Is it possible to incorporate quality into hospital pricing systems?

Australia has recently implemented an activity - based funding system for public hospitals. Policymakers and providers are keen to ensure that the price paid for health care services stimulates improvements in quality and safety , but some remain scept ical that this can be achieved through pricing mechanisms. There are four main ways of linking quality and safety to hospital pricing in the context of activity based funding: Best-practice pricing This involves making evidenced - based decisions on what constitutes ‘best-practice’ for the treatment of a particular condition, then paying health services a set price when they provide best-practice care. Normative pricing This involves using price to influence the delivery of care (for example, providing incentives to deliver more care in the home for certain conditions or to provide day surgery options where appropriate). Structural models of pricing quality This involves linking funding to meeting accreditation standards or participating in benchmarking activities or clinical quality registries. Payment for Performance (P4P) or quality pricing This involves using financial incentives and/or disincentives to encourage providers to behave in certain ways that will improve quality and safety. This paper briefly examines the strength of the evidence for each of these pricing models. It considers both peer-reviewed research as well as non peer-reviewed material, such as program evaluations and government reports

Signal analysis of voltage noise in welding arcs

Gas tungsten arc welds were made on low alloy steel plates to which intentional defects (discontinuities) were imposed. Disruption of shielding gas, welding over surface films, and tack welds produce changes in what is otherwise a relatively uniform voltage signal. The arc voltage was 15 volts + or - 2 volts with 300 mV ripple noise from the power supply. Changes in this steady noise voltage varied from 50 mV to less than one millivolt depending on the severity and the type of change experienced. In some instances the changes were easily detected by analysis of the signal in real time, while in other cases the signal had to transformed to the frequency domain in order to detect the changes. Discontinuities as small as 1.5 mm in length were detected. The ultimate sensitivity and reproducibility of the technique is still being investigated

Implications of the National Disability Insurance Scheme for health service delivery

Executive summary The National Disability Insurance Scheme (NDIS) is not a health scheme. The NDIS funds disability support and a range of related services designed to maximise the independence of a person with a disability. Health care is a specific exclusion. The NDIS is organisationally separate from both the health system and the aged care sector. At the national level, the NDIS is the responsibility of the Minister for Social Services (and not the Minister for Health) and is being administered by the National Disability Insurance Agency (NDIA), which is an independent statutory agency. While the NDIS is not a health scheme, and health care is a specific exclusion, it will intersect with the health system on a number of levels. To ensure the NDIS does not lead to fragmented care for participants, the Department of Health, the Department of Social Services and the NDIA will need to work closely to monitor and resolve any issues that arise during the implementation phase. This will require active, joint collaboration to develop appropriate policy responses.   Recommendations for action 1. Establish formal Department of Health, Department of Social Service and National Disability Insurance Agency tripartite working group with the following roles and responsibilities: Education and information for key targeted audiences regarding eligibility requirement and other key implications of the NDIS and the National Injury Insurance Scheme (NIIS) Workforce implications monitored and addressed in a coordinated manner Patient inequity issues monitored and coordinated policy responses undertaken Permanent and fluctuating impairment required coordinated care and active policy responses Mental health implications need to be better understood and coordinate actions to be taken to overcome barriers Service prevision boundary disputes between health and disability sectors require a resolution mechanism through negotiation rather than determined solely by the NDIA Timely access issues monitored and a fast track system for hospital referrals to/from the NDIS developed Inconsistency with the 2011 National Health Reform Agreement monitored and addressed as appropriate 2. While it is the responsibility of the Department of Social Services and the NDIA to work toward a nationally consistent approach as the scheme moves to full roll-out, the Department of Health should monitor roll-out to ensure health services are not negatively impacted. 3. Review the NDIS evaluation in order to inform the health system with applicable lessons. At the system level, the NDIS presents opportunities to learn more about individualised service planning and funding, and better ways to measure need and outcomes

Role of Technology in Manufacturing Competitiveness

A manufacturing revolution has emerged in the past 50 years that is as significant as the industrial revolution of the 19th century. From 1950 to 2000, the average productivity growth in manufacturing in the United States was 2.8% per year, and this figure has been accelerating for the past two decades as manufacturing productivity growth has exceeded the average of other sectors by more than one percent per year (please see table below). Stated more simply, a US manufacturing worker can produce four times as much per hour today as compared with fifty years ago. This gain has resulted from competitive pressures, the advent of new technologies, and a series of product and process innovations. It has also resulted in a much higher standard of living for Americans, as products become more useful and more affordable. In order to utilize this new manufacturing capacity, U.S. firms (and others) have expanded their marketing abroad, creating rapid increase in global trade. The perception of a crisis in American manufacturing is the result of one of the most difficult realities of large gains in productivity: additional capacity almost always exceeds increased consumption. This results in an inevitable shift of labor. Industries become more productive as they mature, and competitive pressures increase. These two factors require companies to decrease their workforce and often result in movement of commodity industries overseas. The end result is a loss of jobs in the United States. Displaced workers must shift to new occupations, requiring new skills and abilities. History has shown that this shift can be either detrimental or beneficial to workers; the most important determinant of benefit is the presence of innovative new industries, which, create high value for their markets. The sustainability of growth in the U.S. manufacturing sector is based on the ability of America to continue to innovate. Innovation is the key to a vibrant U.S. manufacturing base and continued generation of new jobs

Simulation and sensitivity analysis of controlling parameters in resistance spot welding

This study was performed to investigate the fundamental parameters controlling the nugget growth. The parameters were categorized into four groups, i.e. material parameters, electrical parameters, thermal parameters and geometrical parameters. In order to quantify the sensitivity of nugget growth to changes in these parameters, a numerical model which incorporates the electrical, mechanical and thermal contact was developed. As a result, a sensitivity index table was constructed and analyzed to ascertain the relative importance of these characteristic parameters. It was found that the most important factor in determining the variability of nugget growth behavior is the ratio of contact radius to electrode radius and the ratio of electrode radius to the square of specimen thickness. In general for a variation of 10%, the geometrical parameters are most important, followed by the material parameters. The electrical parameters and the thermal parameters are the least important. The importance of contact at the faying interface is greater for the contact area than for the contact resistance

Restoring an ISO:5840-compliant Pulse Duplicator Device for Hydrodynamic Performance Characterization of Artificial Cardiac Valves

During the summer of 2021, I was employed as an intern at Dynatek Labs, an implantable prosthetics testing company located in southern Missouri. My primary project was to modernize an abandoned pulse duplicator device and protocol to allow the company to re-enter a market area which they left nearly 15 years prior: heart valve testing. The company halted this initiative due to changes in international testing standards in previous years. The International Standards Organization Cardiac Valves Working Group released the latest version of standards concerning artificial heart valve testing (ISO 5840) in January of 2021. Accordingly, my project required that I become abundantly familiar with requirements for the apparatus, procedure, and testing conditions for in vitro evaluations of artificial heart valves. With this knowledge, I made appropriate alterations to the existing device, software, and operation protocols to bring them into accordance with updated regulatory demands. Additionally, I coordinated the purchase of a new particle image velocimetry system which would be used to further characterize implants’ thrombogenic and haemolytic potential. I generated new documentation for the device including a comprehensive manual, user guide and test protocol. Hundreds of tests were performed to fully calibrate, produce the documentation, and implement the new system and device software. By the conclusion of my appointment at Dynatek Labs, the pulse duplicator was fully functional, data acquisition was conducted in full accordance with the most recent standards, and the auxiliary PIV system was successfully integrated into the overall device setup

Measuring the Adaptive Response to Drought

Scientific evidence suggests that future climate change has the potential to bring about an increase in both the frequency and duration of drought in some regions of the world (United Nations, 2012). Economists have theorized that at least some of the adverse effects of these droughts will be mitigated through various adaptive responses by agricultural producers. The effectiveness of any adaptive response to climate change will depend on how quickly producers can recognize a change in climatic patterns and respond accordingly. The following paper investigates the relationship between a specific climate signal (prolonged drought) and the land use decision of a farmer. To accomplish this, we track changes in land use for roughly 50,000 farmers for 5 consecutive years in western Kansas. Using a two-way fixed effect model, we find a statistically significant negative association between drought and the decision to plant corn, a relatively more water intensive crop. However, the magnitude and statistical significance of these findings are quite sensitive to model specification. In addition, although statistically significant, the magnitude of this relationship appears to be small, suggesting that the pace of climate change adaption, with respect to drought and crop choice, may be quite gradual

Investigations of Balsam Woolly Aphid - Fraser Fir Interaction: Feeding Site Characteristics and Wound Response

Young, vigorously growing Fraser firs have exhibited a lower degree of susceptibility to balsam woolly aphid infestations than mature, mixed stands. This study investigated the relationship between balsam woolly aphid feeding site preference and bark morphological features, plus how these morphological features varied with stem size, age, growth rate, percent live crown and stand structure characteristics. Investigations were also conducted on the wound healing processes within the bark of Fraser fir as well as on how the aphid might interfere with these processes. Sampling was performed in the stands considered to be representative of anticipated conditions for the next generation of Fraser fir following the death of existing mature Fraser fir. For successful feeding the balsam woolly aphid required modification of the tight, smooth, gray bark characteristics of young vigorously growing Fraser fir trees. These modifications were in the form of lenticels and splitting of the bark. Fir trees with slow growth rates associated with high stand densities had rougher bark and more lenticels per unit area than trees growing in open, less competitive conditions. The wound healing processes within the bark were studied by observing the rate of formation on non-suberized impervious tissue and necrophylactic periderm following mechanical wounding. Sampling was conducted along an elevational gradient and a stand density gradient. Open-grown trees at low elevations showed the fastest rates of healing (17 days), whereas trees growing at the highest elevations required 26 days to heal. At the same elevation, open-grown trees formed necrophylactic periderm an average of 5 days sooner than forest-grown trees. Wounding combined with injection of selected plant growth substances (some of which are suspected of being secreted by the aphid while feeding) was also investigated. All treatments utilizing auxin-like compounds (indole-3-acetic acid and naphthaleneacetic acid) required 11 more days for periderm formation than for the control of mechanical wounding only. Treatments utilizing a gibberellin and a cytokinin formed necrophylactic periderm at the same rate as the control. Additionally, histological examination of aphid feeding sites failed to reveal a single case of necrophylactic periderm formation around the feeding zone. Thus, the balsam woolly aphid was able to inhibit the normal defense mechanism of Fraser firs following penetration of the living bark tissue by the insect\u27s stylet