Finansiering av helseforetak basert på relative prestasjoner

Hovedspørsmålet i denne rapporten er om regionale helseforetak kan forbedre ressursbruken ved å utnytte informasjon om relative prestasjoner mellom egne helseforetak, dvs. om målestokkonkurranse kan brukes som utgangspunkt for å bestemme finansielle overføringer til helseforetak. Spørsmålet belyses ved å ta utgangspunkt i insentivteoretiske bidrag

Factors associated with formal and informal resource utilization in nursing home patients with and without dementia: cross-sectional analyses from the COSMOS trial

Objectives: To investigate the association between clinical, demographic, and organizational factors and formal (health professionals) and informal (relatives) resource utilization in nursing home patients with and without dementia.Methods: Baseline data from the multicomponent cluster randomized control COSMOS trial including 33 Norwegian nursing homes and 723 residents with and without dementia. Nursing home staff (n = 117) participated as proxy raters to approximate formal and informal resource use in daily care.Measurements: The primary outcome was the Resource Utilization in Dementia - Formal Care scale to assess formal and informal care time in hours/month regarding basic activities of daily living (ADL), instrumental ADL, and supervision. Secondary outcomes were hours/week spent on formal and informal leisure activities. Behavioral and psychological symptoms in dementia (BPSD) were assessed by the Neuropsychiatric Inventory-Nursing Home version, physical function by the Physical Self-Maintenance Scale, and psychotropic drug use by the Anatomical Therapeutic Chemical classification system. Organizational factors were ward size and staff ratio.Results: Generalized linear mixed-effect models and two-part modelling revealed an association between increased formal care time and poorer physical function, higher agitation and psychotropic drug use and lower cognitive function (all p < .05). Enhanced formal leisure time was related to better ADL function (p < .05) and smaller wards (p < .05). The family related leisure time was associated with agitation, decline in ADL function, smaller wards, and better staffing ratio (all p < .05). Married patients received more informal direct care (p < .05) and leisure time (p < .05) compared to unmarried/widowed.Conclusion: For nursing home staff, higher agitation and psychotropic drug use, and lower cognitive function, is associated with more direct care time, whereas leisure time activities are less prioritized in people with lower physical function. Informal caregivers' engagement is encouraged by smaller nursing homes and better staff ratio. Therefore, we recommend stakeholders and healthcare professionals to consider these clinical and organizational factors to optimize treatment and leisure time activities in nursing home patients with various needs

Investigation of Vortex Flaps and Other Flow Control Devices on Generic High-Speed Civil Transport Planforms

A parametric cranked delta planform study has been conducted in the Langley 14- by 22-Foot Subsonic Tunnel with the following objectives: (1) to evaluate the vortex flap design methodology for cranked delta wings, (2) to determine the influence of leading-edge sweep and the outboard wing on vortex flap effectiveness, (3) to evaluate novel flow control concepts, and (4) to validate unstructured grid Euler computer code predictions with modeled vortex and trailing-edge flaps. Two families of cranked delta planforms were investigated. One family had constant aspect ratio, while the other had a constant nondimensional semispan location of the leading-edge break. The inboard leading-edge sweep of the planforms was varied between 68 deg., 71 deg., and 74 deg., while outboard leading-edge sweep was varied between 48 deg. and 61 deg. Vortex flaps for the different planforms were designed by an analytical vortex flap design method. The results indicate that the effectiveness of the vortex flaps was only slightly influenced by the variations in the parametric planforms. The unstructured grid Euler computer code was successfully used to model the configurations with vortex flaps. The vortex trap concept was successfully demonstrated