The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

<p>Abstract</p> <p>Background</p> <p>A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory.</p> <p>Methods/design</p> <p>A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data.</p> <p>Discussion</p> <p>The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical.</p

Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study

Background Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health. Methods/Design EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes. Discussion The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes

A review of the water-related energy consumption of the food system in nexus studies

This study reviewed nexus researches, synthesize and discuss insights, methodological practices, and future outlook of water-related energy consumption assessment of the food system. For the first time, the study assessed: (i) the trends and drivers of water-related energy research in different countries, (ii) how water-related energy in the food system is being evaluated (objectives & scale, study dimension & analysis focus, and methods) and (iii) the significance of food-system water-related energy in comparison with other sectors. Of 686 nexus studies undertaken since 1990, 104 studies (15%) quantified water-related energy. Studies have generally broadened in scope through time. The USA, China, and Australia have conducted most studies representing 23%, 17%, 15% of total respectively. A few of the identified major drivers in these countries leading water-related energy assessment are: providing optimal solutions and avoiding problem-shifting, analyzing the challenges and opportunities to reduce water-related energy, and exploring the energy-saving benefits by saving water. Of the 104 water-related energy studies, 65 articles (∼60%) related to the food system, focussed on the agriculture phase for irrigation energy consumption. Existing nexus studies often ignored other phases such as food processing and cooking, which are more energy-intensive. Over 50% of studies used material flow analysis to evaluate water-related energy in the food system. Few of the nexus studies evaluated inter-regional flows or changes through time. Absence of a comprehensive study of the entire food system, and wide variations in study system boundary and definitions, make it difficult to compare sectoral significance. However, the order of sectoral water-related energy consumption (from highest to lowest) identified as industrial, residential, agriculture, and water and wastewater service. Our review demonstrates a tremendous opportunity and need for an overarching framework to enable systematic evaluation and benchmarking of water-related energy consumption of the food system

A multi-regional input-output analysis of direct and virtual urban water flows to reduce city water footprints in Australia

This study focused on understanding what sector-region combinations could be targeted to reduce total city water footprints? We used multi-regional input-output analysis of direct and virtual water, across five Australian capital cities and their supporting regions. The key novelty of this study is the high spatial resolution policy-relevant sub-sectoral analysis to identify sector-region combinations to reduce city water footprints. Virtual water footprints were 8-10 times higher than direct water consumption (per capita) in all studied cities. Virtual water from outside the city boundary is almost 20 times higher than the virtual water sourced from within the city boundary in all studied cities. Water-efficiency programs can significantly reduce the virtual water footprints of the studied cities. This includes water-efficiency and recycling on farm, and in food processing (e.g. livestock feed growing, dairy cattle farming, vegetable growing and processing) in rural regions of New South Wales, Queensland, and Victoria. The results are relevant to strategic city water footprints reduction, sustainable sourcing and planning for future disturbance of product supply, and water-sensitive city developments considering both direct and virtual water flows

Models for Water-sensitive Middle Suburban Infill Development

Infill development in Australian cities over the coming decades is expected to have considerable negative influence on the hydrology, resource efficiency, liveability and amenity of our cities. This project aims to develop and apply a performance evaluation framework to understand infill impacts, create design options and processes for improved outcomes through case studies, and identify improved governance options and arrangements. A 'typologies catalogue' of spatial configurations and architectural models relevant to high amenity medium density infill development has been prepared, with different arrangements and combinations of buildings and open spaces applied on a case study development site in Adelaide, SA. Design scenarios from the catalogue are evaluated against a range of qualitative and quantitative performative criteria, developed in consultation with industry partners, including water and urban heat performance assessment. The case study site designs offer practical models and methods for achieving infill development and densification in a manner that improves amenity within the dwelling, across the site and for the surrounding precinct – while maintaining or improving water and urban heat performance. During this process, a set of key design principles for water sensitive infill development is defined, with prospects to further inform infill development practice and related policies

Water sensitive outcomes for infill development: Infill performance evaluation framework

Most major Australian (and many global) cities expect intensified infill development over the coming decades. Infill development is promoted nationwide as a way of accommodating growing urban populations by increasing urban densities (densification) rather than allowing urban sprawl. Currently, the bulk of infill development occurring in Australian capital cities involves subdivisions of single suburban lots into denser single- and multi-unit dwellings, and apartment buildings around transport nodes. This pattern achieves higher density targets but increases building footprint and thus imperviousness of the redeveloped lot, most often at the expense of usable greenspace.Without significant intervention, 'business as usual' redevelopment will have a considerable negative influence on urban hydrology, resource efficiency, urban heat, liveability and amenity. The water sensitive city approach aims to resolve these challenges. This document is prepared as a component of Integrated Research Project 4 (IRP4): Water Sensitive Outcomes for Infill Developments. It sets out the Infill Performance Evaluation Framework, which is intended to help guide the assessment and design of water sensitive cities. Specifically the Framework assesses the performance of an ‘urban entity’ defined as the components within a three-dimensional physically bounded system including all flows and storage of piped and natural water flows

NAPLAN and the role of edu-business: new governance, new privatisations and new partnerships in Australian education policy

This paper provides a critical analysis of the edu-businesses currently working in partnership with the Australian Curriculum, Assessment and Reporting Authority to deliver the Commonwealth government policy initiative of the National Assessment Program – Literacy and Numeracy (NAPLAN). These emerging public–private partnerships (PPPs) exemplify new heterarchical governance structures in Australia, where a network of public and private agents now contribute to education policy processes. In analysing the NAPLAN policy network, this account seeks to proffer a critical analysis on the evolving PPPs in Australia and ascertains in whose interests and with what outcomes these PPPs operate. The NAPLAN policy network is analysed in relation to the contemporary state and its changing modus operandi, in which I draw on the notions of heterarchies, networks and new governance structures in education to understand these developments. Network ethnography is employed to document the network of PPPs that are associated with NAPLAN and other government initiatives in Australia, and in particular, I reflect on the activities of Pearson and the Australian Council for Educational Research to problematise what these policy networks mean