The Computing Fleet: Managing Microservices-based Applications on the Computing Continuum

In this paper we propose the concept of "Computing Fleet" as an abstract entity representing groups of heterogeneous, distributed, and dynamic infrastructure elements across the Computing Continuum (covering the Edge- Fog-Cloud computing paradigms). In the process of using fleets, stakeholders obtain the virtual resources from the fleet, deploy software applications to the fleet, and control the data flow, without worrying about what devices are used in the fleet, how they are connected, and when they may join and exit the fleet. We propose a three-layer reference architecture for the Computing Fleet capturing key elements for designing and operating fleets. We discuss key aspects related to the management of microservices-based applications on the Computing Fleet and propose an approach for deployment and orchestration of microservices-based applications on fleets. Furthermore, we present a software prototype as a preliminary evaluation of the Computing Fleet concept in a concrete Cloud- Edge scenario related to remote patients monitoring.acceptedVersio

Exploring the Potential of Aging Network Services to Improve Depression Care

Depression is a prevalent, debilitating yet treatable psychiatric disorder affecting older adults. Older adults underutilize specialty mental health care, persistently receive poor quality care in primary care settings, and have high rates of non-adherence to pharmacotherapy. Aging network services, such as adult day services, homecare services, senior centers, and supportive housing may be able to improve the quality of depression care. However, it is unknown how current models of empirically supported depression care are used within or could be adopted by aging network services. Thus, this study described the organizational factors, staff factors, and current agency practices regarding depression among aging network services to examine their potential to adopt new depression practices. Using mixed methods, data were gathered on the organizational culture, climate, and structure, current depression practices, and staff attitudes through interviews with program managers: n =20) and surveys with staff: n = 142) for 17 agencies. The judgment sample consisted of agencies that have ongoing contact with community-based older adults and was stratified by agency type: i.e., adult day services, homecare services, senior centers, supportive housing). Multilevel modeling and constant comparative analysis was completed. Although agencies did significantly vary according to agency type by organizational context: i.e., funding; the proficiency, rigidity, and resistance of organizational culture; and the engagement, functionality, and stress of organizational climate), these factors were not related to empirically supported depression practices or staff attitudes about depression care. Most barriers to implementing new depression practices were universal. These findings applied to organizational factors: i.e., lack of resources, limited funding) and staff factors: i.e., limited knowledge and interest, concern for client acceptance of depression care). As facilitators, agencies frequently offered psychoeducation, collaborated with health providers, and provided holistic services to promote socialization, independence and health. The distinctions between agency types involved their current depression practices: i.e., supportive housing staff rarely screened for depression due to privacy mandates for housing facilities, competition among homecare agencies prompted delivery of in-home psychotherapy and case management). Findings inform multilevel implementation strategies for translating research into acceptable and sustainable practices for aging network services, and they highlight the broader needs for increased funding, training, and awareness to improve the quality of depression care across agencies

Differences that matter:Understanding case-mix and quality for prospective payment of home care

A suitable payment system is necessary to provide efficient, high-quality care at home. Therefore, in 2017, the Dutch Healthcare Authority initiated a project to develop a new home care payment system based on client profiles. This means a budget per client is determined beforehand, which suits a client’s expected care use. To do so, insight is needed on which client characteristics can predict the expected home care use. This was studied in this dissertation, by asking district nurses and by studying scientific literature. Among others, client characteristics related to a client’s functioning in daily life – for example if a client is independent in showering or using medication – were considered as relevant predictors of home care use. Subsequently, with this knowledge the Case-Mix Short Form was developed, tested and implemented, together with district nurses, home care providers and healthcare insurers, to collect data on relevant predictive client characteristics in a standardized manner. Finally, this dissertation provides an exploration of suitable outcomes for quality measurement in home care

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Background: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. Methods: This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann-Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. Results: The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. Conclusion: Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period