Trajectory and sequence analysis of administrative data

Health policy makers struggle to curb readmission rates despite various health policies. The National Health Service is spending more than half of its healthcare budget to manage emergency inpatient admissions. There is a subgroup of patients who use disproportionately more health resources and have higher rates of unplanned hospitalisation. They are defined as high-impact users. The characteristics and long-term healthcare use of high-impact users are poorly understood. Previous methods and models to identify and predict them have not performed well. More evidence is required to assess the causes of emergency admissions among them and to investigate whether they undergo a repeated cycle of similar events that trigger their long-term use of healthcare. Trajectory modelling and sequence analysis has been used in social and psychological sciences to understand changes in behaviour in the population. It has shown to have an advantage to categorise pupils based on common developmental pathways, and identify the chronological order of events in the life of the pupils. The hypothesis of the research is that trajectory modelling and sequence analysis can be applied to epidemiological administrative data to assess use of hospital care among high-impact users. Trajectory and sequence analysis was successfully applied to various patient cohorts with different medical conditions, using both hospital and primary care administrative datasets. Within each population cohort, discrete groups of patients with independent trends of hospital care use were identified. High-impact users accounted for a significant proportion of the patient population. They had persistently high readmission rates. Significant predictors associated with high-impact users were identified. High-impact users had worse outcomes than the rest of the patient population. They had distinct common sequences of causes of readmissions compared with other groups. Cardiopulmonary conditions were the main contributors to the sequences of readmissions among high-impact users in all patient populations.Open Acces

Kuntapäättäjien käsitykset ja asenteet fysioterapeuttien suoravastaanottotoiminnasta Keski-Suomessa

Fysioterapeutin suoravastaanotto on perusterveydenhuollon akuuttivastaanottotoimintaa. Toiminnan tarkoituksena on ohjata terveyskeskuksissa hoidon tarpeen arvion (HTA) perusteella ne tuki- ja liikuntaelinsairaat potilaat, joilla ei ole tapaturmataustaa tai tulehdukseen viittaavia oireita, fysioterapeutin suoravastaanotolle ilman lääkärin kontaktia. Keski-Suomen sairaanhoitopiirin terveyskeskuksissa suoravastaanottotoiminta käynnistettiin asteittain suoravastaanottokoulutuksen jälkeen vuonna 2013. Opinnäytetyön tarkoituksena oli kuvailla Keski-Suomen kuntapäättäjien käsityksiä ja asenteita fysioterapeuttien suoravastaanottotoiminnasta ja selvittää, miten päättäjät suhtautuvat suoravastaanottotoimintaa mahdollistavien lisäresurssien myöntämiseen. Tavoitteena oli välittää kuntapäättäjille informaatiota fysioterapeuttien suoravastaanottotoiminnan hyödyistä sekä kehittää fysioterapeuttien suoravastaanottotoimintaa. Tutkimusaineisto kerättiin keväällä 2014 sähköisellä kyselylomakkeella sairaanhoitopiirin jäsenkuntien valtuutetuilta (N= 558). Vastausprosentti oli 14,9 %. Tutkimusaineisto analysoitiin Webropol-kyselyohjelmiston avulla käyttäen tulosten kuvailuun lukumääriä, prosenttiosuuksia ja graafisia taulukoita. Kyselyyn vastanneista kuntapäättäjistä suurin osa ei ollut tietoisia suoravastaanottotoiminnan käynnistymisestä kuntansa terveyskeskuksessa eivätkä he olleet saaneet riittävästi informaatiota siitä. Suoravastaanottotoimintaan ja fysioterapeuttiin potilaan ensisijaisena kontaktina suhtauduttiin myönteisesti. Toiminnan uskottiin parantavan terveydenhuollon palveluja ja tuottavan säästöjä. Vastaanottotoiminnan tärkeimmäksi tavoitteeksi nousi tuki- ja liikuntaelinsairaiden potilaiden nopea hoitoon pääsy. Fysioterapeuttiresurssien lisäämiseen suhtauduttiin myönteisesti. Matalan vastausprosentin vuoksi tuloksia ei voida yleistää, mutta niitä voidaan hyödyntää suoravastaanottotoiminnan kehittämistyössä.Direct access to physiotherapy is a part of the primary access services of general health care. The aim of direct access in health care centres is to, based on an assessment of treatment needs, direct patients with Musculoskeletal disorders (MSDs) and without an accident history or any symptoms of an infection to physiotherapy without consultation by a doctor. Direct access in the Health Care District of Central Finland commenced gradually in 2013 after a direct access education. The aim of the thesis was to describe the perceptions and attitudes of the municipal decision makers in Central Finland towards direct access to physiotherapy and to find out the decision makers’ attitudes towards allocating additional resources so as to enable the direct access services. The goal of the study was to inform the decision makers about the benefits of direct access and to further develop direct access services. The research data was collected from the municipal decision makers of the Health Care district of Central Finland (N= 558) in spring 2014 by using an electric questionnaire. The response rate was 14,9 %. The data was analyzed by using the Webropol-software. The results were described by means of quantities, percentages and graphical tables. The majority of the decision makers who answered the survey were neither aware of the availability of direct access to physiotherapy in their local health care centre nor had not been given sufficient information concerning direct access. The attitudes toward direct access and physiotherapists as primary contacts to the patient were positive. Direct access services were believed to improve the health care services and to bring in savings. The most important goal of the direct access was perceived to be the quick access to treatment of patients with MSDs. The attitudes towards increasing resources for physiotherapy were favourable. Due to the low response rate, no generalizations of the results could be made. However, the results can be utilized in the development of the direct access services

June 27, 1991

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

edra 34: Bibliography of Books on Display

edra 34 | People Shaping Places | Minneapolis, MNhttps://digitalcommons.andrews.edu/edra-bibliographies/1018/thumbnail.jp

El plan de recuperación español: una valoración de su contribución a la transición verde en la Unión Europea

Background: The Next Generation EU (NGEU) is the primary financial instrument of the European Union’s post-COVID recovery policy. In particular, this major stimulus package is being used as an opportunity to accelerate the process of decarbonisation and reinforce climate policies. The article analyses Spain’s recovery plan and assess its potential contribution to the EU’s environmental and sustainability goals. Method: the study is drawn on a combination of academic literature, legal instruments and EU institutions and Spanish Government documents. The approach is mainly analytical. Results: NGEU funds provide Spain with the opportunity to undertake profound changes to construct a more resilient economic model. The green transition is the main axis of the Spanish recovery plan, with almost 40 % of resources allocated to this process. Investments and reforms aimed at the ecological transition are currently being implemented in Spain at a rapid pace, in line with the EU’s goals and policies. Conclusions: The new challenges generated by the war in Ukraine will require Spain to deploy additional efforts not initially covered by the recovery plan. In particular, the deployment of renewable energy and improvement of circular economy policies will be crucial to accelerate the green transition.Contexto: Next Generation EU (NGEU) constituye el principal instrumento financiero de la política de recuperación post-COVID de la Unión Europea (UE). Este amplio marco de estímulo está proporcionando una oportunidad para acelerar el proceso de descarbonización y reforzar la política climática. El artículo analiza el plan de recuperación de España, valorando su potencial contribución a los objetivos medioambientales y de sostenibilidad de la UE. Metodología: el estudio se basa en la literatura académica, en instrumentos jurídicos, así como en documentos institucionales de la UE y del Gobierno español. El enfoque es principalmente analítico. Resultados: Los fondos NGEU brindan a España la oportunidad de emprender cambios profundos para construir un modelo económico más resiliente. La transición verde es el eje principal del plan español de recuperación, con casi el 40 % de los recursos destinados a este proceso. Las inversiones y reformas dirigidas a la transición ecológica se están realizando en España a un ritmo rápido, en línea con los objetivos y políticas de la UE. Conclusiones: Los nuevos retos generados por la guerra en Ucrania exigen a España esfuerzos adicionales no cubiertos inicialmente por el plan de recuperación. En particular, el despliegue de energías renovables y la mejora de las políticas de economía circular serán cruciales para acelerar la transición verde

From the Persuasion of Theory to the Certainty of Law:A Multi-Jurisdictional Analysis of the Law of Community Policing in Europe

This paper analyses the legal bases of community policing under European Union (EU) law and the national laws of England, France, Germany, Italy, Romania and Portugal. Community policing arguably helps the police achieve efficient policing while respecting the requirements of the rule of law, a founding value of the EU, and can be a form of co-operation between the EU Member States under the EU legal framework for crime prevention. Moreover, the law in the selected jurisdictions supports four elements of the community policing model: (1) the public-police partnership in establishing policing strategies and priorities; (2) the public-police partnership for crime prevention and detection; (3) proactive and preventive policing; and (4) the police as providers of high quality services tailored to improve people’s quality of life. These elements are interrelated and interdependent: their holistic legal articulation is necessary for their effective existence