The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years

Background Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time. Objective To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits. Design We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized linear models for expenditures and negative binomial models for utilization. Control variables included patient demographics, county, chronic condition indicators, and illness severity. Participants A total of 1,433,297 adults aged 18–64 years, residing in Maryland, Virginia, and the District of Columbia, and insured by CareFirst for at least 3 consecutive months between 2010 and 2013. Intervention CareFirst implemented enhanced fee-for-service payments to the practices, offered a large retrospective bonus if annual cost and quality targets were exceeded, and provided information and care coordination support. Measures Outcomes were quarterly claims expenditures per member for all covered services, inpatient care, emergency care, and prescription drugs, and quarterly inpatient admissions and emergency room visits. Results By the third intervention year, annual adjusted total claims payments were $109 per participating member (95$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. Forty-two percent of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. Much of the reduction in inpatient and emergency spending was explained by lower utilization of services. Conclusions A PCMH model that does not require practices to make infrastructure investments and that rewards cost savings can reduce spending and utilization

Population and labour force projections for 27 European countries, 2002-052: impact of international migration on population ageing: Projections de population et de population active pour 27 pays européens 2002-052: impact de la migration internationale sur le vieillissement de la population

Population and labour force projections are made for 27 selected European countries for 2002-052, focussing on the impact of international migration on population and labour force dynamics. Starting from single scenarios for fertility, mortality and economic activity, three sets of assumptions are explored regarding migration flows, taking into account probable policy developments in Europe following the enlargement of the EU. In addition to age structures, various support ratio indicators are analysed. The results indicate that plausible immigration cannot offset the negative effects of population and labour force ageing

Optimization of concrete I-beams using a new hybrid glowworm swarm algorithm

In this paper a new hybrid glowworm swarm algorithm (SAGSO) for solving structural optimization problems is presented. The structure proposed to be optimized here is a simply-supported concrete I-beam defined by 20 variables. Eight different concrete mixtures are studied, varying the compressive strength grade and compacting system. The solutions are evaluated following the Spanish Code for structural concrete. The algorithm is applied to two objective functions, namely the embedded CO2 emissions and the economic cost of the structure. The ability of glowworm swarm optimization (GSO) to search in the entire solution space is combined with the local search by Simulated Annealing (SA) to obtain better results than using the GSO and SA independently. Finally, the hybrid algorithm can solve structural optimization problems applied to discrete variables. The study showed that large sections with a highly exposed surface area and the use of conventional vibrated concrete (CVC) with the lower strength grade minimize the CO2 emissionsGarcía Segura, T.; Yepes Piqueras, V.; Martí Albiñana, JV.; Alcalá González, J. (2014). Optimization of concrete I-beams using a new hybrid glowworm swarm algorithm. Latin American Journal of Solids and Structures. 11(7):1190-1205. doi:10.1590/S1679-78252014000700007S11901205117Alinia Ahandani, M., Vakil Baghmisheh, M. T., Badamchi Zadeh, M. A., & Ghaemi, S. (2012). Hybrid particle swarm optimization transplanted into a hyper-heuristic structure for solving examination timetabling problem. Swarm and Evolutionary Computation, 7, 21-34. doi:10.1016/j.swevo.2012.06.004Chen, S.-M., Sarosh, A., & Dong, Y.-F. (2012). Simulated annealing based artificial bee colony algorithm for global numerical optimization. Applied Mathematics and Computation, 219(8), 3575-3589. doi:10.1016/j.amc.2012.09.052Collins, F. (2010). Inclusion of carbonation during the life cycle of built and recycled concrete: influence on their carbon footprint. The International Journal of Life Cycle Assessment, 15(6), 549-556. doi:10.1007/s11367-010-0191-4Dutta, R., Ganguli, R., & Mani, V. (2011). Swarm intelligence algorithms for integrated optimization of piezoelectric actuator and sensor placement and feedback gains. Smart Materials and Structures, 20(10), 105018. doi:10.1088/0964-1726/20/10/105018Fan, S.-K. S., & Zahara, E. (2007). A hybrid simplex search and particle swarm optimization for unconstrained optimization. European Journal of Operational Research, 181(2), 527-548. doi:10.1016/j.ejor.2006.06.034García-Segura, T., Yepes, V., & Alcalá, J. (2013). Life cycle greenhouse gas emissions of blended cement concrete including carbonation and durability. The International Journal of Life Cycle Assessment, 19(1), 3-12. doi:10.1007/s11367-013-0614-0Gong, Q. Q., Zhou, Y. Q., & Yang, Y. (2010). Artificial Glowworm Swarm Optimization Algorithm for Solving 0-1 Knapsack Problem. Advanced Materials Research, 143-144, 166-171. doi:10.4028/www.scientific.net/amr.143-144.166Hare, W., Nutini, J., & Tesfamariam, S. (2013). A survey of non-gradient optimization methods in structural engineering. Advances in Engineering Software, 59, 19-28. doi:10.1016/j.advengsoft.2013.03.001He, S., Prempain, E., & Wu, Q. H. (2004). An improved particle swarm optimizer for mechanical design optimization problems. Engineering Optimization, 36(5), 585-605. doi:10.1080/03052150410001704854Karaboga, D., & Basturk, B. (2008). On the performance of artificial bee colony (ABC) algorithm. Applied Soft Computing, 8(1), 687-697. doi:10.1016/j.asoc.2007.05.007Khan, K., & Sahai, A. (2012). A Glowworm Optimization Method for the Design of Web Services. International Journal of Intelligent Systems and Applications, 4(10), 89-102. doi:10.5815/ijisa.2012.10.10Kicinger, R., Arciszewski, T., & Jong, K. D. (2005). Evolutionary computation and structural design: A survey of the state-of-the-art. Computers & Structures, 83(23-24), 1943-1978. doi:10.1016/j.compstruc.2005.03.002Kirkpatrick, S., Gelatt, C. D., & Vecchi, M. P. (1983). Optimization by Simulated Annealing. Science, 220(4598), 671-680. doi:10.1126/science.220.4598.671Koide, R. M., França, G. von Z. de, & Luersen, M. A. (2013). An ant colony algorithm applied to lay-up optimization of laminated composite plates. Latin American Journal of Solids and Structures, 10(3), 491-504. doi:10.1590/s1679-78252013000300003Krishnanand, K. N., & Ghose, D. (2009). Glowworm swarm optimisation: a new method for optimising multi-modal functions. International Journal of Computational Intelligence Studies, 1(1), 93. doi:10.1504/ijcistudies.2009.025340Li, L. J., Huang, Z. B., & Liu, F. (2009). A heuristic particle swarm optimization method for truss structures with discrete variables. Computers & Structures, 87(7-8), 435-443. doi:10.1016/j.compstruc.2009.01.004Liao, W.-H., Kao, Y., & Li, Y.-S. (2011). A sensor deployment approach using glowworm swarm optimization algorithm in wireless sensor networks. Expert Systems with Applications, 38(10), 12180-12188. doi:10.1016/j.eswa.2011.03.053Luo, Q. F., & Zhang, J. L. (2011). Hybrid Artificial Glowworm Swarm Optimization Algorithm for Solving Constrained Engineering Problem. Advanced Materials Research, 204-210, 823-827. doi:10.4028/www.scientific.net/amr.204-210.823Martí, J. V., Gonzalez-Vidosa, F., Yepes, V., & Alcalá, J. (2013). Design of prestressed concrete precast road bridges with hybrid simulated annealing. Engineering Structures, 48, 342-352. doi:10.1016/j.engstruct.2012.09.014Martinez-Martin, F. J., Gonzalez-Vidosa, F., Hospitaler, A., & Yepes, V. (2013). A parametric study of optimum tall piers for railway bridge viaducts. Structural Engineering and Mechanics, 45(6), 723-740. doi:10.12989/sem.2013.45.6.723Medina, J. R. (2001). Estimation of Incident and Reflected Waves Using Simulated Annealing. Journal of Waterway, Port, Coastal, and Ocean Engineering, 127(4), 213-221. doi:10.1061/(asce)0733-950x(2001)127:4(213)Parsopoulos, K. E., & Vrahatis, M. N. (2002). Natural Computing, 1(2/3), 235-306. doi:10.1023/a:1016568309421Paya-Zaforteza, I., Yepes, V., González-Vidosa, F., & Hospitaler, A. (2010). On the Weibull cost estimation of building frames designed by simulated annealing. Meccanica, 45(5), 693-704. doi:10.1007/s11012-010-9285-0Sarma, K. C., & Adeli, H. (1998). Cost Optimization of Concrete Structures. Journal of Structural Engineering, 124(5), 570-578. doi:10.1061/(asce)0733-9445(1998)124:5(570)Shieh, H.-L., Kuo, C.-C., & Chiang, C.-M. (2011). Modified particle swarm optimization algorithm with simulated annealing behavior and its numerical verification. Applied Mathematics and Computation, 218(8), 4365-4383. doi:10.1016/j.amc.2011.10.012Sideris, K. K., & Anagnostopoulos, N. S. (2013). Durability of normal strength self-compacting concretes and their impact on service life of reinforced concrete structures. Construction and Building Materials, 41, 491-497. doi:10.1016/j.conbuildmat.2012.12.042Valdez, F., Melin, P., & Castillo, O. (2011). An improved evolutionary method with fuzzy logic for combining Particle Swarm Optimization and Genetic Algorithms. Applied Soft Computing, 11(2), 2625-2632. doi:10.1016/j.asoc.2010.10.010Wang, H., Sun, H., Li, C., Rahnamayan, S., & Pan, J. (2013). Diversity enhanced particle swarm optimization with neighborhood search. Information Sciences, 223, 119-135. doi:10.1016/j.ins.2012.10.012Yepes, V., Gonzalez-Vidosa, F., Alcala, J., & Villalba, P. (2012). CO2-Optimization Design of Reinforced Concrete Retaining Walls Based on a VNS-Threshold Acceptance Strategy. Journal of Computing in Civil Engineering, 26(3), 378-386. doi:10.1061/(asce)cp.1943-5487.000014

Bio-inspired binary bees algorithm for a two-level distribution optimisation problem

Original article can be found at : http://www.sciencedirect.com/ Copyright Elsevier [Full text of this article is not available in the UHRA]Two uncoupleable distributions, assigning missions to robots and allocating robots to home stations, accompany the use of mobile service robots in hospitals. In the given problem, two workload-related objectives and five groups of constraints are proposed. A bio-mimicked Binary Bees Algorithm (BBA) is introduced to solve this multiobjective multiconstraint combinatorial optimisation problem, in which constraint handling technique (Multiobjective Transformation, MOT), multiobjective evaluation method (nondominance selection), global search strategy (stochastic search in the variable space), local search strategy (Hamming neighbourhood exploitation), and post-processing means (feasibility selection) are the main issues. The BBA is then demonstrated with a case study, presenting the execution process of the algorithm, and also explaining the change of elite number in evolutionary process. Its optimisation result provides a group of feasible nondominated two-level distribution schemes.Peer reviewe