The Service Profit Chain Customer Value Equation – an application to Health Care

The assessment of value in health care is most often considered from a population perspective, using techniques such as burden of illness and economic evaluation. While necessary, such techniques are not sufficient to maximise health benefits from the perspective of the individual. The Service Profit Chain is a model by which better outcomes for both service providers and customers can be achieved. A core component, the Customer Value Equation, describes the perceived value of a service to an individual as: outcomes plus perceptions of the quality of service delivery (process quality) / monetary fees plus access costs (such as time). Based on a series of studies using real-world data, this thesis discusses applicability of these ideas to the health care environment, focusing on process quality and the relationship between clinicians and their consulting patients. Patients must be equal partners in the decision-making process; where this occurred, outcomes were generally better. Engagement, empathy and good communication between clinician and patient were shown to be necessary factors to maximise outcomes. Disconnects between clinical and patient regarding disease severity, recognition of symptoms and side-effects, and perceived lack of communication were all associated with worse quality of life, lower satisfaction and lower adherence to treatment plans. Policy implications arising from the research findings are discussed, including equipping clinicians to better understand the objectives and needs of their patients, improving clinical-patient communication, more widespread use of models of care such as Shared Decision Making, and developing tools to measure satisfaction with the care process. This thesis demonstrates the advantages of real-world data regarding the measurement of process activity and outcomes, highlighting the value of any data source able to capture both clinician and patient perspectives of the same health care encounter. This allows assessment of value from the individual patient perspective which, together with population measures of value, will enable the maximisation of value of health care interventions

What is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?

The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi-structured interviews were conducted with 50 young people with CF aged 13-24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people's homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non-clinical practical and emotional support; (2) Acting as 'troubleshooters' in times of health-related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as 'protectors' of their children. Young people and service staff expressed tensions in managing parental involvement in post-paediatric consultations and the degree to which parents should be aware of their offspring's deteriorating health and social concerns. Parental anxiety and over-involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these 'new' ageing populations. © 2009 Blackwell Publishing Ltd

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

OBJECTIVE: We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. METHODS: Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. RESULTS: The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. CONCLUSION: All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages

Managers, Consumers, Visitors : Roles of Caring Relatives in Emerging Home-based Eldercare in the Czech Republic

Each culture has a deeply rooted understanding of what constitutes the ideal for eldercare organization. This article investigates the role of family members in the delegation and provision of eldercare by private for-profit agencies in the Czech Republic. In this post-socialist country with a high level of intergenerational solidarity, a new market for eldercare has emerged in recent decades. We are interested in how the dominance of the family in eldercare provision is inscribed in the functioning of forprofit agencies and their caring practices. We examine how the role of family members whose elderly relatives receive paid care provided by private for-profit agencies is conceptualized by those who sell the care services, those who provide these services, and the care recipients themselves. We draw upon interviews conducted with the owners of private agencies, ethnographic observations, and informal interviews with paid care workers

A note on the Kutta condition in Glauert's solution of the thin aerofoil problem

Glauert's classical solution of the thin aerofoil problem (a coordinate transformation, and splitting the solution into a sum of a singular part and an assumed regular part written as a Fourier sine series) is usually presented in textbooks on aerodynamics without a great deal of attention being paid to the rôle of the Kutta condition. Sometimes the solution is merely stated, apparently satisfying the Kutta condition automatically. Quite often, however, it is misleadingly suggested that it is by the choice of a sine series that the Kutta condition is satisfied. It is shown here that if Glauert's approach is interpreted in the context of generalised functions, (1) the whole solution, i.e. both the singular part and any non-Kutta condition solution, can be written as a sine-series, and (2) it is really the coordinate transformation which compels the Kutta condition to be satisfied, as it enhances the edge singularities from integrable to non-integrable, and so sifts out solutions not normally representable by a Fourier series. Furthermore, the present method provides a very direct way to construct other, more singular solutions. A practical consequence is that (at least, in principle) in numerical solutions based on Glauert's method, more is needed for the Kutta condition than a sine series expansion

Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England

For women with preeclampsia, BMI >30 kg/m2, infection, or those having cesarean delivery, VTE risk remained elevated for 6 weeks postpartum.For women with postpartum hemorrhage or preterm birth, the relative rate of VTE was only increased for the first 3 weeks postpartum.Impact on the timing of first postpartum venous thromboembolism (VTE) for women with specific risk factors is of crucial importance when planning the duration of thromboprophylaxis regimen. We observed this using a large linked primary and secondary care database containing 222 334 pregnancies resulting in live and stillbirth births between 1997 and 2010. We assessed the impact of risk factors on the timing of postpartum VTE in term of absolute rates (ARs) and incidence rate ratios (IRRs) using a Poisson regression model. Women with preeclampsia/eclampsia and postpartum acute systemic infection had the highest risk of VTE during the first 3 weeks postpartum (ARs ≥2263/100 000 person-years; IRR ≥2.5) and at 4-6 weeks postpartum (AR ≥1360; IRR ≥3.5). Women with body mass index (BMI) >30 kg/m2 or those having cesarean delivery also had elevated rates up to 6 weeks (AR ≥1425 at 1-3 weeks and ≥722 at 4-6 weeks). Women with postpartum hemorrhage or preterm birth, had significantly increased VTE rates only in the first 3 weeks (AR ≥1736; IRR ≥2). Our findings suggest that the duration of the increased VTE risk after childbirth varies based on the type of risk factors and can extend up to the first 3 to 6 weeks postpartum