Using the Workload Indicator of Staffing Need (WISN) – Method to model the HR requirements and costs of Health Care Services in Kyrgyzstan

Health Care systems are facing several challenges. The lack of resources, such as health workers, costing and financing are open and urgent questions in Health Care Systems. Tools from HRManagement (e.g. the Workload Indicator of Staffing Need (WISN) – method, WHO - HR-Management Tool) and Cost-Accounting can help to improve current financing and further develop healthcare reimbursement systems, such as DRG-Systems. Based on empirical data and interviews with healthcare professionals from multiple healthcare institutions in Kyrgyzstan the WISN method was applied to calculate human resource needs in a new perinatal health centre in Bishkek, Kyrgyzstan. The results of the analysis show that it is possible to calculate the required personal resources using the WISN method. Additionally, WISN can be used to calculate personnel costs. The results also show that in combination with material costs, e.g. from a DRG – Cost – Matrix, such as the G-DRG-Report Browser, it is possible to calculate the total costs of healthcare services and to use this as the basis for the reimbursement system. WISN in combination with additional Cost-Accounting systems is a good way to calculate the total costs for an intervention in a healthcare institution, e.g. a hospital. These tools can help to make financing in healthcare more transparent and efficient.

Decreasing Number of Urodynamics in Urological and Gynaecological Clinics Reflects Decreased Importance for Surgical Indications: German Population-Based Data from 2013 to 2019

<b><i>Introduction:</i></b> The routine use of urodynamic studies (UDS) has been questioned. Additionally, the material and personnel costs are poorly remunerated. We aimed to analyse the UDS utilization in Germany. <b><i>Methods:</i></b> We analysed UDS performed by hospitals based on quality reports from 2013 to 2019. A representative sample of 4 million insured persons was used to estimate outpatient UDS utilization from 2013 to 2018. <b><i>Results:</i></b> There was an overall decrease of 14% in UDS in Germany from 2013 to 2018 (60,980 to 52,319; <i>p</i> = 0.003). In the outpatient sector, there was a slight non-continuous drop of 11% from 34,551 to 30,652 from 2013 to 2018 (<i>p</i> = 0.06). UDS utilization in hospitals decreased by 26% from 26,429 in 2013 to 19,453 in 2019 (<i>p</i> = 0.004). University hospitals showed a smaller decrease (3,007 to 2,685; <i>p</i> = 0.02). In urology, the number of UDS (11,758 to 6,409; <i>p</i> &#x3c; 0.001) and the number of performing departments (328 to 263 clinics; <i>p</i> &#x3c; 0.001) decreased. Gynaecological departments also showed a decrease in UDS (1,861 to 866; <i>p</i> &#x3c; 0.001) and performing departments (159 to 68; <i>p</i> &#x3c; 0.001). However, in paediatrics, there was an increase in UDS (1,564 to 2,192; <i>p</i> = 0.02). By age, the number of children remained constant (1,371 to 1,252; <i>p</i> = 0.2), but there was a strong decrease seen in 60- to 79-year-olds (9,792 to 5,564; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> UDS appear to be less important in the indication for surgery. Despite high resource expenditure and low remuneration, the decrease in urodynamics in the outpatient sector is less pronounced, indicating a trend to perform UDS in an outpatient setting.

Resources Required for Implementation of SARS-CoV-2 Screening in Massachusetts K-12 Public Schools in Winter/Spring 2021

Importance CDC guidance emphasizes the importance of in-person education for students in grades kindergarten to 12 (K-12) during the COVID-19 pandemic. CDC encourages weekly SARS-CoV-2 testing of asymptomatic, unvaccinated students and staff ("screening") to reduce infection risk and provide data about in-school SARS-CoV-2 prevalence where community incidence is high. The financial costs of screening assays have been described, but the human resource requirements at the school and district level to implement a SARS-CoV-2 screening program are not well known. Objective To quantify the resources required to implement a screening program in K-12 schools. Design, Setting, and Participants A consortium of Massachusetts public K-12 schools was formed to implement and evaluate a range of SARS-CoV-2 screening approaches. Participating districts were surveyed weekly about their programs, including: type of assay used, individual vs. pooled screening, approaches to return of results and deconvolution (identification of positive individual specimens) of positive pools, number and type of personnel implementing the screening program, and hours spent on program implementation. Main Outcomes and Measures Costs, resource utilization Results In 21 participating districts, over 21 weeks from January to June 2021, the positivity rate was 0.0%-0.21% among students and 0.0%-0.13% among educators/staff, and 4 out of 21 (19%) districts had at least one classroom transition to remote learning at any point due to a positive case. The average weekly cost to implement a screening program, including assay and personnel costs, was $17.00 per person tested; this was $46.68 for individual screenings and $15.61 for pooled screenings. The total weekly costs by district ranged from $1,644-$93,486, and districts screened between 58 and 3,675 people per week. The reported number of personnel working per week ranged from 1-5 to >50, and the total number of hours worked by all personnel ranged from 5-10 to >50. Conclusion and Relevance The human resources required to implement SARS-CoV-2 screening in Massachusetts public K-12 schools were substantial. Where screening is recommended for the 2021-22 school year due to high COVID-19 incidence (e.g., where vaccination uptake is low and/or more infectious variants predominate), understanding the human resources required to implement screening will assist districts policymakers in planning.

First Permanent Inflow Monitoring Experience in a Smart-Liner, Intelligent-Completion, Multi-Lateral Adnoc Offshore Well

The scope of this paper is to share a field experience with permanent inflow tracer deployment and monitoring of an intelligent multi-lateral well, completed with Smart-Liner (Limited Entry Liner). It will describe what ADNOC Offshore has learnt through inflow tracing clean up surveillance from several restarts and steady state production through inflow modelling interpretation techniques. This passive method of permanent monitoring technology utilizes chemistry and materials expertise to design tracers that release signature responses when they come into contact with either in-situ oil or formation water. The chemical tracer technology enables wireless monitoring capabilities for up to five years. Unique chemical tracers are embedded in porous polymer matrix inside tracer carriers along select locations in the lower completion to correlate where the oil and water is flowing in a production well. Interpreting tracer signals can provide zonal rate information by inducing transients to create tracer signals that are transported by flow to surface and captured in sample bottles for analysis. The measured signals are matched with models through history matching to yield zonal rate estimates. ADNOC Offshore has installed inflow tracers in an intelligent multi-lateral well to monitor laterals’ contributions, to verify new completion technology, and to estimate the flow profile from individual sections of Smart-Liner, run for the first time in the field. The interpretation results have been able to characterize inflow performance without any intervention in the well. Several restart and steady state surveys are planned to understand some key characteristics of the well completion and reveal how the well has changed since it was put on production. This technology will help allocate commingled production to the three laterals. The use of inflow tracers will provide multiple inflow surveys that will reduce operational risk, well site personnel, costs and will improve reservoir management practices. Permanent inflow tracing is expected to change the way production monitoring can be performed, especially in advanced wells where PLTs or Fiber Optic technology cannot access multi-laterals.

Different Charging Strategies for Electric Vehicle Fleets in Urban Freight Transport

The transition from diesel-driven urban freight transport towards more electric urban freight transport turns out to be challenging in practice. A major concern for transport operators is how to find a reliable charging strategy for a larger electric vehicle fleet that provides flexibility based on different daily mission profiles within that fleet, while also minimizing costs. This contribution assesses the trade-off between a large battery pack and opportunity charging with regard to costs and operational constraints. Based on a case study with 39 electric freight vehicles that have been used by a parcel delivery company and a courier company in daily operations for over a year, various scenarios have been analyzed by means of a TCO analysis. Although a large battery allows for more flexibility in planning, opportunity charging can provide a feasible alternative, especially in the case of varying mission profiles. Additional personnel costs during opportunity charging can be avoided as much as possible by a well-integrated charging strategy, which can be realized by a reservation system that minimizes the risk of occupied charging stations and a dense network of charging stations.

Time and Personnel Costs Associated with Adverse Event (AE) Management Among Patients with Chronic Lymphocytic Leukemia (CLL) Treated with Acalabrutinib, Ibrutinib, or Venetoclax

Introduction Guidelines recommend chemoimmunotherapy and novel agents such as Bruton's tyrosine kinase inhibitors and B-cell lymphoma 2 inhibitors for the treatment of CLL. AE profiles differ across therapies, and management of AEs in patients with CLL treated with novel agents incurs burden on healthcare professionals (HCPs) and oncology practices. Time and personnel costs associated with AE management are not well understood for patients with CLL and are overlooked while assessing the value of oncology drugs. To assess practice burden, this study quantified HCP time and personnel costs related to AE management for patients with CLL who received a novel agent, either acalabrutinib, ibrutinib, or venetoclax. Methods HCPs (i.e., oncologists, pharmacists, physician assistants, nurse practitioners, and registered nurses) who actively treated ≥5 patients with CLL during the past year with &gt;1 patient receiving acalabrutinib, ibrutinib, or venetoclax in the past month were recruited through a physician panel vendor to participate in a longitudinal, observational, prospective survey. This study was conducted in two phases (November 2020-January 2021; April-June 2021). Over the 2-month data collection period, HCPs reported on a daily basis the time spent performing AE management activities for CLL patients receiving a novel agent, which included 1) interactions with patients in-person or via remote consultation (telephone, video, or email), 2) interactions with other HCPs, and 3) other management activities that did not include interactions with patients or other HCPs (e.g., recording notes in patient's charts, ordering lab tests). Mean time and personnel costs per AE management activity were summarized using descriptive statistics. Personnel costs (USD) were calculated by multiplying median wage information reported by the ureau of Labor Statistics Occupational Employment Statistics survey by HCP-reported time spent managing AEs. Results Among 49 HCPs enrolled in the survey, 36 (73%; Table 1) reported managing ≥1 AE during a total of 1,106 AE management activities (229 for acalabrutinib; 500 for ibrutinib; 377 for venetoclax) for 421 patients with CLL during the 2-month study period. Among all patients, 108 (26%), 186 (44%), and 129 (31%) received acalabrutinib, ibrutinib, or venetoclax in any line, respectively (Table 2). Anemia was the most frequently managed AE reported among all patients (19%), but differed by treatment: 11%, 19%, and 26% for patients treated with acalabrutinib, ibrutinib, and venetoclax, respectively (Table 2). Other AEs reported among ≥10% of patients with a reported AE management activity also differed by treatment. For acalabrutinib, this included only headache. For both ibrutinib and venetoclax patients, thrombocytopenia, diarrhea, and myalgia were managed in ≥10% of patients. For venetoclax patients, back pain and arthralgia were also managed in ≥10% of patients. Mean (standard deviation [SD]) time spent managing AEs per activity was 11.8 (7.7) minutes (min) overall, 12.1 (7.4) min for acalabrutinib, 11.6 (6.9) min for ibrutinib, and 11.8 (8.9) min for venetoclax (Table 3). Mean time per AE management activity was numerically similar across the three treatments overall and stratified by type of HCP, treatment duration, and line of therapy. We noted differences in the type of HCP managing AEs by treatment, with a lower proportion of oncologists managing acalabrutinib AEs compared to the other two therapies. Corresponding mean (SD) personnel costs per AE management activity were $16.0 ($10.6) overall, and $14.4 ($9.8) for acalabrutinib, $16.3 ($9.8) for ibrutinib, and $16.7 ($11.9) for venetoclax. Conclusions This study demonstrates the importance of accounting for time and labor costs related to AE management, as results suggest that the burden to HCPs related to AE management for patients with CLL treated with acalabrutinib, ibrutinib, and venetoclax is substantial. During the 2-month study period, almost three-quarters of HCPs reported managing ≥1 AEs and an average of 12 AE management days was observed across these HCPs. While mean time and personnel costs were similar, differences in types of AE and types of HCPs managing AEs were observed across treatments. Future research should confirm our observed differences in types of AE and types of HCPs managing AEs by treatment to comprehensively assess the burden of managing AEs for patients with CLL. Figure 1 Figure 1. Disclosures Wahlstrom: AstraZeneca: Current Employment, Current equity holder in publicly-traded company. DerSarkissian: Analysis Group, Inc.: Current Employment. Kunzweiler: Apellis: Other: Employee of Analysis Group, Inc., Research Funding. Castriota: Analysis Group, Inc.: Ended employment in the past 24 months. Chang: Analysis Group, Inc.: Current Employment. Cheung: Analysis Group, Inc.: Ended employment in the past 24 months. Gu: Analysis Group, Inc.: Current Employment. Guo: Analysis Group, Inc.: Current Employment. Duh: Novartis: Other: I am an employee of Analysis Group, a consulting company that received funding from Novartis for this research study.. Ryan: AstraZeneca: Current Employment, Current equity holder in publicly-traded company.

Transformation of consumer needs in the context of personality environmental culture formation and innovative development of national economy

The article is devoted to the issues of substantiation of a new ecological worldview built on the basic principles of environmental culture. It is shown that the violation of the means of maintaining balance in the system “a man-nature-society” poses a significant threat to the existence of a man as a biosocial being, determining the appropriate response of nature to destructive human activities, requiring the identification of environmental priorities for further socio-cultural development. It was found that solving problems related to the current environmental situation involves limiting human practical and transformational activities aimed at transforming nature into the introduction of “careful”, “gentle” consumption with the need to adjust the criteria of environmental feasibility, it is possible in the formation of environmental culture and deepening the field of environmental education. We have established that the innovative direction of the state’s development should be focused on the targeted satisfaction of the consumer needs.The main indicators of the labor market in 2013-2019 are analyzed as well as personnel costs of business entities. The closeness of the relationship between net income and labor costs of enterprises is established.

A time-driven activity-based costing approach for identifying variability in costs of childbirth between and within types of delivery

Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost. Methods A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age > 25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks. Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.

In-Hospital Economic Burden for COVID-19 Infection Using Step-Down Cost Accounting; a Case from Central Iran

Background: The novel coronavirus disease 2019 (COVID-19) has placed heavy direct and indirect economic burden on the people and the health system. Objectives: The present study aimed to estimate the economic burden of COVID-19 in Qom Province, using the step-down cost accounting (SDCA) method. Methods: This descriptive, cross-sectional study included all COVID-19 patients in Qom Province from February 19, 2020, to June 19, 2020. The patients’ data were collected in the form of major cost groups with integrated health system (IHS), health information system (HIS), and a financial software called Roozamad. The governmental, out-of-pocket, and opportunity costs paid by patients and hospitals were calculated and evaluated using SDCA in Microsoft Excel software. Results: The incidence of COVID-19 infection was 518 per 100,000 populations in Qom Province in the aforementioned period. The total government costs for the treatment of the patients were calculated to be 2,229,216,930,370 Rials (8,916,867 $). Among the major governmental cost groups, personnel costs accounted for the highest total expenditures. In addition, out-of-pocket costs of patients and their families equaled 30,038,013,060 Rials (120,152 $). The costs of final service departments accounted for more than half of the total costs. The opportunity costs were calculated as 420 billion Rials (15.68% of total costs). Conclusions: According to the findings, the direct and indirect costs associated with the treatment of COVID-19 patients can impose a heavy economic burden on the households and health care system. Therefore, disease prevention strategies such as observing health protocols are recommended to reduce the burden of the disease.