Dollar Expenditures Research Articles

Indigenous corporate responsibility and financial performance

ABSTRACT The impact of Corporate Social Responsibility with respect to Indigenous (CSRI) initiatives and issues on financial performance was studied using several CSRI metrics, both innovated (where necessary) and pre-existing (where possible). We find that CSRI initiatives based on dollar expenditures and firm website scores are positively associated with financial performance while increase to reputation risk has a negative impact. We also find that a CSRI score can only be moderated by an overall ESG score that is substantially stronger than the CSRI metric. In a world that increasingly emphasizes the importance of ‘truth and reconciliation’ with its Indigenous populations while meeting environmental resource needs, we must seek a path that recognizes and respects Indigenous rights and cultural practices. Providing well developed, consistently measured and acceptable CSRI metrics and assessing their impact on firm financial performance is a crucial step in this reconciliation process. This paper makes important contributions to that goal.

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation.

BACKGROUNDPre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation, less is known about the risks, particularly infectious, associated with this therapy among this specific group of patients.AIMTo describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation.METHODSRetrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children’s Hospital from 2008 through 2015 (n = 96). Patients with a central line for administration of PN (n = 63) were identified and details of each CLABSI event were abstracted. We compared the group of patients who experienced CLABSI to the group who did not, to determine whether demographic, clinical, or laboratory factors correlated with development of CLABSI.RESULTSNineteen of 63 patients (30%, 95%CI: 19, 43) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI was predominantly associated with Gram-negative organisms (14/29 episodes, 48%) including Klebsiella spp., Enterobacter spp., and Escherichia coli. The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae. Gram-positive organisms (all Staphylococcus spp.) and fungus (all Candida spp.) comprised 9/29 (31%) and 6/29 (21%) episodes, respectively. No demographic, clinical, or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysisCONCLUSIONThere is substantial risk for CLABSI among children with BA listed for liver transplantation. No clinical, demographic, or laboratory factor we tested emerged as an independent predictor of CLABSI. While our data did not show an impact of CLABSI on the short-term clinical outcome, it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization, unnecessary healthcare dollar expenditures, and may exact an opportunity cost, in terms of missed allograft offers.

Community Benefit Spending Among North Carolina's Tax-Exempt Hospitals After Performing Community Health Needs Assessments.

As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities. To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA. Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics. Fifty-three private, nonprofit hospitals across North Carolina. Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs. Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94). The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.

Using Health Care Utilization and Publication Patterns to Characterize the Research Portfolio and to Plan Future Research Investments.

ObjectiveGovernment funders of biomedical research are under increasing pressure to demonstrate societal benefits of their investments. A number of published studies attempted to correlate research funding levels with the societal burden for various diseases, with mixed results. We examined whether research funded by the Department of Veterans Affairs (VA) is well aligned with current and projected veterans’ health needs. The organizational structure of the VA makes it a particularly suitable setting for examining these questions.MethodsWe used the publication patterns and dollar expenditures of VA-funded researchers to characterize the VA research portfolio by disease. We used health care utilization data from the VA for the same diseases to define veterans’ health needs. We then measured the level of correlation between the two and identified disease groups that were under- or over-represented in the research portfolio relative to disease expenditures. Finally, we used historic health care utilization trends combined with demographic projections to identify diseases and conditions that are increasing in costs and/or patient volume and consequently represent potential targets for future research investments.ResultsWe found a significant correlation between research volume/expenditures and health utilization. Some disease groups were slightly under- or over-represented, but these deviations were relatively small. Diseases and conditions with the increasing utilization trend at the VA included hypertension, hypercholesterolemia, diabetes, hearing loss, sleeping disorders, complications of pregnancy, and several mental disorders.ConclusionsResearch investments at the VA are well aligned with veteran health needs. The VA can continue to meet these needs by supporting research on the diseases and conditions with a growing number of patients, costs of care, or both. Our approach can be used by other funders of disease research to characterize their portfolios and to plan research investments.

A Developer’s Perspective: Embracing Diversity in Economic Development

A Developer’s Perspective:Embracing Diversity in Economic Development Larry Curtis (bio) Often people assume that preservation has one principal objective—to restore a building of perceived architectural quality to its once attractive physical state. They believe that historic preservation is simply about bringing buildings back to life. Yet this perspective neglects a crucial aspect about preservation. Buildings, and the surrounding communities, have a multilayered history that goes beyond architectural styles and bricks and mortar. Buildings are icons of an era past and symbols of uses long gone—a textile mill in Massachusetts, for example, or an automotive factory in Illinois. On a broader scale, these historic buildings also represent the people that constructed them and the residents that lived or worked in them. Transformations of architectural gems have to happen within the context of the people involved with them—many times this involves a diverse group of Americans. This article focuses on ways that the diversity manifest in the historic sites and programs of the National Trust for Historic Preservation, the National Park Service, and the historic preservation community (organizations both local and national) can—and should—be integrated into the business and economic side of historic preservation. As a developer of historic properties, my company WinnDevelopment, has made a commitment to understanding what makes a building historic and how this history relates to the people who built it, the people who labored in it, the neighborhoods that evolved around it, and the people who could or should be involved in rehabilitating it. In short—to make diversity part of our work at all levels. Most people care about diversity and, by and large, opportunities exist for all. Sure opportunities exist, but are they practiced? Maybe not as much. An article in Massachusetts’s Commonwealth [End Page 32] Magazine in Fall 2013, for example, notes that less than 1 percent of partners at Boston’s premier law firms are minorities. Similar numbers and percentages likely exist among developers of historic properties; however, these figures are harder to come by. This lack of diversity permeates the construction industry in general and most of the historic industry, despite the fact that we all value diversity. Click for larger view View full resolution Before and after photos of Canal Lofts, a former industrial building that has been converted into apartments in Worcester, Mass. Photo courtesy WinnDevelopment Our development company, WinnDevelopment, and our parent company, WinnCompanies, has focused for more than four decades on developing strong ties to the neighborhoods and communities we serve. One of our specialties is property rehabilitation and turnaround. Urban revitalization is important to us and we strive to better our communities by working with the U.S. Department of Housing and Urban Development and various state and local agencies. We are also experienced in acquiring and sensitively re-creating dilapidated historic structures into vibrant living or working spaces. Although we are certainly not unique among for-profit developers in embracing diversity, we believe it is both good business and equitable to do so. For affordable housing developments, including rehabilitations of existing housing, new construction, or adaptive use of vacant historic buildings into housing (market or affordable), we take steps to make sure that our projects benefit those who live and work in the community. [End Page 33] At WinnCompanies we approach every project with the goal of building partnerships and promoting economic growth within the community. We work hard to engage businesses that have been under-represented in the real estate field. Often our properties are developed using federal and state affordable housing programs (such as Low Income Housing Tax Credits) and initiatives. Additionally, we strive to achieve a minimum of 15 percent, sometimes 50 percent minority and/or women employment. We also strive to have similar multi-million dollar expenditures and percentages for minority-owned business enterprises (MBEs) and woman-owned business enterprises (WBEs) and suppliers that we contract with. This ensures that a greater percentage of the historic redevelopment expenditures flow back to the communities in which the rehabilitated buildings are located. Click for larger view View full resolution WinnDevelopment reached out to local businesses, minority contractor associations and community organizations to encourage bids from minority...

Measuring the economic impact of publicly funded research in Northern Canada

This paper provides the first empirical estimate of the local economic impact of publicly funded research expenditures in the Yukon, Nunavut, and Northwest Territories of Canada between 2000 and 2009. The total dollar expenditures of northern research during this period was estimated to be $284 million and peaked in 2009 at close to $110 million. Using data acquired from major granting agencies in Canada and Statistics Canada multipliers, the economic impact of northern research on local income, Gross Domestic Product (GDP), and employment impacts were estimated. It was determined that at its peak, northern research impacted the territorial GDP by 0.04%, income by 0.09% and employment by 0.11%. While the total economic impact of publicly funded research expendituers may be small relative to other northern industries, individual communities where the field research is conducted, may experience significant income, employment and other intangible benefits. The community of Old Crow is used to illustrate the potential community-level importance of local expenditures associated with northern research.

US National Healthcare Expenditures, 1960-2000: Public and Private Cubic Growth Dynamics

US national healthcare expenditures (NHE) displayed cubic growth dynamics between 1960 and 2000. In any year, current NHE must equal population times consumer price index (CPI) times per capita CPI-adjusted constant dollar healthcare expenditures. Cubic growth dynamics are a consequence of the fact that essentially linear growth relationships were observed over time with total population, CPI, and per capita CPI-adjusted dollar healthcare expenditures. Similarly in any year, current private and public NHE must equal population times consumer price index (CPI) times private and public per capita CPI-adjusted constant dollar healthcare expenditures respectively. This study examined whether private and public per capita CPI-adjusted dollar healthcare expenditures displayed linear growth. Linear relationships were observed over this time period for both private per capita CPI-adjusted dollar healthcare expenditures and public per capita CPI-adjusted dollar healthcare expenditures. The finding that both of these factors were well described by linear equations suggests that that both private and public NHE growth should display cubic growth dynamics over time. From 1960 through 2000, cubic growth dynamics were observed for both private NHE and public NHE. This model suggests that shifting healthcare costs between the private and public domains will not alter the underlying cubic growth dynamics of US NHE as long as per capita CPI-adjusted constant dollar private and public healthcare expenditures increase reasonably linearly over time.

Pharmaceutical Supply Chain and Distribution Network in Tanzania

Problem: Despite the efforts made by the Government of Tanzania since 1994 to reform the health sector, Tanzania is still facing a number of challenges: increasing morbidity and mortality rate due to HIV/AIDS and Malaria, increasing demand for health care due to population increase at a 2.032% growth rate and varying disease patterns, difficulties in forecasting demand fluctuations of medicines, shortfall in annual health sector budget allocations and increasing costs of essential health care medicines. These challenges hinder the achievement of quality health and weaken the nation. Objective: The aim of this research was to critically analyze the current challenges facing the pharmaceutical supply chain and distribution network, evaluate implications on access to medicine and quality health care and identify areas for application of process innovation to improve the performance and match demand and supply of pharmaceuticals. The case study focused on the Public Pharmaceutical Sector in Tanzania.Design/Methodology/Approach: This was an explanatory research design based on embedded multiple case studies. The unit of analysis was pharmaceutical supply chain and its participating organizations. The case study was based on “how” and “what” type of questions with a mixture of qualitative and quantitative data. Multiple sources of evidence “triangulation” were used to collect primary and secondary data. Worldwide pharmaceutical supply chain cases from the USA, India, China, Ghana and Zambia were selected for analysis to guide analytic generalization and recommendations. Cross-case and within case analysis techniques along with the conceptual framework and literature review were used to analyze the cases and case study protocol and database were developed.Key Findings: The study found critical challenges; significant delays of more than 3 months of government funding to MSD, medicines are expensive; more than 20 million US dollar expenditures per year on medicines, a staggering debt of approximately 24 million US dollar to government, lack of stock control, poor demand and stock information flow, errors in demand forecasting as a result causing delays in delivery, stock-out, medicine shortages at health facilities and demand-supply mismatching. Changing disease patterns was also contributing to unavailability of medicines. Conclusion: The poor performance of pharmaceutical supply chain and distribution network has negative implications on access to medicines and quality health care.Recommendations: Process innovation model was proposed for analyzing the pharmaceutical supply chain performance. It was recommended a need for integration of activities in the supply chain along with collaboration and coordination among participants at each stage.

Assessing an academic library collection through capacity and usage indicators: testing a multi‐dimensional model

PurposeThe purpose of this paper is to test a multi‐dimensional model of indicators for collection evaluation (proposed in a previous paper by the authors) and to illustrate how to apply these indicators in practice.Design/methodology/approachAn analytical study will be used to test the use of the multi‐dimensional collection evaluation model to assess an academic library collection. The study will: define the scope of the collection; focus on two of the dimensional categories (capacity and usage) and identify indicators for the two categories.FindingsThis paper demonstrates that combining usage indicators with capacity measurement (in terms of dollar expenditures) provides a powerful method of assessment with the potential to provide valuable data.Research limitations/implicationsThis study provides an accurate assessment of a library's collection in the current information environment. It does not currently include institutional repositories or locally created digital resources that will need to be addressed in the future as they mature and become more robust.Practical implicationsAcademic libraries will have a reliable and sustainable model for the assessment of their collections. This paper illustrates how to assess the collection using the selected indicators.Originality/valueThe value of this study is in its development of the multi‐dimensional model for collection assessment and in the reliability and accuracy of the collection data it provides. It provides an evidence‐based method for assessing an academic library collection.

U.S. National Healthcare Expenditures: Demonstration and Explanation of Cubic Growth Dynamics

U.S. national healthcare expenditures (NHE) increased from under 28 billion dollars in 1960 to over 1.35 trillion dollars in 2000. This enormous growth threatens the sustainability of the provision of healthcare. By definition, in any year, current NHE must equal population times consumer price index (CPI) times per capita CPI-adjusted constant dollar healthcare expenditures. Linear relationships were observed over time with total population (r2 > 0.99), with CPI (r2 > 0.96), and with per capita CPI-adjusted dollar healthcare expenditures (r2 > 0.98). The finding that those three factors were well described by linear equations suggests that NHE growth should display cubic dynamics over time. NHE from 1960 through 2000 did display cubic growth dynamics (r2 > 0.99). Moreover, actual NHE from 1960 through official U.S. government NHE projections in 2019 also displayed cubic growth dynamics (r2 > 0.99). This model explains why U.S. NHE has displayed cubic growth dynamics and suggests that U.S. NHE will continue to display cubic growth dynamoics as long as increases in population, CPI, and per capita CPI-adjusted constant dollar healthcare expenditures continue to increase reasonably linearly over time.

Personal Selling Elasticities: A Meta-Analysis

This article presents a meta-analysis of prior econometric estimates of personal selling elasticity—that is, the ratio of the percentage change in an objective, ratio-scaled measure of sales output (e.g., dollar or unit purchases) to the corresponding percentage change in an objective, ratio-scaled measure of personal selling input (e.g., dollar expenditures). The authors conduct a meta-analysis of 506 personal selling elasticity estimates drawn from analyses of 88 empirical data sets across 75 previous articles. They find a mean estimate of current-period personal selling elasticity of .34. They also find that elasticity estimates are higher for early life-cycle-stage offerings, higher from studies set in Europe than from those set in the United States, and smaller in more recent years. In addition, elasticity estimates are affected significantly by analysts’ use of relative rather than absolute sales output measures, by cross-sectional rather than panel data, by omission of promotions, by lagged effects, by marketing interaction effects, and by the neglect of endogeneity in model estimation. The method bias–corrected mean personal selling elasticity is approximately .31. The authors discuss the implications of their results for sales managers and researchers.

Pharmaceutical Supply Chain and Distribution Network: Implications on Access to Medicine and Quality Health Care- Critical Analysis of The Public Pharmaceutical Sector in Tanzania

Problem: Despite the efforts made by the Government of Tanzania since 1994 to reform the health sector, Tanzania is still facing a number of challenges: increasing morbidity and mortality rate due to HIV/AIDS and Malaria, increasing demand for health care due to population increase at a 2.032% growth rate and varying disease patterns, difficulties in forecasting demand fluctuations of medicines, shortfall in annual health sector budget allocations and increasing costs of essential health care medicines. These challenges hinder the achievement of quality health and weaken the nation. Objective: The aim of this research is to critically analyze the current challenges facing the pharmaceutical supply chain and distribution network, evaluate implications on access to medicine and quality health care and identify areas for application of process innovation to improve the performance and match demand and supply of pharmaceuticals. The case study focuses on public pharmaceutical sector in Tanzania. Design/Methodology/Approach: This is an explanatory research design based on embedded multiple case studies. The unit of analysis is pharmaceutical supply chain and its participating organizations. The case study was based on “how” and “what” type of questions with a mixture of qualitative and quantitative data. Multiple sources of evidence “triangulation” were use to collect primary and secondary data. Worldwide pharmaceutical supply chain cases from the USA, India, China, Ghana and Zambia were selected for analysis to guide analytic generalization and recommendations. Cross-case and within case analysis techniques along with the conceptual framework and literature review were used to analyze the cases and case study protocol and data were developed. Key Findings: The study found critical challenges; significant delays of more than 3 months of government funding to MSD, medicines are expensive; more than 20 million US dollar expenditures per year on medicines, a staggering debt of approximately 24 million US dollar to government, lack of stock control, poor demand and stock information flow, errors in demand forecasting as a result causing delays in delivery, stock-out, medicine shortages at health facilities and demand-supply mismatching. Changing disease patterns is also contributing to unavailability of medicines. Conclusion: The poor performance of pharmaceutical supply chain and distribution network has negative implications on access to medicines and quality health care. Recommendations: Process innovation model was proposed for analyzing the pharmaceutical supply chain performance. It was recommended a need for integration of activities in the supply chain along with collaboration and coordination at each stage.

The Importance of Oral Health in Long-Term Care

Emerging evidence has shown a strong link between the effects of chronic oral inflammation and general health. The mouth is the visible gateway to the rest of the body and reflects what is happening deep inside. Periodontal disease has been linked to systemic disease; likewise, systemic disease can have an impact on oral health. In fact, there are over 100 systemic diseases that have oral manifestations, such as cardiovascular disease, stroke, respiratory infections, pancreatic cancer, diabetes, and nutritional problems. This is a bidirectional relationship and the link is inflammation. Oral health problems can have an adverse effect on the quality of life and are more prevalent in older adults, but are not caused by aging. Approximately 75% of baby boomers will enter long-term care facilities with the majority of their natural teeth and this trend is expected to continue. Studies indicate that residents with good oral care require less health care dollar expenditures. Therefore, dental professionals, such as the dental hygienist, should be part of the multidisciplinary team to assist in providing expert regular dental care and training to caregivers and other health care professionals in long-term care facilities.

The Impact of Integrating Mental and General Health Services on Mental Health's Share of Total Health Care Spending in Alberta

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Chronic obstructive pulmonary disease: Diagnosis and management

The purpose of this article is to provide a comprehensive review of the current modalities employed in diagnosing and treating chronic obstructive pulmonary disease (COPD). Special emphasis is placed on current guidelines, as defined by the Global Initiative for Chronic Obstructive Lung Disease. A comprehensive literature review for COPD serves as the basis for this article. According to the National COPD Coalition (2004), there are nearly 24 million Americans who suffer from COPD. The incidence of COPD is rising globally and is associated with increased morbidity and mortality. COPD is characterized by progressive decline in function, resulting in concomitant diseases, which increase healthcare dollar expenditures, thus making COPD a concern for healthcare providers in the United States and abroad. Once a diagnosis of COPD is made, healthcare providers should explore multiple treatment options in an effort to find the most beneficial regimen. It is only when the treatments are individualized, including physiological therapies and cognitive approaches to lessen risks as well as to reduce exacerbations, that the patient with COPD is able to potentially experience a reasonable quality of life.

Brand Efficiency and Brand Relevance - Introducing and Linking Both Concepts

Brand managers are under increased pressure to illustrate the performance of their multimillion dollar expenditures. This paper provides three contributions in the context of brand management. First, we introduce the concept of brand efficiency as a measure for the performance of the brand management process. Second, we develop a measure for the industry-specific brand relevance (influence of branding on purchase decisions). Third, we link these concepts and examine if brand management efficiency in an industry is influenced by brand relevance.

Countermarketing in the Courts: The Case of Marketing Channels and Firearms Diversion

Rarely has the field of marketing thought been closely associated with the topic of citizens' use of firearms in the United States, but it is now at the center of interest in this controversial and multifaceted area. Public policy has not yet resolved the challenges from conflicts among personal freedoms, fundamental rights, deaths, pain, and huge dollar expenditures to address the problems from guns used in crimes; it is still evolving in this area. A more recent addition to the public policy debate is a set of major judicial cases that raise issues about the U.S. distribution system for firearms, how it is designed and operated, and what role it should play with respect to contributing to the control of firearms diversion. In response, marketing academics have begun to conduct channels-of-distribution analyses to inform these judicial deliberations. This article presents the framework of one such analysis and reveals the considerable insights that marketing theory and concepts, especially countermarketing, demarketing, and channels-of-distribution theory, can bring to public policy makers' understanding of these issues. In addition, assessment of this framework should assist marketing scholars in explicating key topics for future attention in the realm of the marketing of other potentially harmful or dangerous products and services.

An Approach to Determine the Need for Expanding Small Airports: A Case Study

An Approach to Determine the Need for Expanding Small Airports: A Case Study

Acute Treatment of Atrial Fibrillation

Atrial fibrillation (AFib) is a common clinical entity, responsible for significant morbidity and mortality, but it also accounts for a large percentage of healthcare dollar expenditures. Efforts to treat this arrhythmia in the past have focused on subacute antithrombotic therapy and eventually use of antiarrhythmic drugs for maintenance of sinus rhythm. However, there has been a growing interest in the concept of acute electrical and pharmacologic conversion. This treatment strategy has a number of benefits, including immediate alleviation of patient symptoms, avoidance of antithrombotic therapy, and prevention of electrophysiologic remodeling, which is thought to contribute to the perpetuation of the arrhythmia. There is also increasing evidence that this is a cost-effective strategy in that it may obviate admission to the hospital and the cost of long-term therapy. This article represents a summary of the treatments that may be used acutely to control the ventricular response to AFib, prevent thromboembolic events, and provide for acute conversion either pharmacologically or electrically. It includes information on modalities that are currently available and those that are under active development. We anticipate that an active, acute treatment approach to AFib and atrial flutter will become the therapeutic norm in the next few years, especially as the benefits of these interventions are demonstrated in clinical trials.

Introduction to outcomes measurement

Much attention has been focused recently on assessing the outcomes of technology utilization. As streamlined services, cost cutting, and broadbased accountability have been mandated in all sectors of society, it is imperative that the value of technologies be demonstrated in order to assure their continued funding, development, and availability. While anecdotal evidence may suffice when working with new services, techniques, and devices, our successes have made technological interventions commonplace. The growth in the number of technological products produced has resulted in lower unit costs, and the demand has risen. Thus, total dollar expenditures for technologies continue to increase. We live in a time when we need to do more with less and stretch every dollar available to us. Unused technologies represent wasted resources as well as poor needs assessment. The time has come to optimize the process of matching person and technology. This challenge is one we must all learn to meet. The authors of the articles in this special issue have met the challenge head-on. They have developed and pioneered means of assessing outcomes, tested those means, and written the results of their efforts for you to read, discuss, and use in