Disparate Impacts of Two Public Reporting Initiatives on Clinical and Perceived Quality in Healthcare

Purpose: Transparency is increasingly viewed as a prerequisite for value-based health care that invites quality in the assessment of achieved value. However, nowadays the ability of transparency initiatives to enhance quality of care remains obscure, if not rejected. Thus, this study aims to investigate how transparency initiatives influence two types of quality of care: clinical and perceived quality. Methods: First, factor analyses were conducted to construct three dependent variables: healthcare-associated infections (HAIs), 30-day readmission rates, and patient satisfaction. Then, the three quality models were compared by running ordinary least squares multiple regressions using STATA 14.1. The existence of heteroskedasticity was remedied by using robust standard errors. Results: Examining general acute care hospitals in the US, the present study noted that the ability of public reporting to improve quality of care remains inconclusive and that the pursuit of transparency may lead to inadvertent results. The disclosure of all-payer claims data (APCD) was found to have the power to differentiate hospitals’ clinical and perceived quality, but it failed to reach the desired outcomes without market pressure. The impact of transparency on quality of care diverges depending on the unique characteristics of each transparency policy, even though they pursue the same ends through information dissemination. Furthermore, the same public policy showed starkly disparate impacts on clinical quality (eg, healthcare-associated infections (HAIs) and 30-day readmission rates) and perceived quality (eg, patient satisfaction). Conclusion: Despite the theoretically acknowledged merits of transparency, the present study noted that its ability to enhance quality of care remains inconclusive, and the pursuit of transparency may even inadvertently harm quality of care. While hospitals may need to finetune their strategies for each quality measurement in order to cope with the new environmental pressure, it is health policymakers’ role to coordinate those quality metrics and improve the validity of patient experience measures and surveys

World Bank Education Sector: From Internal and External Perspectives

This paper describes the authors’ almost 30-year (1972-1998) personal experience with the World Bank (WB) education sector operations from the internal perspective. Then, it discusses the authors’ 20-year (1999-2020) observation from an external perspective. The paper aims to reveal the goals, objectives, strategies, the mechanism, and processes of decision-making, especially on how an education loan and credit is justified, of the world’s largest international aid organization for the education sector in developing countries (some $4 billion a year). Through this effort, the author provides a sound basis for insiders’ and outsiders’ fair assessments or criticisms of WB education sector operations. It also allows for some lessons/suggestions for the future WB education sector operations and for possible participations, collaborations, and cooperation with outsiders interested in WB operations in the education sector

The Impact of Public Reporting Schemes and Market Competition on Hospital Efficiency

In the wake of growing attempts to assess the validity of public reporting, much research has examined the effectiveness of public reporting regarding cost or quality of care. However, relatively little is known about whether transparency through public reporting significantly influences hospital efficiency despite its emerging expectations for providing value-based care. This study aims to identify the dynamics that transparency brought to the healthcare market regarding hospital technical efficiency, taking the role of competition into account. We compare the two public reporting schemes, All-Payer Claims Database (APCD) and Hospital Compare. Employing Data Envelopment Analysis (DEA) and a cross-sectional time-series Tobit regression analysis, we found that APCD is negatively associated with hospital technical efficiency, while hospitals facing less competition responded significantly to increasingly transparent information by enhancing their efficiency relative to hospitals in more competitive markets. We recommend that policymakers take market mechanisms into consideration jointly with the introduction of public reporting schemes in order to produce the best outcomes in healthcare

evidence from panel data of 120 countries

Thesis(Master) --KDI School:Master of Development Policy,2015This study verifies whether the current aid allocation practice gives a priority to the business environment of aid receiving nations. Since traditional aid practice has registered many unsuccessful results over the last couple of decades, author believe that strengthening the private sector with aid in developing countries is one of good attempts to lift those countries from poverty. Econometric estimations with panel data of 120 developing countries from 2007 to 2012 indicate that the recent aid practice has not much changed from the past practice. Donors respond mainly to the recipients’ economic and physical needs, represented by income level, infant mortality and population, rather than considering the aid’s value for money. In addition, the finding regarding government effectiveness is inconsistent with the existing claim that aid should be allocated more to countries with sound policies and institutions. This paper suggests that donor states carefully consider the soundness of business polices of a recipient country as a prime determinant when selecting where to give aid. Furthermore, donor countries should deliberately design how to utilize their aid resources to strengthen the business policies and regulations for recipient countries.OutstandingmasterpublishedAhreum HAN

Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs

Effects of follicular versus luteal phase-based strength training in young women

Hormonal variations during the menstrual cycle (MC) may influence trainability of strength. We investigated the effects of a follicular phase-based strength training (FT) on muscle strength, muscle volume and microscopic parameters, comparing it to a luteal phase-based training (LT). Eumenorrheic women without oral contraception (OC) (N = 20, age: 25.9 ± 4.5 yr, height: 164.2 ± 5.5 cm, weight: 60.6 ± 7.8 kg) completed strength training on a leg press for three MC, and 9 of them participated in muscle biopsies. One leg had eight training sessions in the follicular phases (FP) and only two sessions in the luteal phases (LP) for follicular phase-based training (FT), while the other leg had eight training sessions in LP and only two sessions in FP for luteal phase-based training (LT). Estradiol (E2), progesterone (P4), total testosterone (T), free testosterone (free T) and DHEA-s were analysed once during FP (around day 11) and once during LP (around day 25). Maximum isometric force (Fmax), muscle diameter (Mdm), muscle fibre composition (No), fibre diameter (Fdm) and cell nuclei-to-fibre ratio (N/F) were analysed before and after the training intervention. T and free T were higher in FP compared to LP prior to the training intervention (P < 0.05). The increase in Fmax after FT was higher compared to LT (P <0.05). FT also showed a higher increase in Mdm than LT (P < 0.05). Moreover, we found significant increases in Fdm of fibre type ΙΙ and in N/F only after FT; however, there was no significant difference from LT. With regard to change in fibre composition, no differences were observed between FT and LT. FT showed a higher gain in muscle strength and muscle diameter than LT. As a result, we recommend that eumenorrheic females without OC should base the periodization of their strength training on their individual MC

Time-motion analysis in women’s team handball: importance of aerobic performance

Women’s handball is a sport, which has seen an accelerated development over the last decade. Data on movement patterns in combination with physiological demands are nearly nonexistent in the literature. The aim of this study was twofold: first, to analyze the horizontal movement pattern, including the sprint acceleration profiles, of individual female elite handball players and the corresponding heart rates (HRs) during a match and secondly to determine underlying correlations with individual aerobic performance. Players from one German First League team (n = 11) and the Norwegian National Team (n = 14) were studied during one match using the Sagit system for movement analysis and Polar HR monitoring for analysis of physiological demands. Mean HR during the match was 86 % of maximum HR (HRmax). With the exception of the goalkeepers (GKs, 78 % of HRmax), no position-specific differences could be detected. Total distance covered during the match was 4614 m (2066 m in GKs and 5251 m in field players (FPs)). Total distance consisted of 9.2 % sprinting, 26.7 % fast running, 28.8 % slow running, and 35.5 % walking. Mean velocity varied between 1.9 km/h (0.52 m/s) (GKs) and 4.2 km/h (1.17 m/s) (FPs, no position effect). Field players with a higher level of maximum oxygen uptake (V̇O2max) executed run activities with a higher velocity but comparable percentage of HRmax as compared to players with lower aerobic performance, independent of FP position. Acceleration profile depended on aerobic performance and the field player’s position. In conclusion, a high V̇O2max appears to be important in top-level international women’s handball. Sprint and endurance training should be conducted according to the specific demands of the player’s position

Respiratory failure in a diabetic ketoacidosis patient with severe hypophosphatemia

Phosphate is essential in regulating human metabolic processes, and severe hypophosphatemia can induce neurologic and hematological complications and result in respiratory failure and cardiac dysfunction. Therefore, correction of severe hypophosphatemia can be pivotal in the management of diabetic ketoacidosis (DKA). We report the case of a 14-year-old female who was diagnosed with type 1 diabetes and referred to our institute for treatment of DKA. Although the patient received fluid and continuous insulin administration according to the current DKA treatment protocol, generalized tonic seizures and cardiac arrest developed. After cardiopulmonary resuscitation, the patient recovered and was stable. Within 16 hours after DKA treatment, the patient developed respiratory failure with severe hypophosphatemia that required mechanical ventilation. Concurrent neurologic evaluation revealed no specific abnormalities. The patient recovered without any complications after correcting the hypophosphatemia. We suggest vigilant monitoring of the phosphate level in DKA patients and active replacement when required

A Case Study of K-8 Mathematics Teachers’ Agency and Learning within a Research-Practice Partnership

This dissertation study examines K-8 mathematics teacher agency and learning within a research-practice partnership (RPP) context. The study is framed by three primary research questions: (a) How is teacher agency enacted within an RPP? (b) What do teachers perceive they are learning from their participation in an RPP? and (c) How is teacher agency connected to teacher learning in an RPP context? An ecological framework for teacher agency and situated learning theory about teacher learning were both utilized to frame the questions and analyses. Furthermore, case study methodology was employed to closely examine K-8 mathematics teachers’ participation and experience in a co-design team in one school district. Multiple types of data were collected including semi-structured interviews, meeting observations, and related documents for two years. Additionally, those data sources were supplemented with a targeted set of semi-structured interviews about teacher agency and teacher learning. The data were analyzed using primarily qualitative methods, and specifically, with coding approaches associated with grounded theory. The study’s findings indicate that the quality of teacher agency enactment changed over time, and there are multiple factors that potentially impacted their participation. Amid the teachers’ involvement in the RPP, teacher learning occurred not just about mathematics teaching but also about other areas such as leadership, collaborative abilities, and understanding of the iterative process of designing teacher support, which are all crucial components of capacity building for creating sustainable learning opportunities even after the partnership with the university. Possible connections between teacher agency and learning are discussed, and implications for inviting teachers to the RPP are offered