A value case methodology to enable a transition towards generative health management

Abstract Issue/problem Health systems sustainability is a critical public health issue. A value-based approach is essential to improve patient-centeredness, appropriateness, quality and funding allocation in healthcare. Description of the problem This project was aimed to develop an innovative transferable tool to assess value-based activities in Hospital by monitoring care pathways costs and outcomes. Main questions were to: assess cost and outcome variance in homogeneous groups of patients; evaluate clinical activities contribution to the hospital budget; identify and monitor critical points. In 2018 a Business Intelligence system fed by different Hospital datasets was developed and tested in a Teaching Hospital in Rome to quantify and integrate data on pathways efficacy and costs. It was based on an algorithm of 20 indicators related to Women and Child Care Pathways. Results Preliminary results showed a great variance for the same intervention/procedure concerning length of stay (3-8 days), waiting times (1-4 days), innovative technologies costs (2000-6000€) and obsolete reimbursement rates (2000-5000€) that do not guarantee adequate economic contribution margins. Improvement actions were defined concerning pathways’ workflow and organizational appropriateness. The need for negotiations with Ministry of Health was highlighted, aimed to update reimbursement rates. Lessons The tool, built on a value-based process view, allowed analyzing online outcomes and costs data aggregated by path, benchmarking results, identifying critical issues and providing improvement solutions. It turned out to be an innovative methodology - also applicable in other settings/countries - to trigger changes in health management and pursue quality and efficiency in healthcare. Key messages Value-based healthcare is the new public health paradigm. Assessing simultaneously Hospital costs and outcomes is a valuable way to derive overall healthcare value, improve quality and rationalize resources allocation.

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Organizational health management through metaphor: a mission-based approach

Journal of Health Organization and Management ◽

10.1108/jhom-05-2017-0098 ◽

2018 ◽

Vol 32 (3) ◽

pp. 374-393 ◽

Cited By ~ 3

Author(s):

Joseph M. Woodside

Keyword(s):

Health Management ◽

Organizational Health ◽

Healthcare Management ◽

Managerial Decision ◽

Organizational Mission ◽

Content Type ◽

A Value ◽

Building Process ◽

The Usa ◽

Value Based Care

PurposeThe purpose of this paper is to identify the underlying metaphors that hospitals use to establish their organizational mission. Metaphors impact the direction and managerial decision making of organizations, and provide a method to more easily communicate to a variety of stakeholders.Design/methodology/approachA text analytics process is run to evaluate the mission statements from the largest hospitals by revenue in each of the 50 states of the USA and District of Columbia to identify the types of metaphor-based organizational health management methods.FindingsA cluster analysis is generated to evaluate primary mission-based metaphors, and metatriangulation is used to evaluate output, develop theory and provide practical implications for healthcare management.Originality/valueKey contributions include a review of healthcare metaphors, an analysis for understanding commonly utilized metaphors, a theory building process for developing a new integrated value-based care management metaphor, and a value-based process is developed for providing healthcare managers an easy to follow and repeatable process for improving organizational communication.

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Observations of the Thermal Decomposition of Brucite

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100101980 ◽

1968 ◽

Vol 26 ◽

pp. 446-447

Author(s):

P. L. Burnett ◽

W. R. Mitchell ◽

C. L. Houck

Keyword(s):

Thermal Decomposition ◽

Magnesium Oxide ◽

Basal Plane ◽

Magnesium Ions ◽

A Value ◽

Reaction Proceeds

Natural Brucite (Mg(OH)2) decomposes on heating to form magnesium oxide (MgO) having its cubic ﹛110﹜ and ﹛111﹜ planes respectively parallel to the prism and basal planes of the hexagonal brucite lattice. Although the crystal-lographic relation between the parent brucite crystal and the resulting mag-nesium oxide crystallites is well known, the exact mechanism by which the reaction proceeds is still a matter of controversy. Goodman described the decomposition as an initial shrinkage in the brucite basal plane allowing magnesium ions to shift their original sites to the required magnesium oxide positions followed by a collapse of the planes along the original <0001> direction of the brucite crystal. He noted that the (110) diffraction spots of brucite immediately shifted to the positions required for the (220) reflections of magnesium oxide. Gordon observed separate diffraction spots for the (110) brucite and (220) magnesium oxide planes. The positions of the (110) and (100) brucite never changed but only diminished in intensity while the (220) planes of magnesium shifted from a value larger than the listed ASTM d spacing to the predicted value as the decomposition progressed.

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Field-assisted ionization theory for microscopists

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100171833 ◽

1994 ◽

Vol 52 ◽

pp. 820-821

Author(s):

Patrick P. Camus

Keyword(s):

Electric Field ◽

Electron Tunneling ◽

Ionization Probability ◽

Critical Distance ◽

Tunneling Probability ◽

Field Ionization ◽

Radius Of Curvature ◽

Field Evaporation ◽

A Value ◽

Ion Emission

The theory of field ion emission is the study of electron tunneling probability enhanced by the application of a high electric field. At subnanometer distances and kilovolt potentials, the probability of tunneling of electrons increases markedly. Field ionization of gas atoms produce atomic resolution images of the surface of the specimen, while field evaporation of surface atoms sections the specimen. Details of emission theory may be found in monographs.Field ionization (FI) is the phenomena whereby an electric field assists in the ionization of gas atoms via tunneling. The tunneling probability is a maximum at a critical distance above the surface,xc, Fig. 1. Energy is required to ionize the gas atom at xc, I, but at a value reduced by the appliedelectric field, xcFe, while energy is recovered by placing the electron in the specimen, φ. The highest ionization probability occurs for those regions on the specimen that have the highest local electric field. Those atoms which protrude from the average surfacehave the smallest radius of curvature, the highest field and therefore produce the highest ionizationprobability and brightest spots on the imaging screen, Fig. 2. This technique is called field ion microscopy (FIM).

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Possible influence of herd health management and hygiene on the in-herd prevalence of Clostridium perfringens type C in pig breeding farms

Schweizer Archiv für Tierheilkunde ◽

10.1024/0036-7281/a000503 ◽

2013 ◽

Vol 155 (9) ◽

pp. 520-522 ◽

Cited By ~ 3

Author(s):

K. Schäfer ◽

W. Zimmermann ◽

H. Posthaus

Keyword(s):

Clostridium Perfringens ◽

Health Management ◽

Herd Health ◽

Herd Prevalence ◽

Type C ◽

Breeding Farms

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Vitamin A Value of Plant Food Provitamin A - Evaluated by the Stable Isotope Technologies

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000183 ◽

2014 ◽

Vol 84 (Supplement 1) ◽

pp. 25-29 ◽

Cited By ~ 7

Author(s):

Guangwen Tang

Keyword(s):

Stable Isotope ◽

Vitamin A ◽

Provitamin A ◽

Animal Origin ◽

Plant Food ◽

Plant Foods ◽

A Value ◽

Provitamin A Carotenoids ◽

Β Carotene

Humans need vitamin A and obtain essential vitamin A by conversion of plant foods rich in provitamin A and/or absorption of preformed vitamin A from foods of animal origin. The determination of the vitamin A value of plant foods rich in provitamin A is important but has challenges. The aim of this paper is to review the progress over last 80 years following the discovery on the conversion of β-carotene to vitamin A and the various techniques including stable isotope technologies that have been developed to determine vitamin A values of plant provitamin A (mainly β-carotene). These include applications from using radioactive β-carotene and vitamin A, depletion-repletion with vitamin A and β-carotene, and measuring postprandial chylomicron fractions after feeding a β-carotene rich diet, to using stable isotopes as tracers to follow the absorption and conversion of plant food provitamin A carotenoids (mainly β-carotene) in humans. These approaches have greatly promoted our understanding of the absorption and conversion of β-carotene to vitamin A. Stable isotope labeled plant foods are useful for determining the overall bioavailability of provitamin A carotenoids from specific foods. Locally obtained plant foods can provide vitamin A and prevent deficiency of vitamin A, a remaining worldwide concern.

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Körperliche Beschwerden bei älteren Migranten in Deutschland 1Erstellt unter Mitwirkung der Arbeitsgruppe «Abuse of the Elderly in the European Region» (ABUEL): Joaquim F. J. Soares, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Francisco Torres-González, Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Spain; Elisabeth Ioannidi-Kapolou, National School of Public Health, Department of Sociology, Athens, Greece; Giovanni Lamura, Italian National Research Centre on Ageing Department of Gerontological Research, Unit of Health Economics, Ancona, Italy; Mindaugas Stankunas, Kaunas University of Medicine, Department of Health Management, A. Mickeviciaus, Kaunas, Lithuania; Henrique Barros, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

Zeitschrift für Psychiatrie Psychologie und Psychotherapie ◽

10.1024/1661-4747.a000028 ◽

2010 ◽

Vol 58 (3) ◽

pp. 199-206 ◽

Cited By ~ 3

Author(s):

Rosina-Martha Csöff ◽

Gloria Macassa ◽

Jutta Lindert

Keyword(s):

Public Health ◽

Health Management ◽

The Elderly ◽

Health Department ◽

Research Unit ◽

Research Centre ◽

Public Health Department ◽

Karolinska Institute ◽

Psychological Medicine ◽

Körperliche Beschwerden

Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.

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