66 research outputs found

    Design, recruitment outcomes, and sample characteristics of the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial

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    This manuscript describes the study protocol, recruitment outcomes, and baseline participant characteristics for the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial. SPACE is a pragmatic randomized comparative effectiveness trial conducted in multiple VA primary care clinics within one VA health care system. The objective was to compare benefits and harms of opioid therapy versus non-opioid medication therapy over 12 months among patients with moderate-to-severe chronic back pain or hip/knee osteoarthritis pain despite analgesic therapy; patients already receiving regular opioid therapy were excluded. Key design features include comparing two clinically-relevant medication interventions, pragmatic eligibility criteria, and flexible treat-to-target interventions. Screening, recruitment and study enrollment were conducted over 31 months. A total of 4491 patients were contacted for eligibility screening; 53.1% were ineligible, 41.0% refused, and 5.9% enrolled. The most common reasons for ineligibility were not meeting pain location and severity criteria. The most common study-specific reasons for refusal were preference for no opioid use and preference for no pain medications. Of 265 enrolled patients, 25 withdrew before randomization. Of 240 randomized patients, 87.9% were male, 84.1% were white, and age range was 21–80 years. Past-year mental health diagnoses were 28.3% depression, 17% anxiety, 9.4% PTSD, 7.9% alcohol use disorder, and 2.6% drug use disorder. In conclusion, although recruitment for this trial was challenging, characteristics of enrolled participants suggest we were successful in recruiting patients similar to those prescribed opioid therapy in usual care

    Adapting the Evidence Academy model for virtual stakeholder engagement in a national setting during the COVID-19 pandemic

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    The COVID-19 pandemic raised the importance of adaptive capacity and preparedness when engaging historically marginalized populations in research and practice. The Rapid Acceleration of Diagnostics in Underserved Populations' COVID-19 Equity Evidence Academy Series (RADx-UP EA) is a virtual, national, interactive conference model designed to support and engage community-academic partnerships in a collaborative effort to improve practices that overcome disparities in SARS-CoV-2 testing and testing technologies. The RADx-UP EA promotes information sharing, critical reflection and discussion, and creation of translatable strategies for health equity. Staff and faculty from the RADx-UP Coordination and Data Collection Center developed three EA events with diverse geographic, racial, and ethnic representation of attendees from RADx-UP community-academic project teams: February 2021 (n = 319); November 2021 (n = 242); and September 2022 (n = 254). Each EA event included a data profile; 2-day, virtual event; event summary report; community dissemination product; and an evaluation strategy. Operational and translational delivery processes were iteratively adapted for each EA across one or more of five adaptive capacity domains: assets, knowledge and learning, social organization, flexibility, and innovation. The RADx-UP EA model can be generalized beyond RADx-UP and tailored by community and academic input to respond to local or national health emergencies

    Issues in Measuring the Efficiency of Property-Liability Insurers

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    To date there is little evidence on the relationship between property-liability (P/L) insurer’s frontier efficiency measures and the market. The establishment of a connection is important since there are a number of difficulties associated with measuring P/L insurer efficiency—there is uncertainty regarding the firm’s primary objective, the main services produced, and the measurement of these services. The main goal of the dissertation is to assess the robustness of two approaches to measuring P/L insurer efficiency —the production approach (Cummins and Weiss, 2001) and the flow approach (Brockett, et al, 2004). A secondary objective is to evaluate the performance of two proxies for the production approach’s risk-bearing and “real” loss-services output to observe whether unexpected losses leads to a distortion of efficiency. A third purpose is to determine the sensitivity of the use of the policyholder supplied debt capital input in the production approach. A fourth aim is to evaluate the performance of the range adjusted measure (RAM) of efficiency compared to the traditional data envelopment analysis (DEA) method. A final objective is to assess the connection of accounting-based efficiency to market performance measures. The empirical evidence suggests that unexpected losses do not appear to overly distort the efficiency analysis. The production approach is not extraordinarily sensitive to the inclusion (or exclusion) of the policyholder supplied debt capital input. Traditional DEA measures of efficiency, in comparison to RAM, are more accurate predictors of insolvency and are more highly related to traditional measures of firm performance. Overall, the flow approach is not consistent with the production approach. Firms identified as highly efficient by the production approach are found to be significantly less likely to fail, indicating that the production approach is consistent with the economic reality of P/L insurance market. In contrast, high flow efficient firms are often found to have a higher proclivity to fail. Production approach efficiency is also more highly correlated to traditional measures of firm performance than flow measures of efficiency. The accounting-based production approach is directly related to market measures of firm performance, while flow efficiency is inversely related or unrelated to these measures

    The Demise of the Mutual Organizational Form: An Investigation of the Life Insurance Industry

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    We investigate the role of organizational structure in financial services markets by examining the U.S. life insurance industry. Traditionally, stock and mutual life insurers were equally represented, but now the industry is mainly composed of stock firms. We find operational efficiency, access to capital, and tax savings are important determinants for this shift. The incentive to demutualize differs by the type of conversion: full demutualization is chosen for efficiency and access to capital reasons and partial conversion, using a mutual holding company, is chosen for tax savings. Firm operational efficiency improves after conversion. We also find the efficiency of the stock organizational form dominates that of the mutual structure during our sample period, 1995 to 2004. Copyright (c) 2010 The Ohio State University.
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