Cost Of Services Research Articles

Mobile Money Adoption and Performance of Informal Family Enterprises During COVID-19 Lockdown in Ekiti State, Nigeria

The study was carried out on family enterprises in Ekiti state during COVID-19 Lockdown: to identify socio-economic characteristics of the family enterprises; to determine the types of mobile money adopted; to determine the factors influencing the types of mobile money adopted; and to examine the effect of mobile money adopted on the performance of family enterprises during COVID-19 lockdown in Ekiti state. The study administered questionnaire on one hundred and fifty (150) respondents and retrieved one hundred (100) which was used for the analysis of this study using SPSS (Statistical Package for the Social Sciences). Findings from the study shows that majorities of the respondents had Diploma and Degree as their highest certificate. The nature of the family enterprises considered are publishing and printing, metal and aluminum fabrication, poultry and fishery farming and furniture, upholstery and carpentry, leather shoe making, graphic designer, automobiles mechanic and panel beaters, Gas seller, tailoring/fashion designer, and dry cleaners. Findings from the study further shows that the enterprises were self-started, owned through inheritance and while the remaining were acquired. The study findings show the factors that are influencing the adoption of mobile money by family enterprises in Ekiti State such as: perceived electronic fraud among the family enterprises discourages mobile money adoption; perceived ease of use of mobile money among the family enterprises encourages the adoption of mobile money; perceived low cost of service of use of mobile money among the family enterprises encourages the adoption of mobile money; perceived usefulness of mobile money among the family enterprises encourages the adoption of mobile money; low level of knowledge about mobile money (high level of illiteracy) among others. Findings further shows that mobile money adopted by the family enterprises are significantly influencing their performance in Ekiti State Nigeria. The study concluded that family enterprises considered are micro scales, and mostly adopted USSD (unstructured short messages) and mobile app including online banking as mobile money adopted by the selected family enterprises. The enterprises used the mobile money adopted for different transactions such as payment of salaries, products bought from suppliers, payment received on products/services sold/rendered to their customers. The study further concluded that the index factors considered in this study are cogent factors that are really influencing the adoption of mobile money. The study also concluded that mobile money adopted are significantly influencing the performance of the selected family enterprises during COVID-19 Lockdown in Ekiti State Nigeria.

The True Cost-to-Serve in Nursing Homes: A Methodological Issue in Applying Activity-Based Costing

The healthcare sector is marked by intense competition, escalating costs, service personalization, quality standards, financial constraints, and increased demand. Healthcare organizations must implement efficient cost management systems to navigate this intricate environment. The debate persists in the literature regarding the optimal cost accounting system for healthcare: traditional cost-center-based or activity-based costing (ABC). This article delves into the factors influencing the selection of a suitable cost accounting system, examining the implementation of ABC in an Italian nursing home. A methodological challenge emerged during the ABC implementation, relevant to all healthcare facilities serving diverse elderly populations. The article explores this issue, evaluates potential solutions and their impacts, and determines the approach enabling managers to accurately assess service costs and uphold service quality.

Opinions regarding equine veterinarian attire and attributes: results of a horse owner survey.

To investigate potential equine clients' perceptions of equine veterinarians based on attire. 763 horse owners/lessees. Participants were invited to complete a survey shared mainly via equestrian social media pages between August and October 2022.1-3 Survey participants were shown pictures of a male veterinarian and a female veterinarian in 7 outfits ranging from casual to business attire and were asked to score the veterinarian on 7 traits: easygoing attitude, friendliness, compassion, trustworthiness, professionalism, competence, and cost of services. The survey asked which of the traits were most valued in an equine veterinarian, as well as whether various aspects of appearance including tattoos, piercings, and hair dyed a nonorganic color were acceptable for equine veterinarians. Of the 2,655 individuals who opened the survey, 763 responses were included. Respondents were predominantly female (743/763 [97.4%]) from rural areas (493/763 [64.6%]). Only 37.1% (283/763) of respondents agreed that what a veterinarian wears influences their confidence in them. The highest-ranked traits in an equine veterinarian were knowledge/competency (mean ± SD, 1.46 ± 0.98), followed by trustworthiness (2.34 ± 1.08) and compassion (3.50 ± 1.20), with coveralls and scrubs being the preferred attire clients associated with these attributes (with the exception of compassion, for which polo shirt/jeans was the preferred attire). T-shirt/jeans was consistently ranked lowest by respondents in association with these attributes, except in the area of compassion, where polo shirt/black pants was ranked lowest. Our findings suggested the attire and appearance of equine veterinarians can impact client perceptions, with veterinarians wearing scrubs and coveralls associated with higher competency and trustworthiness.

Cost and efficiency analysis in Iranian primary health centers: a micro costing and data envelopment analysis

BackgroundHealth Complex Model was implemented to provide primary health care services in urban, especially in slum areas. As a pilot at a provincial level, Chamran Health Complex offers healthcare for more than 57,000 residents of Tabriz. Despite the necessity of cost information in healthcare decision-making, there was limited knowledge about the unit cost of services. This study aims to analyze the cost and efficiency of health centers.MethodsActivity-Based Costing method with direct and step-down allocation methods was adopted. We estimated unit costs in a hypothetical scenario according to national standards to quantify the gap between current and standard practice. Input-oriented Data Envelopment Analysis was administered to measure the efficiency of health centers.ResultsThe total cost of the complex was $2,841,897, of which 67% ($1910373) and 33% ($931523) were accounted for direct and indirect costs, respectively. The vaccination center had the lowest ($9), and the occupational health center had the highest average unit cost ($76). The average technical efficiency of the health centers was 0.519, where the HC1 and HC3 showed the best performance.ConclusionThere is remarkable variability in service costs across health centers, which must be addressed in performance management and contracting practices. Although we found a gap between current and standard practice in terms of staff and facilities according to national standards, Chamran Health Complex has an untouched capacity that can be utilized with better planning and without incurring additional costs. It raises the need for revising national standards by the Iran Ministry of Health.

Care Nursing in Immune Disorder Assessment among Adult Oncology Patients: A Scoping Review.

International guidelines recommend a pathway for preferable nursing handling in a specific cancer topic, like chemotherapy toxicity, low adhesion in toxicity reported with a consequential increase in adverse events (AEs) frequency, poorer QoL outcomes, and increased use of healthcare service until death. Unpredictability, postponed reports, and incapability to access healthcare services can compromise toxicity-related effects by including patients' safety. In this scenario, a more attentive nursing intervention can improve patients' outcomes and decrease costs for healthcare services, respectively. The present scoping review aims to describe and synthesize scientific care nursing evidence assessment in oncology patients. PubMed, Embase, Nursing & Allied Health Database, and British Nursing were the databases examined. Keywords used and associated with Boolean operators were assessment, care, nursing, immune disorder, oncology, and patient. Research articles considered were published between 2013-2023. All systematic processes were performed according to the PRISMA procedure in order to reach all manuscripts considered in the present scoping review. The Embase database showed a total of 25 articles, PubMed displayed 77, the Nursing & Allied Health Database evidenced a total of 74, and the British Nursing database showed 252 records. Then, after a first revision in each database by considering the inclusion criteria, the abovementioned titles and abstracts were selected and, 336 records were removed, and 92 studies remained. Of these, 65 manuscripts were excluded after verifying abstracts. Finally, a total of 7 articles were carefully analysed and selected for this scoping review. Specifically, 2 articles belonged to the British Nursing Database, 3 articles belonged to Embase, 1 to the Nursing & Allied Health Database and one related to PubMed. Oncology nursing should consider several aspects, such as therapy-related toxicity and its related morbidity and mortality, worsening levels of quality of life, and increasing duty by the healthcare organization or endorsements for the principal symptoms and signs which may anticipate few diseases and worst clinical conditions, too. Therefore, careful monitoring may allow prompt recognition and subsequent earlier management in the treatment efficacy.

The analysis of educational informatization management learning model under the internet of things and artificial intelligence

This study explores the influence of the Internet of Things (IoT) and Artificial Intelligence (AI)-enhanced learning models on student management in educational informatization management. A game-theoretic enhanced learning model is proposed to achieve this objective, incorporating resource scheduling strategies under fog computing and a student management system that integrates IoT and AI technologies. This model’s performance and the student management system are then tested. The results indicate that the fog computing-based hierarchical Q-learning (Q) model proposed in this study achieves faster convergence than a single Q model, reaching convergence after 80 training rounds, ten rounds earlier than the comparative algorithm. The model exhibits a lower average workload delay of 0.5 ms and fog node delay below 1 ms, showcasing significant advantages in terms of overall cost-effectiveness, thus minimizing service costs. The student management system has 3000 concurrent user connections, static page request times ranging from 0 to 25 s, login response time predominantly at 60 s, and a capacity to process up to 20 parallel tasks per second with zero errors. The system functionalities are fully realized, meeting usage demands effectively and achieving the highest average functional score of 9.03 for online interaction functionality. This study demonstrates the efficacy of the game-theoretic enhanced learning model in a fog computing environment and the positive impact of IoT and AI technologies on student management. The proposed student management system better caters to individual student needs, enhancing learning outcomes and experiences. The study's innovation lies in the integration of IoT technology with AI-enhanced learning models, coupled with the introduction of game-theoretic resource scheduling strategies, enabling the student management system to intelligently identify student requirements, allocate learning resources, and dynamically optimize the educational process, ultimately improving learning outcomes. This holds significant implications for enhancing education quality and promoting personalized student development.

A network meta-analysis of the timing of wound dressing removal.

Wounds are invariably dressed postoperatively but the evidence for the timing of dressing changes is limited. This meta-analysis evaluated whether the relative risk of wound infection varies depending on when dressings are changed. A frequentist random-effects network meta-analysis was conducted on the results of a systematic review of the MEDLINE®, Ovid®, Scopus®, Web of Science™ and PubMed® databases and the Cochrane Central Register of Controlled Trials performed in May 2023. Evidence quality was graded using the Confidence In Network Meta-Analysis tool. A total of 4 studies were included with 878 patients. A significant increase in the relative risk of wound infection was found when dressings were left in situ for more than 4.5 days when compared with 48 hours (3.18, 95% confidence interval: 1.22-8.33). There were no significant differences in the relative risk of infection between the other groups. Model heterogeneity and inconsistency were insignificant (Cochran's Q: 0.44, p=0.51). The quality of the evidence was graded as generally very low and risk of bias evaluations showed it to be of high concern for bias. Late dressing changes significantly increase the risks of wound infection and changes at 48 hours minimise these risks. There was no advantage demonstrated for earlier dressing changes. Ensuring that dressings are changed appropriately can minimise patient harm and health service costs.

Health care resource use and costs in patients with food allergies: a United States insurance claims database analysis

Aims Food allergies impose a large clinical and financial burden on patients and the health care system. However, little is known about the factors associated with health care resource use and costs. The aim of this study was to investigate health care resource use and costs in individuals with food allergies utilizing health care in the United States. Methods We conducted a retrospective analysis of insurance claims data from the Merative MarketScan Research Databases (indexed from 1 January 2015 to 30 June 2022). All-cause and food allergy-related health care resource use, direct medical, and out-of-pocket costs for medical services were estimated for 12 months post-index using International Classification of Diseases [ICD] codes. Results Of 355,520 individuals with food allergies continuously enrolled in a health insurance plan for ≥12 months pre- and post-index, 17% had a food allergy-related emergency department visit and 0.9% were hospitalized. The top patient characteristic associated with all-cause and food allergy-related hospitalizations, all-cause costs, and food allergy-related outpatient visit costs was a Charlson Comorbidity Index score of ≥2. Food allergy-related direct medical and out-of-pocket costs were high among patients with a food allergy-related visit. Out-of-pocket cost per patient per year for outpatient visits, emergency department visits, and hospitalizations had an estimated mean of $1631 for patients with food allergy-related visits, which is ∼11% of the total costs for these services ($14,395 per patient per year). Limitations Study limitations are primarily related to the nature of claims databases, including generalizability and reliance on ICD codes. Nevertheless, MarketScan databases provide robust patient-level insights into health care resource use and costs from a large, commercially insured patient population. Conclusion The health care resource use of patients with food allergies imposes a burden on both the health care system and on patients and their families, especially if patients had comorbidities.

Implementation of the clinical practice guidelines among family medicine doctors at primary health care facilities in Khartoum and Gezira states of Sudan

IntroductionThe health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients’ outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan.MethodsDescriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant.ResultsMost of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation.ConclusionGuidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources.

Survival of the fittest: does Riva Self Cure outperform Equia Forte when used to restore mesio-occlusal cavities in atraumatic restorative technique?

Double-blind (participant and outcome assessor), randomised, non-inferiority, two-arm (1:1 allocation) clinical trial. The study included children aged 4-8 years old from public schools in Tietê, Brazil, who had mesio-occlusal carious lesions, into dentine, in primary molars. The carious teeth had to be asymptomatic of pulpal involvement. The children had to be medically fit and cooperative for dental treatment within their classroom environment. Consent was gained from a parent/guardian prior to entering the study. Children with carious lesions in multiple teeth, only one tooth was included, which was selected by a random draw. Treatment on other teeth would be carried out in the nearest health centre. The primary outcome was the 2-year survival of the restorations, analysed using Kaplan-Meier survival curves and Cox regression (α = 5%). Costs for materials and professional services were recorded in Brazilian Reais (R$), converted to US dollars (US$), and analysed using Monte Carlo simulation. Of the 152 children enrolled (76 per group), 121 (79%) were evaluated at the 2-year mark. Overall, the 2-year survival rate of the restorations was 39% (EF: 45%; RSC: 32%), with no significant difference between the two groups. The total cost of restorations with RSC was lower than with EF, resulting in a cost saving of US$6.18 per restoration. After 2 years, Riva Self Cure demonstrated comparable survival rates to Equia Forte for mesio-occlusal restorations in primary molars, while being more cost-effective from a Brazilian perspective.

LIBRARIANS’ PERCEPTION ON THE USE OF SOCIAL MEDIA AS A TOOL FOR INFORMATION SERVICE PROVISION IN KASHIM IBRAHIM LIBRARY, AHMADU BELLO UNIVERSITY, ZARIA, NIGERIA

Social media have become an indispensable and current trend of communication in the modern era today, as a result of this, academic libraries adopt social media such as Facebook, X (formally Twitter), YouTube, and Flickr for effective and efficient information services provision in the 21st century. The study investigates the librarians’ perception on the use of social media (SM) as a tool for information service provision in Kashim Ibrahim Library, Ahmadu Bello University, Zaria. A total number of 91 copies of the questionnaire were administered to the respondents and a total of 85 were returned and found useful for the study. All data were categorized and analysed using tables, frequency, and simple percentage were used to analyse the data. Findings revealed that SM are used to render various library services. However, the major challenges faced by the academic library staff when using SM for information services provision include inadequate power supply, inadequate bandwidth, security privacy and copyright issues, high cost of Internet services. The study recommended that the academic librarians should be encouraged in the use of SM to develop their skills in information services provision.

The Brazilian National Plan to Combat Marine Litter: A critical assessment

The Brazilian National Plan to Combat Marine Litter was launched in March 2019 and in its context, 577 campaigns were carried out to clean up beaches, rivers, estuaries and mangroves, until January 2023, at an estimated cost of US$ 16,733,000.00. The volume collected in four years represented only 0.0041 % of the total solid waste discharged annually in the maritime waters under the country's jurisdiction. The direct benefit to society was only US$ 173,751.41 at market value for the litter collected. Litter lesser than 2.5 cm was left out, not been characterized. The results achieved deserve reflection and critical evaluation, in order to allow improvements, serving as reference. The participation of around 43,000 people in cleanup campaigns is an indication of environmental citizenship and an asset that cannot be overlooked by managers, demanding focus, tangible results and benefits in terms of environmental quality, well-being and savings on public cleaning services costs.

A Cross-Sectional Study to Assess the Perceived Oral Health Care Needs, Barriers to Accessing Oral Health Care Services, and Utility Among the Rural Population in Chengalpattu District, Tamil Nadu.

Introduction Utilization is the actual attendance of people at oral healthcare facilities to receive treatment. This study aimed to determine the perceived oral health care needs and barriers to utilizing dental services among rural populations. Materials and methods A cross-sectional survey using a questionnaire was designed to identify the perceived oral health care needs and obstacles to accessing dental facilities and their utility among rural populations. The sample size was set at 570. A data collection sheet was used to collect the required data, which included informed consent, demographic details, and the questionnaire.A pretested and validated questionnaire was used in the study. Result Among the 570 respondents, 43.3% of the population had experienced toothache, out of which 67.6% perceived the need for dental care. Only around 37.5% reported that their dental needs were met during the past year. Dental expenses were significantly related to access to the dentist. Conclusion This survey revealed that the majority of the population tends to utilize the available services only when absolutely necessary. High dental service costs and inadequate knowledge about oral problems act as major barriers.

Reproductive health care seeking behavior in Bangladesh: Asystematic literature review.

Maternal health, in terms of pregnancy and childbirth, is an important aspect of women's reproductive health and remains a public health concern in underdeveloped countries of the world. Reproductive health care seeking behavior (RHSB), in both men and women in society, is influenced by a variety of social and environmental factors that needs to be summarized. This review aims to enhance understanding and perception of services in relation to RHSBs in several domains such as antenatal care (ANC), delivery care, postnatal care (PNC), and family planning (FP) services, for married women of reproductive age in Bangladesh. In major databases, for example, Medline, Ovid, PubMed, Web of Science, ProQuest and Google Scholar following keywords, timeline set as 2010 up to December 30, 2022. Articles that included discussion on married women of reproductive age, and their type of care seeking behavior for reproductive health. A systematic literature search was carried out and expected outcome was health care seeking behavior in the aspects of ANC, delivery care, PNC, and FP services. A data extraction form and quality appraisal form were used for data on RHSB of married women of the reproductive age group in Bangladesh and associated factors. A total of 245 articles were retrieved from databases; stepwise screening was done and finally 23 full-text articles were included for analysis. Descriptive statistics were used based on the included articles for narrative synthesis. In the selected articles, 17 (73.91%) were cross-sectional studies and more than half discussed both urban and rural women. Ante- and postnatal visits have proven to have positively influenced overall RHSB, as seen in Bangladesh. Grass root level workers play a major role in upgrading RHSB in women. Many factors limit rural access to mother and child health services including distance of the health facility and cost of the health service. In particular, education level, women's autonomy in family decision making and distance from health service can be considered as factors influencing RHSBs in Bangladesh. Exposure to mass media and TV watching are likely to positively impact RHSB patterns for women in Bangladesh.

Two-dimensional warranty policy design with the consideration of protection term

In practice, car products are sold with 2-dimensional (2D) warranty policies, on which existing literature usually assumes that the products are repaired upon failures throughout the warranty period. However, this is not always the case in real life; for example, car manufacturers may need to replace defective cars during an early period of warranty, when the total time on repairing the failures reaches a specified repair time constraint or the number of repair attempts reaches a specified repair number constraint. Motivated by this, this paper divides a warranty period into two stages: the initial protection term and the subsequent repair stage. During the initial protection term, the manufacturer needs to provide a replacement service when a specified replacement condition is satisfied; while during the subsequent repair stage, the manufacturer should provide repair services upon product failures. Taking the warranty servicing cost into account, a profit model is built. The expected total profit of the product is derived, and the optimal warranty period and product price are designed to maximize the manufacturer’s profit. Finally, numerical experiments on car examples are provided to illustrate the considered warranty policy with protection term.

Digitization and Citizens’ Satisfaction with Land Services in Rwanda

Purpose: The purpose of the study was to examine whether there is a relationship between digitization and service quality of land services and to establish if the relationship is significant. Methodology: The study used a quantitative research approach to collect the data. A probability sampling technique was employed to choose a sample of 2,229 respondents from a population of 47,260 land service customers. A bivariate correlation analysis was conducted for all questions and the Pearson correlation coefficient was statistically significant with a value less than 0.05. Using Cronbach’s Alpha calculation, reliability was tested and produced a value of 0.946 &gt; 0.7 which demonstrates excellent reliability of the tool. An ordinal logistic regression method was applied to model the relationship between one outcome variable and seven predictor variables. Findings: the research findings show that the seven elements of digitization have a significant influence on the satisfaction of customers with land services. The element with the highest influence is the digitization of land services preserves the security of land information effectively (6.555); digitization of land services reduces the cost of land transfer services (6.476); digitization of land services increases quality and consistency in land services provision (6.096); digitization of land transfer services offers easy access to files and information (6.049); digitization of land services minimizes corruption (5.937); digitization of land services reduces human error (5.863) and digitization of land services reduces the time to process land documents (5.745). Contribution to Theory, Policy, and Practice: Establishing if digitization can measure service quality is a new aspect that the study adds to the body of knowledge. The researchers recommend that digitization be added to the dimensions that measure service quality in ways that take into consideration study contexts

Barriers and facilitators to HIV care linkage and retention among older adults diagnosed with HIV in Malaysia: a qualitative study.

Older adults newly diagnosed with HIV experience poorer prognosis and higher mortality compared to those diagnosed at younger ages. We explored the barriers and facilitators in HIV care linkage and retention among newly diagnosed older persons living with HIV (OPLWH) in Malaysia. We conducted in-depth interviews with OPLWH and focus group discussions with healthcare providers (HCPs) from five specialties (primary care medicine, psychological medicine, gynecology, geriatrics and infectious disease) at a tertiary hospital between September 2021 to April 2022. All sessions were audio-recorded, transcribed verbatim and analysed thematically. We recruited 16 OPLWH and 7 HCPs. Thirteen OPLWH were male. Eight of them self-identified as men who have sex with men (MSM) and the rest were heterosexual. Diagnosis of HIV was between the ages of 50-61 years old. Barriers and facilitators could be categorized into three levels: individual, interpersonal and institutional. Individual barriers included misinformation about HIV treatment, unable to afford HIV-related services, and belief that life was futile. Interpersonal barriers were HIV-related stigma, poor social and family support, and social prejudice towards MSM. Lastly, institutional barriers were the need for frequent hospital visits, high cost for HIV-related services, a lack of guidance following diagnosis and poor communication with HCPs. Facilitators included doctor or friend support and positive institutional reputation. Multiple challenges hindered optimal care for OPLWH after HIV diagnosis. Issues like high costs, belief that treatment is futile, and a lack of family support need to be addressed as part of long-term support services for OPLWH.

Autism Among Adults with Down Syndrome: Prevalence, Medicaid Usage, and Co-Occurring Conditions.

Our objective was to examine occurrence of both conditions in Medicaid; and compare Medicaid service use and cost, and chronic conditions among adults with Down syndrome and autism to those with Down syndrome alone and those with autism alone. We used ICD9 and ICD10 codes in Medicaid claims and encounters from 2011 to 2019 to identify autism and Down syndrome in adults > 18 years. We then calculated costs, claims, hospitalizations, long term care days, and chronic conditions, and compared by group- autism alone, Down syndrome alone, Down syndrome + autism. Between 2011 and 2019, there were 519,450 adult Medicaid enrollees who met our criteria for autism (N = 396,426), Down syndrome (N = 116,422), or both Down syndrome and autism (N = 6,602). In 2011, 4.1% of enrollees with Down syndrome had co-occurring autism; by 2011 it was 6.6%. The autism group had the fewest claims and inpatient hospitalizations, followed by the Down syndrome group, then the Down syndrome + autism group. After age adjustment, those with Down syndrome alone and Down syndrome + autism had elevated prevalence of atrial fibrillation, dementia, heart failure, kidney disease, and obesity compared to the autism alone group. Both groups also had decreased occurrence of depression and hypertension compared to the autism alone group. Prevalence of autism is higher among people with Down syndrome than in peers. The increased costs and service use for those with both conditions highlight the extent to which this population need health care and signal the need for more effective preventative care and therapies.

Identifying cost-based quality and performance indicators for home care: a modified delphi method study

BackgroundThis study, part of a multi-study program, aimed to identify a core set of cost-based quality and performance indicators using a modified Delphi research approach. Conceptually, this core set of cost-based indicators is intended for use within a broader health system performance framework for evaluating home care programming in Canada.MethodsThis study used findings from a recently published scoping review identifying 34 cost-focused home care program PQIs. A purposive and snowball technique was employed to recruit a national panel of system-level operational and content experts in home care. We collected data through progressive surveys and engagement sessions. In the first round of surveying, the panel scored each indicator on Importance, Actionable, and Interpretable criteria. The panel set the second round of ranking the remaining indicators’ consensus criteria. The panel ranked by importance their top five indicators from operational and system perspectives. Indicators selected by over 50% of the panel were accepted as consensus.ResultsWe identified 13 panellists. 12 completed the first round which identified that 30 met the predetermined inclusion criteria. Eight completed the ranking exercise, with one of the eight completing one of two components. The second round resulted in three PQIs meeting the consensus criteria: one operational and two systems-policy-focused. The PQIs: “Average cost per day per home care client,” “Home care service cost (mean) per home care client 1y, 3y and 7y per health authority and provincially and nationally”, and “Home care funding as a percent of overall health care expenditures.”ConclusionsThe findings from this study offer a crucial foundation for assessing operational and health system outcomes. Notably, this research pioneers identifying key cost-based PQIs through a national expert panel and modified Delphi methodology. This study contributes to the literature on PQIs for home care and provides a basis for future research and practice. These selected PQIs should be applied to future research to test their applicability and validity within home care programming and outcomes. Researchers should apply these selected PQIs in future studies to evaluate their applicability and validity within home care programming and outcomes.

Facility Location Problem: Modeling Joint Disruptions Using Subordination

We study the facility location problem with disruptions where the objective is to choose a set of locations that minimizes the sum of expected servicing and setup costs. Disruptions can affect multiple locations simultaneously and are caused by multiple factors like geography, supply chain characteristics, politics, and ownership. Accounting for the various factors when modeling disruptions is challenging due to a large number of required parameters, the lack of calibration methodologies, the sparsity of disruption data, and the number of scenarios to be considered in the optimization. Because of these reasons, existing models neglect dependence or prespecify the dependence structures. Using partially subordinated Markov chains, we present a comprehensive approach that starts from disruption data, models dependencies, calibrates the disruption model, and optimizes location choices. We construct a metric and a calibration algorithm that learns from the data the strength of dependence, the number of necessary factors (subordinators), and the locations each subordinator affects. We prove that our calibration approach yields consistent estimates of the model parameters. Then, we introduce a variant of the standard approach to the underlying optimization problem, which leverages partially subordinated Markov chains to solve it quickly and precisely. Finally, we demonstrate the efficacy of our approach using twelve different disruption data sets. Our calibrated parameters are robust, and our optimization algorithm performs better than the simulation-based algorithm. The solutions from our model for disruptions have lower costs than those from other disruption models. Our approach allows for better modeling of disruptions from historical data and can be adapted to other problems in logistics, like the hub location, capacitated facility location, and so on., with joint disruptions. Supplemental Material: The online appendix is available at https://doi.org/10.1287/trsc.2023.0103 .