effectiveness of EOB-MRI for Hepatocellular Carcinoma in Japan.

Science.gov (United States)

Nishie, Akihiro; Goshima, Satoshi; Haradome, Hiroki; Hatano, Etsuro; Imai, Yasuharu; Kudo, Masatoshi; Matsuda, Masanori; Motosugi, Utaroh; Saitoh, Satoshi; Yoshimitsu, Kengo; Crawford, Bruce; Kruger, Eliza; Ball, Graeme; Honda, Hiroshi

2017-04-01

The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning. A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results. Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT. EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

Science.gov (United States)

Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

2014-12-01

In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.

Consequent use of IT tools as a driver for cost reduction and quality improvements

Science.gov (United States)

Hein, Stefan; Rapp, Roberto; Feustel, Andreas

2013-10-01

The semiconductor industry drives a lot of efforts in the field of cost reductions and quality improvements. The consequent use of IT tools is one possibility to support these goals. With the extensions of its 150mm Fab to 200mm Robert Bosch increased the systematic use of data analysis and Advanced Process Control (APC).

Zebra Mussel Farming in the Szczecin (Oder Lagoon: Water-Quality Objectives and Cost-Effectiveness

Directory of Open Access Journals (Sweden)

Gerald Schernewski

2012-06-01

Full Text Available The Oder (Szczecin Lagoon in the southern Baltic Sea is a heavily eutrophicated and degraded coastal ecosystem. We applied a systems approach framework to critically evaluate whether existing water-management measures achieve water-quality objectives for the river and lagoon systems. Our simulations reveal that the existing water-quality objectives for the river and the coastal waters are not sufficiently complementary. We suggest new water-quality threshold concentrations, which are in agreement with the European Water Framework Directive, and we calculate acceptable maximum nutrient loads for the Oder River. These calculations suggest that external nutrient-load reductions in the river basin alone seem insufficient to achieve good water quality in the lagoon. A comprehensive eutrophication management approach should also include internal nutrient-retention and nutrient-removal measures in the lagoon. We focus on mussel farming, i.e., that of zebra mussels, Dreissena polymorpha, because they are efficient in removing nutrients and improving water transparency in the Oder Lagoon. For this purpose, the ecosystem model ERGOM is extended by a mussel module and an economic model. The economic model describes costs and benefits of mussel cultivation depending on the the farm size. We included additional potential sources of income such as water-quality tax or emission certificates. The simulations show that mussel farming in the lagoon is a suitable supportive measure and, at a load-reduction target of 50% or more, it is a cost-efficient measure for removing nutrients and for implementing the Baltic Sea Action Plan. In the Oder Lagoon, mussel farming could potentially remove nearly 1000 t of N (70 t of P/year, or about 2% of the present N and P loads, and it would have the additional benefit of improving water transparency.

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

Science.gov (United States)

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

A Novel Approach to Mineral Carbonation: Enhancing Carbonation While Avoiding Mineral Pretreatment Process Cost

Energy Technology Data Exchange (ETDEWEB)

Andrew V. G. Chizmeshya; Michael J. McKelvy; Kyle Squires; Ray W. Carpenter; Hamdallah Bearat

2007-06-21

Known fossil fuel reserves, especially coal, can support global energy demands for centuries to come, if the environmental problems associated with CO{sub 2} emissions can be overcome. Unlike other CO{sub 2} sequestration candidate technologies that propose long-term storage, mineral sequestration provides permanent disposal by forming geologically stable mineral carbonates. Carbonation of the widely occurring mineral olivine (e.g., forsterite, Mg{sub 2}SiO{sub 4}) is a large-scale sequestration process candidate for regional implementation, which converts CO{sub 2} into the environmentally benign mineral magnesite (MgCO{sub 3}). The primary goal is cost-competitive process development. As the process is exothermic, it inherently offers low-cost potential. Enhancing carbonation reactivity is key to economic viability. Recent studies at the U.S. DOE Albany Research Center have established that aqueous-solution carbonation using supercritical CO{sub 2} is a promising process; even without olivine activation, 30-50% carbonation has been achieved in an hour. Mechanical activation (e.g., attrition) has accelerated the carbonation process to an industrial timescale (i.e., near completion in less than an hour), at reduced pressure and temperature. However, the activation cost is too high to be economical and lower cost pretreatment options are needed. We have discovered that robust silica-rich passivating layers form on the olivine surface during carbonation. As carbonation proceeds, these passivating layers thicken, fracture and eventually exfoliate, exposing fresh olivine surfaces during rapidly-stirred/circulating carbonation. We are exploring the mechanisms that govern carbonation reactivity and the impact that (1) modeling/controlling the slurry fluid-flow conditions, (2) varying the aqueous ion species/size and concentration (e.g., Li+, Na+, K+, Rb+, Cl-, HCO{sub 3}{sup -}), and (3) incorporating select sonication offer to enhance exfoliation and carbonation. Thus

Use of a quality improvement tool, the prioritization matrix, to identify and prioritize triage software algorithm enhancement.

Science.gov (United States)

North, Frederick; Varkey, Prathiba; Caraballo, Pedro; Vsetecka, Darlene; Bartel, Greg

2007-10-11

Complex decision support software can require significant effort in maintenance and enhancement. A quality improvement tool, the prioritization matrix, was successfully used to guide software enhancement of algorithms in a symptom assessment call center.

High-surgical-volume hospitals associated with better quality and lower cost of kidney transplantation in Taiwan

Directory of Open Access Journals (Sweden)

Shu-Yun Tsao

2011-01-01

Conclusion: Seventy-seven percent of kidney transplant surgeries were concentrated at six hospitals in Taiwan. There were significant differences in quality and cost between HSVHs and LSVHs. We suggest adopting volume-based strategies for nonurgent kidney transplants.

A comparative study on indoor air quality in a low cost and a green ...

African Journals Online (AJOL)

A study on Indoor Air Quality (IAQ) is important because people spend most of their time inside houses. IAQ was monitored in two different types of rural houses namely a low cost house and a “green” house built with pyramidal shape of roof in the rural area. Carbon monoxide (CO) and Carbon Dioxide (CO2) concentrations ...

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis with Policy Implications

OpenAIRE

Harris, Catherine R.; Osterberg, E. Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W.; McAninch, Jack W.; McCulloch, Charles E.; Breyer, Benjamin N.

2016-01-01

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality.We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear ...

73 Activity Based Costing and Product Pricing Decision: the Nigerian Case

Directory of Open Access Journals (Sweden)

Ebipanipre Gabriel Mieseigha

2014-06-01

Full Text Available This paper examined activity based costing and product pricing decisions in Nigeria so as to ascertain whether activity based costing have the ability to enhance profitability and control cost of manufacturing firms. Towards this end, a multiple correlation and regression estimation technique was used in analyzing the data obtained in the study. The study found that activity based costing affects product costing and pricing decision. In addition, the results showed that improved profitability and cost control can be achieved by implementing activity based costing approach by manufacturing firms. The implication is that traditional costing approach fails in many pricing situations by arbitrarily allocating indirect cost and activity based costing helps in allocating indirect cost accurately. Thus, it was recommended amongst others that activity based costing need to be practiced, maintained and implemented by manufacturing firms since it has a broad range of uses for a wide variety of company functions and operations in the area of process analysis, strategy support, time-based accounting, monitoring wastage, as well as quality and productivity management.

Quality education enhancement by means of university environmental edification

Directory of Open Access Journals (Sweden)

Katarína Čekanová

2014-12-01

Full Text Available The submitted work partly describes the historical and actual trends of the introduction of targeted environmental edification at universities based on the framework of Slovakian sustainable development as well as its enhancement of quality educational processes. There has been a need to accentuate environmental consciousness and to bring closer a current state in an incorporating of more environmental and quality aspects for the education process at technical universities. The article emphasizes continuous development of observed problems and introduces the possible future visions from the point of reorganization and tending of study fields. This reorganization requires very a sensitive approach because duplications or triplicities can frequently occur in the environmental education of individual subjects. For this reason students’ interest and ability to learn better can gradually decrease and consequently, results can become worse. Upon graduation, students may not be as well prepared to face the strong competition of the labour market in the Slovak Republic as well as in European Union countries.

Alignment between chain quality management and chain governance in EU pork supply chains: a Transaction-Cost-Economics perspective.

Science.gov (United States)

Wever, Mark; Wognum, Nel; Trienekens, Jacques; Omta, Onno

2010-02-01

Although inter-firm coordination of quality management is increasingly important for meeting end-customer demand in agri-food chains, few researchers focus on the relation between inter-firm quality management systems (QMS) and inter-firm governance structures (GS). However, failure to align QMSs and GSs may lead to inefficiencies in quality management because of high transaction-costs. In addition, misalignment is likely to reduce the quality of end-customer products. This paper addresses this gap in research by empirically examining the relation between QMSs and GSs in pork meat supply chains. Transaction-Cost-Economic theory is used to develop propositions about the relation between three aspects of QMSs--ownership, vertical scope and scale of adoption--and the use of different types of GSs in pork meat supply chains. To validate the propositions, seven cases are examined from four different countries. The results show that the different aspects of QMSs largely relate to specific GSs used in chains in the manner predicted by the propositions. This supports the view that alignment between QMSs and GSs is important for the efficient coordination of quality management in (pork meat) supply chains.

Social/economic costs and health-related quality of life in patients with spinal muscular atrophy (SMA) in Spain.

Science.gov (United States)

López-Bastida, Julio; Peña-Longobardo, Luz María; Aranda-Reneo, Isaac; Tizzano, Eduardo; Sefton, Mark; Oliva-Moreno, Juan

2017-08-18

The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) of patients with Spinal Muscular Atrophy (SMA) and their caregivers in Spain. This was a cross-sectional and retrospective study of patients diagnosed with SMA in Spain. We adopted a bottom up, prevalence approach design to study patients with SMA. The patient's caregivers completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and non-healthcare services. Costs were estimated from a societal perspective (including healthcare costs and non-healthcare costs), and health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire. The main caregivers also answered a questionnaire on their characteristics and on their HRQOL. A total of 81 caregivers of patients with different subtypes of SMA completed the questionnaire. Based on the reference unitary prices for 2014, the average annual costs per patient were € 33,721. Direct healthcare costs were € 10,882 (representing around 32.3% of the total cost) and the direct non-healthcare costs were € 22,839 (67.7% of the total cost). The mean EQ-5D social tariff score for patients was 0.16, and the mean score of the EQ-5D visual analogue scale was 54. The mean EQ-5D social tariff score for caregivers was 0.49 and their mean score on the EQ-5D visual analogue scale was 69. The results highlight the burden that SMA has in terms of costs and decreased HRQOL, not only for patients but also for their caregivers. In particular, the substantial social/economic burden is mostly attributable to the high direct non-healthcare costs.

Determinação dos custos da qualidade em produção de mudas de eucalipto Determination of quality costs in eucalyptus seedling production

Directory of Open Access Journals (Sweden)

Helio Garcia Leite

2005-12-01

quality are at a good level, the costs of defects are high. This can be attributed to the lack of evaluation, that hinders the determination of the conformity degree of the several operations that comprise the process of seedling production, allied the lack of investments in some strategic points of prevention such as training for enhancing quality. The flaw costs in relation to the seedling cost only represent 7.8%. This value is relatively low, considering the absence of investments in evaluation and in training of the operational staff. This fact can be attributed to the high qualification of the technical body and the investments in research. Although this value seems small, when it is extrapolated for the annual program of 10 million seedlings, and depending on the real cost of the production, it can represent a considerable amount.

Differential investment and costs during avian incubation determined by individual quality: an experimental study of the common eider (Somateria mollissima).

Science.gov (United States)

Hanssen, Sveinn Are; Erikstad, Kjell Einar; Johnsen, Vigdis; Bustnes, Jan Ove

2003-03-07

Individuals of different quality may have different investment strategies, shaping responses to experimental manipulations, thereby rendering the detection of such patterns difficult. However, previous clutch-size manipulation studies have infrequently incorporated individual differences in quality. To examine costs of incubation and reproductive investment in relation to changes in clutch size, we enlarged and reduced natural clutch sizes of four and five eggs by one egg early in the incubation period in female common eiders (Somateria mollissima), a sea duck with an anorectic incubation period. Females that had produced four eggs (lower quality) responded to clutch reductions by deserting the nest more frequently but did not increase incubation effort in response to clutch enlargement, at the cost of reduced hatch success of eggs. Among birds with an original clutch size of five (higher quality), reducing and enlarging clutch size reduced and increased relative body mass loss respectively without affecting hatch success. In common eiders many females abandon their own ducklings to the care of other females. Enlarging five-egg clutches led to increased brood care rate despite the higher effort spent incubating these clutches, indicating that the higher fitness value of a large brood is increasing adult brood investment. This study shows that the ability to respond to clutch-size manipulations depends on original clutch size, reflecting differences in female quality. Females of low quality were reluctant to increase investment at the cost of lower hatch success, whereas females of higher quality apparently have a larger capacity both to increase incubation effort and brood care investment.

Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review.

Science.gov (United States)

Wong, Carlos K H; Liao, Qiuyan; Guo, Vivian Y W; Xin, Yiqiao; Lam, Cindy L K

2017-05-31

To describe and systematically review the modelling and reporting of cost-effectiveness analysis of vaccination in Hong Kong, and to identify areas for quality enhancement in future cost-effectiveness analyses. We conducted a comprehensive and systematic review of cost-effectiveness studies related to vaccination and government immunisation programmes in Hong Kong published from 1990 to 2015, through database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of selected studies was assessed using Consolidated Health Economic Evaluation Reporting Standards checklist (CHEERS). Decision making of vaccination was obtained from Scientific Committee on Vaccine Preventable Diseases (SCVPD) and Department of Health in Hong Kong. Nine eligible studies reporting twelve comparative cost-effectiveness comparisons of vaccination programme for influenza (n=2), pneumococcal disease (n=3), influenza plus pneumococcal disease (n=1), chickenpox (n=2), Haemophilus influenzae b (n=1), hepatitis A (n=1), cervical cancer (n=1) and rotavirus (n=1) were identified. Ten comparisons (83.3%) calculated the incremental cost-effectiveness ratio (ICER) of a vaccination strategy versus status quo as outcomes in terms of cost in USD per life-years, cost per quality-adjusted life-years, or cost per disability-adjusted life-years. Among those 10 comparisons in base-case scenario, 4 evaluated interventions were cost-saving relative to status quo while the ICER estimates in 3 of the 6 remaining comparisons were far below commonly accepted threshold and WHO willingness-to-pay threshold, suggestive of very cost-effective. Seven studies were of good quality based on the CHEERS checklist; one was of moderate quality; and one was of excellent quality. The common methodological problems were characterisation of heterogeneity and reporting of study parameters. There was a paucity of cost-effectiveness models evaluating vaccination targeted to the Hong Kong population. All

Contrast-enhanced MR angiography vs intra-arterial digital subtraction angiography for carotid imaging: activity-based cost analysis

International Nuclear Information System (INIS)

U-King-Im, Jean Marie; Cross, Justin J.; Higgins, Nicholas J.; Graves, Martin J.; Antoun, Nagui M.; Gillard, Jonathan H.; Hollingworth, William; Trivedi, Rikin A.; Kirkpatrick, Peter J.

2004-01-01

The aim of this study was to compare the costs of performing contrast-enhanced MR angiography (CE MRA) with intra-arterial digital subtraction angiography (DSA) for the evaluation of carotid atherosclerotic disease. Activity-based cost analysis was used to identify the costs of performing each procedure. The variable direct costs of performing CE MRA and DSA were determined in 20 patients by using detailed time and motion studies. All personnel directly involved in the cases were tracked to the nearest minute and all consumable items used were recorded. Moreover, procedure times were prospectively recorded for an additional 80 patients who underwent both DSA and CE MRA. The variable direct costs of bed usage in the angiography day-case unit, all direct fixed costs as well as indirect costs were assessed from hospital and departmental accounting records. Total costs for each procedure were calculated and compared using Wilcoxon signed-rank sum test. Mean aggregate costs were and euro;721 for DSA and and euro;306 for CE MRA, resulting in potential savings of and euro;415 per patient (p<0.0001). On average, a DSA procedure thus cost approximately 2.4 (95% confidence intervals: 2.2-2.6) times more than CE MRA to our medical institution. Sensitivity analyses confirmed the robustness of our conclusions across wide ranges of plausible values for various parameters. Assuming equal diagnostic performance, institutions may have substantial cost savings if CE MRA is used instead of DSA for carotid imaging. (orig.)