Improving radiotherapy utilization rates in Ontario.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 48-48 ◽  
Author(s):  
Michelle Ang ◽  
Eric Gutierrez ◽  
Nicoda Foster ◽  
Lisa Favell ◽  
Padraig Richard Warde
Keyword(s):  
Capital Investment ◽  
Resource Planning ◽  
Investment Strategy ◽  
Utilization Rate ◽  
Local Health ◽  
Capital Investments ◽  
Term Care ◽  
Gradual Improvement ◽  
Medical Physicists ◽  
Regional Cancer Centre

48 Background: Radiotherapy (RT) utilization is the proportion of patients (Pts) with a new diagnosis of carcinoma that receives at least one course of RT during the duration of their illness (MacKillop et al). In Ontario, the benchmark for utilization is 42%, and the target rate for Cancer Care Ontario (CCO) is 48%. However in 2005/06 Ontario’s utilization rate was only 35%. This shortfall implies that a significant number of Pts in Ontario were not receiving the best possible treatment. Methods: CCO has developed Capital Investments Strategies to take into account a growing population, an increased incidence of cancer (2.7% per annum), and changing demographics. The most recent (2012) has developed a plan for a gradual improvement in utilization at a rate of 0.5% per annum. With support from the Ministry of Health and Long-Term Care (MOHLTC), the amount of RT Units (RTUs) available increased from 77 (2005/06) to 103 (2013/14). In addition, the MOHLTC supported training programs for provincial Medical Physicists and Radiation Therapists to ensure effective staffing for increased RTUs. Results: Due to investments in RTUs and training, the number of Pts treated in Ontario has risen over 38% from 26,448 in 2005/06 to 36,613 in 2012/13. As a result, provincial utilization rates have risen from 35.1% in 2004/05 to 38.8% in 2012/13, closer to provincial targets. Notable improvements have been seen in centres such as The Carlo Fidani Peel Regional Cancer Centre, where the total number of RT Pts treated increased from 623 (2005/06) to 2532 (2012/13). Similar improvements are seen in other Local Health Integration Networks where comparable investments have been made. These improvements have been attained at the same time as provincial RT wait times have significantly improved from 80.2% (Jan 2010) to 91.6% (Dec 2012) of Pts seen within targets, exceeding provincial targets of 87%. Conclusions: The increase in RT utilization rates provincially demonstrates the success of developing a comprehensive capital investment strategy and coupling it with increased investments in human resource planning. The increased utilization rate has outpaced the increasing cancer incidence and demonstrates the success of these strategies, providing better access to care for cancer Pts in Ontario.

Development of a capital investment strategy for radiation (RT) equipment in Ontario.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 279-279
Author(s):  
Eric Gutierrez ◽  
Padraig Richard Warde ◽  
Dianne Belfour-Barnett ◽  
Garth Matheson ◽  
Elaine Meertens ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Capital Investment ◽  
Radiation Treatment ◽  
Investment Strategy ◽  
Incidence Rates ◽  
Investment Strategies ◽  
Capital Investments ◽  
Modest Improvement ◽  
Treatment Demand ◽  
Radiation Equipment

279 Background: To ensure appropriate access to radiation treatment (RT) for Ontario cancer patients for the next decade and that future capital investments in radiation equipment are appropriately timed and strategically placed, Cancer Care Ontario (CCO) has updated its RT Capital Investment Strategy. The strategy was designed around 4 core principles: i) recognizing treatment machine capacity should match the demand resulting from increasing cancer incidence rates and increasing utilization rates as per CCO goals; ii) keeping pace with advancing technology; iii) ensuring value for money by maximising the use of current infrastructure; and iv) minimizing costs through centralized planning and procurement processes. Methods: A multidisciplinary provincial expert panel reviewed and revised the planning parameters used to project treatment demand and required capacity (including fractions of RT per treated case, number of cases treated per hour, uptime of treatment units). The panel reviewed current practice, impact of new and emerging treatment technologies and benchmarks from other jurisdictions. To project the future demand for radiation therapy, growth in cancer incidence (by county) as well as modest improvement in RT utilization rates were assumed. Results: Recommendations included: i) moving to 12-hour treatment days in all large centres and on 50% of equipment in centres operating fewer than 6 treatment units; ii) ensuring appropriate funding for the replacement of existing RT equipment; iii) equipping constructed rooms in 4 regional cancer centers – thereby adding 6 linacs; iv) equipping swing bunkers across the province – thereby adding 10 linacs; and v) planning for the construction of new facilities to add RT capacity in 3 regions of the province. Conclusions: Funding to implement recommendations from previous capital investment strategies has resulted in an equitable distribution of RT resources across the province. We believe the planning strategies and recommendations outlined in the strategy will improve access to quality RT care as close to home as feasible for Ontario patients.

Solar Renewable Energy Credit Price Volatility and Investment Returns: Have Policies Stranded Capital Investment?

Commonwealth ◽  
2017 ◽  
Vol 19 (1) ◽  
Author(s):  
Somayeh Youssefi ◽  
Patrick L. Gurian
Keyword(s):  
Solar Energy ◽  
Capital Investment ◽  
Supply And Demand ◽  
Price Volatility ◽  
The United States ◽  
Investment Model ◽  
Capital Investments ◽  
Demand Model ◽  
Market Prices ◽  
Investment Returns

Pennsylvania is one of a number of U.S. states that provide incentives for the generation of electricity by solar energy through Solar Renewal Energy Credits (SRECs). This article develops a return on investment model for solar energy generation in the PJM (mid-­Atlantic) region of the United States. Model results indicate that SREC values of roughly $150 are needed for residential scale systems to break even over a 25-­year project period at 3% interest. Market prices for SRECs in Pennsylvania have been well below this range from late 2011 through the first half of 2016, indicating that previous capital investments in solar generation have been stranded as a result of steep declines in the value of SRECs. A simple conceptual supply and demand model is developed to explain the sharp decline in market prices for SRECs. Also discussed is a possible policy remedy that would add unsold SRECs in a given year to the SREC quota for the subsequent year.

A Predictive Model of Intrinsic Factors Associated with Long-Stay Nursing Home Care After Hospitalization

2020 ◽  
pp. 105477382098527
Author(s):  
Jane Flanagan ◽  
Marie Boltz ◽  
Ming Ji
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Receiver Operating Characteristic ◽  
Predictive Model ◽  
Operating Characteristic ◽  
Resource Planning ◽  
Term Care ◽  
Intrinsic Factors ◽  
Patients At Risk ◽  
Receiver Operating

We aimed to build a predictive model with intrinsic factors measured upon admission to skilled nursing facilities (SNFs) post-acute care (PAC) to identify older adults transferred from SNFs to long-term care (LTC) instead of home. We analyzed data from Massachusetts in 23,662 persons admitted to SNFs from PAC in 2013. Explanatory logistic regression analysis identified single “intrinsic predictors” related to LTC placement. To assess overfitting, the logistic regression predictive model was cross-validated and evaluated by its receiver operating characteristic (ROC) curve. A 12-variable predictive model with “intrinsic predictors” demonstrated both high in-sample and out-of-sample predictive accuracy in the receiver operating characteristic ROC and area under the ROC among patients at risk of LTC placement. This predictive model may be used for early identification of patients at risk for LTC after hospitalization in order to support targeted rehabilitative approaches and resource planning.

Decision Support Tools for Managing Unpredictability in the Supply Chain

2000 ◽  
Author(s):  
Carol Vesier
Keyword(s):  
Supply Chain ◽  
Decision Support ◽  
Inventory Management ◽  
Production Scheduling ◽  
Capital Investment ◽  
Investment Strategy ◽  
Decision Support Tools ◽  
Business Outcomes ◽  
Support Tools

Abstract Effectively managing unpredictability requires decision support tools that can predict the financial and business outcomes of various supply chain strategies. This paper will discuss the role of these decision support tools and their characteristics as well as review a case study. In the case study, decision support tools facilitated development of strategies that increased after tax profit by $140 Million. These strategies included: • Reliability improvement strategy: Identifying the reliability improvements that offered the biggest profitability impact. • Supply chain strategy: Defining inventory management and production scheduling rules that ensured order shipment within two days. • Capital investment strategy: Defining when new capacity should come on line as well as the minimum capital investment.

Capital Budgeting and Public Investment Projects in Ukraine

2019 ◽  
pp. 93-112
Author(s):  
Olha Krupa
Keyword(s):  
Capital Investment ◽  
Capital Expenditure ◽  
Public Capital ◽  
Capital Budgeting ◽  
Budget Process ◽  
Capital Investments ◽  
Public Projects ◽  
Capital Spending ◽  
The Government ◽  
And Performance

This chapter discusses the budget process for public capital investments in Ukraine, presents controversies in the current process, and offers several avenues for improvement. In doing so, the author provides a description of the country's normative capital public budgeting framework, presents the institutional setup, and tracks Ukraine's public capital expenditure trends for nearly three decades (1991-2016). The study then discusses implementation, audit, and performance issues in Ukraine's public capital expenditure management and provides recommendations. Because of the country's limited fiscal capacity as compared to its massive infrastructure needs, the author posits that Ukraine can no longer afford to delay or ignore its most pressing public capital investment needs. Because the current list of capital investment proposals is underfunded and too long, the author suggests that the government focuses on finishing strategic, high-priority public projects, while other capital spending proposals target private sector financing once it becomes more readily available.

scholarly journals ‘Post-pandemic’ transnational gentrifications: A critical outlook

Urban Studies ◽  
2020 ◽  
Vol 57 (15) ◽  
pp. 3202-3214 ◽  
Author(s):  
Georgia Alexandri ◽  
Michael Janoschka
Keyword(s):  
Political Economy ◽  
Middle Class ◽  
Capital Investment ◽  
Social Practices ◽  
Analytical Tool ◽  
Capital Investments ◽  
Rural Landscapes ◽  
Economic Transformations ◽  
Culture Heritage ◽  
Systemic Violence

Transnational gentrifications have been occurring at the crossroads of capital investment fuelled to satisfy the remarkable increase of so-called leisure-oriented mobilities. Such mobilities, however, cause disruptive social, spatial and economic transformations of urban and rural landscapes across the globe. Consequently, transnational gentrifications may be considered a crucial testimonial of economic shifts, during the 2008–2020 period of accumulation. In this article, we argue that the underlying conceptual assumptions of transnational gentrifications require crucial adjustments. We should especially consider the intellectual roots that simply celebrate leisure-oriented mobilities while setting aside the exclusionary social practices of the consumption of space, culture, heritage and place. We do this by interpreting the phenomenon by means of a political economy that understands (i) the lens of the multi-scalar organisation of state power as a centrepiece for orchestrating the conditions for transnational gentrifications; (ii) transnational middle-class leisure-oriented mobilities linked dichotomously with labour precariousness and flexibility; and (iii) the rent gap as an analytical tool to understand dispossession, and corresponding displacement of people, practices and discourses. This approach sheds light on the nuances of gentrification as an attribute of systemic violence exercised in financialised capitalism. It also supports us to sketch out a theoretically informed outlook for the ongoing reorientation of intertwined gentrifications by transnational capital investments with intermittent flows of people in the aftermath of the COVID-19 pandemic.

Agreeing to disagree: structuring future capital investment provisions in joint ventures

2020 ◽  
Vol 13 (1) ◽  
pp. 12-22
Author(s):  
Edgar Elliott ◽  
Lois D’Costa ◽  
James Bamford
Keyword(s):  
Joint Ventures ◽  
Capital Investment ◽  
Joint Venture ◽  
Investment Decisions ◽  
Capital Investments ◽  
Agreeing To Disagree ◽  
Structural Work ◽  
Opt Out ◽  
Contractual Structures

Abstract Prior to entering into any joint venture agreement (JVA), dealmakers should be aware of the options available to resolve future investment disagreements. There are three broad capital investment structures commonly found in joint ventures: (i) standard passmark rules; (ii) non-consent/opt-out; and (iii) sole risk. Within each category, deal practitioners have numerous options to tailor capital investment structures. As much as possible, deal practitioners should contemplate the most likely areas of disagreement, and then tailor the capital investment structures appropriately to ensure that the joint ventures (JV) can manage capital investment decisions in an efficient, value-preserving way. While it is impossible to establish a formula to determine which specific contractual structures will best accommodate future capital investments in a given JV, companies should weigh various factors to inform their position. We reviewed 40 JVAs to understand various capital investment mechanics and how they differ based on the nature of the venture and owner context. Our research found an extremely diverse array of creative structural work-arounds to address different owner appetites to make future capital investments. The purpose of this article is to describe, illustrate and provide benchmarks on different mechanics and contractual terms found in joint venture agreements, and to offer guidance as to which future capital investment mechanics should be included in venture agreements.

scholarly journals Capital structure, capital investment and profitability among Malaysian listed firms

2018 ◽  
Vol 7 (4.9) ◽  
pp. 14
Author(s):  
Yamunah Vaicondam ◽  
Ramakrishnan Ramakrishnan
Keyword(s):  
Capital Structure ◽  
Capital Investment ◽  
Moderating Effect ◽  
The Other ◽  
Capital Investments ◽  
Significant Positive Effect ◽  
Listed Firms ◽  
Empire Building ◽  
The Relationship ◽  
Positive Effect

Capital investments are referred as a critical managerial decision on firm's fixed asset for generating profitability. However, the empirical finding shows that not every capital investment has a significant positive effect on profitability. Literature indicates mixed results of examining the capital investment relationship with firm's profitability, which vary in respects to the debt structure. On the other hand, strong government reinforcement has pushed Malaysia up as one of the top ten countries with robust private capital investment in the year 2004. Since the capital investments are typically irreversible and hypothesized as profit generator, the first aim of this study is to examine the effect of the capital investment on the firm's profitability across firms and sectors. The second aim is to examine the moderating effect of capital structure on the relationship between capital investment and profitability across firms and sectors. This study utilized pooled ordinary least squares and fixed effect analysis across 708 non-financial Malaysian listed firms. The unbalanced datasets for the period 2001 to 2015 were employed to check the robustness of these results. This study suggested that capital investment has a strong significant positive effect on profitability measurements across Malaysian listed firms in non-financial sectors. On the other hand, the significant negative moderating effect of capital structure on the relationship between capital investment and return on capital across Malaysian listed firms reflected the perspective of empire building theory. In addition, the independent sample test engaged across sectors affirmed that moderating effect of capital structure are different across sectors. Thus, this study concluded the existence of moderating effect of capital structure on the relationship between capital investment and profitability. This study addressed the knowledge gap on the moderating effect of capital structure based on empire building theory.  

Promotion Signaling and Human Capital Investments

2020 ◽  
Vol 12 (1) ◽  
pp. 125-155 ◽  
Author(s):  
Michael Waldman ◽  
Ori Zax
Keyword(s):  
Human Capital ◽  
Labor Market ◽  
Capital Investment ◽  
Investment Decisions ◽  
Human Capital Investment ◽  
Capital Investments ◽  
Human Capital Investments ◽  
Asymmetric Learning ◽  
Specific Human Capital ◽  
Investment Choices

In a world characterized by asymmetric learning, promotions can serve as signals of worker ability, and this, in turn, can result in inefficient promotion decisions. If the labor market is competitive, the result will be practices that reduce this distortion. We explore how this logic affects human capital investment decisions. We show that, if commitment is possible, investments will be biased toward the accumulation of firm-specific human capital. We also consider what happens when commitment is not possible and show a number of results including that, if investment choices are not publicly observable, choices are frequently efficient. (JEL D82, J24, J31, M12, M51)

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