scholarly journals National Trends and Disparities in Hospitalization for Hypertensive Emergencies Among Medicare Beneficiaries, 1999-2019

2021 ◽  
Author(s):  
Yuan Lu ◽  
Yun Wang ◽  
Erica S Spatz ◽  
Oyere Onuma ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Hypertensive Emergency ◽  
Fee For Service ◽  
The South ◽  
Black Adults ◽  
Cross Sectional ◽  
Hypertensive Emergencies ◽  
Hospitalization Rates ◽  
Icd 10 ◽  
Dual Eligible ◽  
Demographic Subgroups

Background: In the last two decades, hypertension control in the U.S. population has not improved, and there are widening disparities. Less is known, however, about progress in reducing hospitalizations related to hypertensive emergencies. Methods: We conducted serial cross-sectional analysis of Medicare fee-for-service beneficiaries aged 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. We evaluated trends in national hospitalization rates for hypertensive emergencies and longer-term outcomes, including 30-day readmission and 30-day mortality. Because substantial demographic and regional variation may exist in hypertension prevalence and outcomes, we also evaluated rates of hospitalization and associated outcomes by demographic subgroups and county. We identified all beneficiaries admitted with a primary discharge diagnosis of hypertensive emergency, hypertension urgency, or hypertension crisis (ICD-9 code of 401.0, 402.0x, 403.0x, 404.0x, and 405.0x from January 1, 1999, to September 31, 2015, ICD-10 code of I100, I119, I110, I120, I132, I150, and I158 from October 1, 2015, to September 31, 2016, ICD-10 code of I16.0, I16.1, I16.9 from October 1, 2016, to December 31, 2019). Results: The sample consisted of 397,238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for hypertensive emergencies increased significantly from 51.5 to 125.9 per 100,000 beneficiary-years; this increase was most pronounced among the following subgroups: adults ≥85 years (66.8 to 274.1), females (64.9 to 160.1), Blacks (144.4 to 369.5), and Medicare-Medicaid insured (dual eligible, 93.1 to 270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Blacks and Whites from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South (so-called "Stroke Belt"). Among 3,143 counties and county-equivalents included in the study, less than 1% of counties either had no change (n=7) or decreased (n=20) hospitalization rates since 1999. Among patients hospitalized for a hypertensive emergency, the observed 30-day all-cause mortality rate decreased from 2.6% to 1.7% and 30-day all-cause readmission rate decreased from 15.7% to 11.8%. Conclusion: Among Medicare fee-for-service beneficiaries aged 65 years or older, hospitalization rates for hypertensive emergencies increased substantially and significantly from 1999 to 2019. Black adults had the largest increase in hospitalization rates across age, sex, race, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.

scholarly journals Association between obesity and urinary albumin-creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040214
Author(s):  
Shan Qin ◽  
Anping Wang ◽  
Shi Gu ◽  
Weiqing Wang ◽  
Zhengnan Gao ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Northern China ◽  
Cross Sectional Study ◽  
Urinary Albumin ◽  
Creatinine Ratio ◽  
Sectional Study ◽  
The South ◽  
Northern Population ◽  
Cross Sectional ◽  
Albumin Creatinine Ratio

ObjectiveThe relationship between obesity and albuminuria has not been clarified. This study aimed to investigate the correlation between obesity and the urinary albumin-creatinine ratio (UACR) in Southern and Northern China.DesignA descriptive, cross-sectional study.SettingEight regional centres in REACTION (China’s Risk Evaluation of cAncers in Chinese diabeTic Individuals, a lONgitudinal study), including Dalian, Lanzhou, Zhengzhou, Guangzhou, Guangxi, Luzhou, Shanghai and Wuhan.ParticipantsA total of 41 085 patients who were not diagnosed with chronic kidney disease (CKD) and had good compliance were selected according to the inclusion criteria. Patients who were diagnosed with CKD, who had other kidney diseases that could lead to increased urinary protein excretion, who were using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers and whose important data were missing were excluded.ResultsParticipants with both, central and peripheral obesity, had a higher risk of elevated UACR, even after adjusting for multiple factors (OR: 1.14, 95% CI: 1.07 to 1.12, p<0.001), and the risk of high UACR in the South was more prominent than that in the North (OR South: 1.22, 95% CI: 1.11 to 1.34; OR North: 1.13, 95% CI: 1.04 to 1.22, p<0.001). The risk was also elevated in the male population, hypertensive individuals, glycosylated haemoglobin (HbA1c)≥6.5% and age ≥60 years in the South. Besides the above groups, diabetes was also a risk factor for the Northern population.ConclusionsIn China, people with both central and peripheral obesity are prone to a high UACR, and the southern population has a higher risk than northern population. Factors such as male sex, hypertension, HbA1c≥6.5% and an age ≥60 years are also risk factors for CKD.

scholarly journals 967. Concordance of Antibiotic Prescribing with the Proposed American Dental Association Acute Oral Infection Guidelines within Veterans Affairs (VA) Dentistry

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S31-S32
Author(s):  
Daniel Carlsen ◽  
Katie J Suda ◽  
Ursula C Patel ◽  
Gretchen Gibson ◽  
Marianne M Jurasic ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Oral Infections ◽  
American Dental Association ◽  
Dental Procedures ◽  
Icd 10 ◽  
Future Work ◽  
Irreversible Pulpitis

Abstract Background US dentists prescribe 10% of outpatient antibiotics. However, assessing the appropriateness of dental antibiotic prescribing has been challenging due to a lack of guidelines for common infections. In 2019, the American Dental Association proposed clinical practice guidelines (CPG) on the management of common acute oral infections for the first time. Our objective was to describe national baseline antibiotic prescribing for the treatment of irreversible pulpitis, apical periodontitis, and acute apical abscess prior to the release of the proposed CPG. Methods We performed a cross-sectional analysis of national VA data from January 1, 2017 to December 31, 2017. We identified cases of irreversible pulpitis, apical periodontitis, and acute apical abscess using ICD-10-CM codes. Patient demographics, facility location, medical conditions, dental procedure codes (“CDTs”), and diagnostic (ICD-10-CM) codes were extracted from the VA Corporate Data Warehouse. Antibiotics prescribed by a dentist within 7 days of a visit were included. Multivariable logistic regression identified variables associated with antibiotic prescribing for each infection. Results Of the 470,039 VA dental visits with oral infections coded, 25% of irreversible pulpitis, 41% of apical periodontitis, and 61% of acute apical abscess visits received antibiotics. Amoxicillin was prescribed most frequently. Although the median days’ supply was 7 days, prolonged use of antibiotics was frequent (9.2% of irreversible pulpitis, 17.8% of apical periodontitis, 28.7% of acute apical abscess received antibiotics for ≥8 days). Of the irreversible pulpitis visits with antibiotics prescribed, 20.0% received ≥2 antibiotics. Patients with high-risk cardiac conditions, prosthetic joints, and certain dental procedures were associated with receipt of antibiotics (table). Conclusion Prior to the release of the ADA guidelines, 75.8% and 59.4% of irreversible pulpitis and apical periodontitis were concordant with proposed recommendations. These data identify opportunities to improve prescribing and serve as a benchmark for future outpatient antimicrobial stewardship efforts. Future work should assess definitive dental treatment and populations without access to oral health care. Disclosures All Authors: No reported Disclosures.

Prevalence of Physical Activity and Sedentary Behaviors in US High School Students by Metropolitan Status and Geographic Region

2006 ◽  
Vol 3 (4) ◽  
pp. 365-380 ◽  
Author(s):  
Andrew E. Springer ◽  
Deanna M. Hoelscher ◽  
Steven H. Kelder
Keyword(s):  
Physical Activity ◽  
High School Students ◽  
Sedentary Behavior ◽  
Geographic Region ◽  
Sedentary Behaviors ◽  
The South ◽  
School Students ◽  
Cross Sectional ◽  
Nationally Representative ◽  
Tv Watching

Background:Geographic differences in the prevalence of physical activity (PA) have been found among adults in the US; similar studies have not been conducted among adolescents.Methods:Using nationally representative cross-sectional data from the CDC’s 2003 Youth Risk Behavior Survey, we estimated the prevalence of PA and sedentary behaviors by metropolitan status and geographic region.Results:The prevalence of PA was lowest and prevalence of sedentary behavior highest for urban students. Students from the South reported the lowest prevalence of PA and the highest prevalence of TV watching, while students from the West generally reported the highest PA prevalence and lowest sedentary behavior prevalence. Prevalence differences ranged from < 1.0% to > 15%, with most differences falling between 5% and 10%.Conclusions:Findings mirror regional variations previously observed in adult PA. We need to understand factors that contribute to lower PA in youth living in the South and in urban settings.

Dispersion in total cost of care for Medicare fee-for-service (FFS) patients with metastatic pancreatic cancer receiving FDA-approved/NCCN Category 1 regimens at 340B verus non-340B institutions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18843-e18843
Author(s):  
Helen Latimer ◽  
Samantha Tomicki ◽  
Gabriela Dieguez ◽  
Paul Cockrum ◽  
George P. Kim
Keyword(s):  
Pancreatic Cancer ◽  
Cost Of Care ◽  
Metastatic Pancreatic Cancer ◽  
Fee For Service ◽  
Total Cost ◽  
Diagnosis Codes ◽  
Heavily Pretreated ◽  
Icd 10 ◽  
Liposomal Irinotecan ◽  
Line Of Therapy

e18843 Background: The Department of Health and Human Services (HHS) designed the 340B drug pricing program to allow institutions that service specialty populations to acquire drugs at lower prices. Objective: To analyze the dispersion in total cost of care (TCOC) for Medicare FFS patients (pts) with metastatic pancreatic cancer (m-PANC) treated at 340B or non-340B institutions, by NCCN Category 1 regimen. Methods: We identified pts with m-PANC using ICD-10 diagnosis codes in the 2016-18 Medicare Parts A/B/D 100% Research Identifiable Files. Study pts had 2+ claims with a pancreatic cancer diagnosis and Medicare FFS coverage for 6 months pre- and 3 months post-metastasis diagnosis. Study pts were treated with NCCN Category 1 regimens: 1L gemcitabine monotherapy (gem-mono), 1L gemcitabine/nab-paclitaxel (gem-nab), 1L FOLFIRINOX (FFX), and 2L liposomal irinotecan-based regimen (nal-IRI). Pts were attributed to 340B or non-340B institutions based on plurality of chemotherapy claims. TCOC reflects insurer-paid services per line of therapy (LOT) for 3 categories: chemotherapy/supportive drugs (chemo/Rx), inpatient care (IP), and other outpatient care (OP). We grouped pts by quartile (qrt) and evaluated drivers of TCOC and mean rates of admissions (admits/pt). Results: We identified 2,697 (340B) and 3,839 (non-340B) pts taking NCCN Category 1 regimens. Gem-mono represented 1% and 4% of all pts in 340B and non-340B institutions, respectively. Gem-nab accounted for 72% of pts in both cohorts. For gem-nab, FFX, and nal-IRI pts, median TCOC was similar in both cohorts, although mean TCOC by qrt was lower at 340B institutions than non-340B institutions, except for gem-nab in the 1st qrt. The components of TCOC were similar between 340B and non-340B institutions in all qrts. In both cohorts, % IP costs increased between the 1st and 4th qrt (340B:15% to 23%, non-340B:14% to 25%). From the 1st to the 4th qrt, admits/pt increased in both cohorts. In the 340B cohort, nal-IRI pts had the lowest admits/pt while gem-nab pts had the highest in all qrts. In the non-340B cohort, nal-IRI pts had the lowest admits/pt except for in the 1st qrt. Conclusions: Median TCOC was lower at 340B institutions than non-340B institutions for all regimens, and the range of TCOC dispersion was also smaller at 340B institutions. Across qrts, chemotherapy accounted for approximately half the TCOC; however, IP costs were proportionally higher in the 4th qrt. Comparing regimens, despite 2L nal-IRI pts being more heavily pretreated, median costs in each cohort were similar to 1L gem-nab and 1L FFX, while admits/pt were generally lower than 1L gem-nab and 1L FFX across qrts and cohorts.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mariana F Lobo ◽  
Vanessa Azzone ◽  
Luis Azevedo ◽  
Armando Teixeira-Pinto ◽  
Jose Pereira Miguel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
The United States ◽  
Billing Data ◽  
Cross Sectional ◽  
Medical Technologies ◽  
Hospitalization Rates ◽  
The Us ◽  
International Comparative

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

scholarly journals Oxford elbow scores in an asymptomatic population

2013 ◽  
Vol 95 (6) ◽  
pp. 415-417 ◽  
Author(s):  
PM Guyver ◽  
AE Cattell ◽  
MJ Hall ◽  
MD Brinsden
Keyword(s):  
Healthcare Delivery ◽  
Hand Dominance ◽  
The South ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Elbow Injury ◽  
South West ◽  
Clinical Difference ◽  
Background Population ◽  
Patient Reported

Introduction Patient reported outcome measures (PROMs) are being used increasingly to assess the quality of healthcare delivery in the UK. It is important when using PROMs to know the score of the background population against which any clinical intervention may be benchmarked. The purpose of this study was to measure an elbow specific PROM for the population of the South West Peninsula. Methods A cross-sectional survey was undertaken of patients and healthcare professionals from the South West Peninsula population. Participants were asked to complete a simple demographic questionnaire and an Oxford elbow score for each elbow. Respondents with a history of elbow surgery, elbow injury, chronic elbow problems or an incomplete dataset were excluded from the study. Results A total of 1,765 respondents (3,530 elbows) completed the survey but 567 questionnaires were excluded due to incomplete datasets, pre-existing elbow pathology or age criteria, leaving 1,198 individuals (2,396 elbows) for analysis. The median scores for each decade group were 48, with mean scores ranging from 46.74 to 47.94. There was no significant clinical difference in the scores for age, sex or hand dominance. Conclusions When using the Oxford elbow score to assess outcomes after surgery, a normal score should be used as the benchmark. This benchmark is independent of age, sex and hand dominance.

scholarly journals Integrated management systems diffusion models in South European countries

2018 ◽  
Vol 35 (10) ◽  
pp. 2289-2303 ◽  
Author(s):  
Mónica Cabecinhas ◽  
Pedro Domingues ◽  
Paulo Sampaio ◽  
Merce Bernardo ◽  
Fiorenzo Franceschini ◽  
...  
Keyword(s):  
Integrated Management ◽  
Early Years ◽  
Iso 14001 ◽  
European Countries ◽  
Saturation Level ◽  
Management Systems ◽  
The South ◽  
Cross Sectional ◽  
Data Set ◽  
Content Type

Purpose The purpose of this paper is to dissect the diffusion of the number of organizations that implemented multiple management systems (MSs), considering the International Organization for Standardization (ISO) 9001, ISO 14001 and OHSAS 18001 standards (quality, environment and safety) in the South European countries: Italy, Portugal and Spain. In addition, based on the data collected, forecasting models were developed to assess at which extent the multiple certifications are expected to occur in each studied country. Design/methodology/approach Data concerning the evolution of the amount of multiple MSs in Italy, Portugal and Spain were collected for the period between 1999 and 2015. The behavior of the evolution of the number of MSs over the years was studied adopting both the Gompertz and the Logistic models. The results obtained with these two models were compared and analyzed to provide a forecast for the next years. Findings The diffusion throughout the years of the number of MSs presents an S-shaped behavior. The evolution of the amount of MSs in countries with a lower saturation level are properly fitted by the Gompertz model whereas the Logistic model fits more accurately when considering countries with a larger saturation level. Research limitations/implications The data related to the early years are not available in some of the countries. To overcome this shortcoming missing data were extrapolated from the data set provided by the annual ISO survey. Additionally, the integration level attained by each company was not assessed and, on this regard and in the scope of this paper, an integrated management system is understood as implemented when organizations have multiple MSs implemented. Practical implications The results provide a cross-sectional portrayal of the diffusion of MSs certifications in the South European countries and enable a forecast for the trend in the next years. Originality/value This study aims for the first time, to the best of the authors’ knowledge, to analyze the diffusion of multiple MSs throughout the years.

scholarly journals Mental stress in infertility: a tertiary care hospital-based study

2018 ◽  
Vol 7 (10) ◽  
pp. 4249
Author(s):  
Susmita Bhattacharya ◽  
Amit Kyal ◽  
Payel Mondal ◽  
Partha Mukhopadhyay ◽  
Mrinalini Chowdhury ◽  
...  
Keyword(s):  
Mental Stress ◽  
Married Couple ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Dyadic Adjustment ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional ◽  
Primary Infertility ◽  
Icd 10

Background: Most of the couples suffering from infertility report it to be the most stressful and depressing period of their life, more so if it is a primary infertility. Studies regarding the prevalence and role of infertility-specific stress especially in eastern part of India is very limited. The objective of the present study was to estimate the prevalence of infertility-specific stress and its role in marital adjustment in women diagnosed with infertility.Methods: It was a cross-sectional study done on 80 married couple diagnosed with infertility (both primary and secondary) over 1 year from July 2016 to June,2017. Dyadic Adjustment Scale (DAS), "semi-structured questionnaire" compiled by the authors and "ICD-10 Classification of Mental and Behavioral Disorders (Clinical Descriptions and Diagnostic Guidelines)" were used for the evaluation. The analysis was done using SPSS (version 16) and Chi-square test.Results: Around 86% infertile women and 21% infertile men were found to suffer from mental stress. Infertility related stress were more in patients with primary infertility than in secondary one. Women mostly (56.5%) coped with stress by self-blaming whereas men (58.2%) by blaming the partner.Conclusions: Mental stress was significantly associated with infertility. In fact, maladjustment in marital relation caused by the stress adversely affected the conjugal life and thus also the fertility. Proper counselling of both partners might be helpful to solve this problem.

scholarly journals ORGANIZATIONAL LEARNING CAPABILITY AND FIRM INNOVATIVENESS OF MANUFACTURING FIRMS IN THE SOUTH-SOUTH OF NIGERIA

2021 ◽  
pp. 24-44
Author(s):  
Agadah Mienipre ◽  
Omoankhanlen Akhigbe
Keyword(s):  
Organizational Learning ◽  
Rank Order ◽  
Manufacturing Firms ◽  
The South ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Learning Capability ◽  
Firm Innovativeness ◽  
The Relationship ◽  
System Orientation

The purpose of this study was to investigate the relationship between Organizational learning capability and firm innovativeness of manufacturing firms in the south-south of Nigeria. The study offers an empirical assessment of the relationship as based on its model – 4 null hypothetical statements are put forward. The research design adopted was the cross-sectional survey and data for this study was generated from managers and key personnel of the target organizations using structured questionnaire. The study adopted the Spearman’s rank order correlation in its assessment for the bivariate correlations between dimensions of organizational learning capability (managerial commitment and system orientation) and measures of firm innovativeness (propensity to create new products and propensity to create new processes). The findings reveal significant relationships between dimensions of organizational learning capability and the measures of firm innovativeness. In conclusion, it was stated that organizational learning capability, through dimensions such as managerial commitment and system orientation, offers the necessary support, orientation and knowledge control for enhancing firm innovativeness.

Sign in / Sign up

Export Citation Format

Share Document