Development and validation of the Vietnamese Primary Care Assessment Tool : provider version

Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider's perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or 'don't know/don't remember' response rate, and there were no floor or ceiling effects. All scales had a Cronbach's alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective

Innovative public governance through cloud computing: Information privacy, business models and performance measurement challenges

Purpose: The purpose of this paper is to identify and analyze challenges and to discuss proposed solutions for innovative public governance through cloud computing. Innovative technologies, such as federation of services and cloud computing, can greatly contribute to the provision of e-government services, through scaleable and flexible systems. Furthermore, they can facilitate in reducing costs and overcoming public information segmentation. Nonetheless, when public agencies use these technologies, they encounter several associated organizational and technical changes, as well as significant challenges. Design/methodology/approach: We followed a multidisciplinary perspective (social, behavioral, business and technical) and conducted a conceptual analysis for analyzing the associated challenges. We conducted focus group interviews in two countries for evaluating the performance models that resulted from the conceptual analysis. Findings: This study identifies and analyzes several challenges that may emerge while adopting innovative technologies for public governance and e-government services. Furthermore, it presents suggested solutions deriving from the experience of designing a related platform for public governance, including issues of privacy requirements, proposed business models and key performance indicators for public services on cloud computing. Research limitations/implications: The challenges and solutions discussed are based on the experience gained by designing one platform. However, we rely on issues and challenges collected from four countries. Practical implications: The identification of challenges for innovative design of e-government services through a central portal in Europe and using service federation is expected to inform practitioners in different roles about significant changes across multiple levels that are implied and may accelerate the challenges' resolution. Originality/value: This is the first study that discusses from multiple perspectives and through empirical investigation the challenges to realize public governance through innovative technologies. The results emerge from an actual portal that will function at a European level. © Emerald Group Publishing Limited

Cloud Migration: A Case Study of Migrating an Enterprise IT System to IaaS

This case study illustrates the potential benefits and risks associated with the migration of an IT system in the oil & gas industry from an in-house data center to Amazon EC2 from a broad variety of stakeholder perspectives across the enterprise, thus transcending the typical, yet narrow, financial and technical analysis offered by providers. Our results show that the system infrastructure in the case study would have cost 37% less over 5 years on EC2, and using cloud computing could have potentially eliminated 21% of the support calls for this system. These findings seem significant enough to call for a migration of the system to the cloud but our stakeholder impact analysis revealed that there are significant risks associated with this. Whilst the benefits of using the cloud are attractive, we argue that it is important that enterprise decision-makers consider the overall organizational implications of the changes brought about with cloud computing to avoid implementing local optimizations at the cost of organization-wide performance.Comment: Submitted to IEEE CLOUD 201

The Challenges of Multimorbidity from the Patient Perspective

BACKGROUND Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective. OBJECTIVE The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses. DESIGN. This research is designed as a cross-sectional survey. PARTICIPANTS Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients. MEASUREMENTS Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers. RESULTS Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers. CONCLUSIONS Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.US Department of Veterans Affairs (01-110, 02-197); Agency for Healthcare Research and Quality (K08 HS013008-02

Sustainable Value Proposition Design in a Product-Service System

Many companies have started to add services to their tangible products in order to defend themselves from increased competition from low-cost economies. Research regarding the transition towards product-service systems (PSS) and how the PSS providers' business models are affected exists, but there is a lack of research regarding how the suppliers to the PSS providers are affected by the transition towards PSS. Therefore, this thesis studies the situation for a supplier/partner to an OEM that has changed their business model to a PSS providing one. As the first step in a development of a new business model aims this thesis to provide guidelines for how to set up value propositions suitable for a supplier/partner in this new environment. When technologically complex products, such as aircraft engines, are provided through PSS offerings it is hard to translate customer needs into quality parameters, which makes it hard to sustain the value to customer over time. Therefore, how to keep the value offering sustainable over time is also investigated in this thesis. The aim of this study was to investigate how a sustainable value proposition can be designed for a product and technology supplier/partner to an OEM that offers PSS solutions. The research has been performed through studying relevant literature and collecting empirical data from a case company through semi-structured interviews and a workshop. The case company in this research is Volvo Aero Corporation (VAC). The empirical findings show that VAC wants to offer product-service bundled solution, which fit the whole spectra of PSS value propositions, to their partners/customers. To be able to deliver these different types of product-service bundled solutions different value propositions that suit the different kinds of PSS offerings are needed. Requirements that must be fulfilled to be able to offer and deliver the different types of value propositions exist in terms of securing sufficient information access, aligning the incentives of all actors involved and achieving an internal consensus of what is delivered

Direct Payment Schemes for People with Disabilities: A New and Innovative Policy Approach to Providing Services to Disabled People in Ireland

[Excerpt] This research project commenced initially in August 2002 and was initiated by the Disability Cluster Group – a network of local disability groups and service-providers, facilitated by the Bray Partnership. The Disability Cluster Group established a Disability Research Steering Committee for the project which, in turn, employed 80:20 Educating and Acting for a Better World – a non-governmental development education organisation – to undertake the research. The core objective of the work is to explore and move forward the agenda relating to direct payments in the East Coast Area Health Board (ECAHB). This is primarily a piece of qualitative research focusing on the many elements that make up a direct payment scheme from a number of stakeholder perspectives. In terms of the cross-border comparative element of the research, 10% of the total number of direct payments users in NI were interviewed. Given low overall numbers of direct payments service users, this figure is too limited for any significant statistical analysis. Instead, they serve to highlight some of the issues, experiences and challenges associated with introducing direct payments for a number of people with disabilities in Northern Ireland and allows for a range of conclusions to be drawn out

Towards Autonomic Service Provisioning Systems

This paper discusses our experience in building SPIRE, an autonomic system for service provision. The architecture consists of a set of hosted Web Services subject to QoS constraints, and a certain number of servers used to run session-based traffic. Customers pay for having their jobs run, but require in turn certain quality guarantees: there are different SLAs specifying charges for running jobs and penalties for failing to meet promised performance metrics. The system is driven by an utility function, aiming at optimizing the average earned revenue per unit time. Demand and performance statistics are collected, while traffic parameters are estimated in order to make dynamic decisions concerning server allocation and admission control. Different utility functions are introduced and a number of experiments aiming at testing their performance are discussed. Results show that revenues can be dramatically improved by imposing suitable conditions for accepting incoming traffic; the proposed system performs well under different traffic settings, and it successfully adapts to changes in the operating environment.Comment: 11 pages, 9 Figures, http://www.wipo.int/pctdb/en/wo.jsp?WO=201002636

Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya.

BackgroundGlobally, there has been increasing attention to women's experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women's and providers' perceptions may negatively impact women's compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care.MethodsTo fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys.ResultsOur findings suggest high discordance between women and providers' perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors.ConclusionsImplications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals