Further evidence on the link between health care spending and health outcomes in England

This report describes results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative. It builds on our earlier report for the Health Foundation – The link between health care spending and health outcomes: evidence from English programme budgeting data – that took advantage of the availability of a major new dataset to examine the relationship between health care expenditure and mortality rates for two disease categories (cancer and circulation problems) across 300 English Primary Care Trusts. Our results are useful from a number of perspectives. Scientifically, they confirm our previous findings that health care has an important impact on health across a range of conditions, suggesting that those results were robust across programmes of care and across years. From a policy perspective, these results can help set priorities by informing resource allocation across a larger number of programmes of care. They also add further evidence to help NICE decide whether its current QALY threshold is at the right level.

The link between health care spending and health outcomes for the new English Primary Care Trusts

English programme budgeting data have yielded major new insights into the link between health care spending and health outcomes. This paper updates two recent studies that have used programme budgeting data for 295 Primary Care Trusts (PCTs) in England to examine the link between spending and outcomes for several programmes of care. We use the same economic model employed in the two previous studies. It focuses on a decision maker who must allocate a fixed budget across programmes of care so as to maximize social welfare given a health production function for each programme. Two equations – a health outcome equation and an expenditure equation – are estimated for each programme (data permitting). The two previous studies employed expenditure data for 2004/05 and 2005/06 for 295 health authorities and found that in several care programmes – cancer, circulation problems, respiratory problems, gastro-intestinal problems, trauma burns and injury, and diabetes – expenditure had the anticipated negative effect on the mortality rate. Each health outcome equation was used to estimate the marginal cost of a life year saved. In 2006/07 the number of PCTs in England was reduced to 152, largely through a series of mergers. In addition, several changes were made to the methods employed to construct the programme budgeting data. This paper employs updated budgeting and mortality data for the new 152 PCTs to re-estimate health production and expenditure functions, and also presents updated estimates of the marginal cost of a life year saved in each programme. Although there are some differences, the results obtained are broadly similar to those presented in our two previous studies.

The Link Between Health Care Spending and Health Outcomes: Evidence from English Programme Budgeting Data

This report describes preliminary results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative.

Does Better Disease Management in Primary Care Reduce Hospital Costs?

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.Quality; disease management; primary care; hospital costs; ambulatory care sensitive conditions; preventative care.

health outcomes for the new English Primary Care Trusts 1

CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The new CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge). Acknowledgements This study was undertaken as part of the Quest for Quality and Improved Performance, a fiveyear initiative of The Health Foundation. We are grateful to Mark Dusheiko, Hugh Gravelle, Andrew Jackson, Dawn Godber and Peter Brambleby for helpful comments and advice. We are also grateful to Daniel Eayres at the National Centre for Health Outcomes Development for assistance with the mortality data and Linda Williams at the Office for National Statistics for providing census data for the new PCT boundaries. Disclaimer Papers published in the CHE Research Paper (RP) series are intended as a contribution to current research. Work and ideas reported in RPs may not always represent the final position and as such may sometimes need to be treated as work in progress. The material and views expressed in RPs are solely those of the authors and should not be interpreted as representing the collective views of CHE research staff or their research funders. Further copies Copies of this paper are freely available to download from the CHE websit

A Trustworthiness of Commercial Airline Pilots (T-CAP) Scale for American Consumers

The purpose of this study was to create a Trustworthiness of Commercial Airline Pilots (T-CAP) scale that could be used with American participants. Previous research (Rice, Mehta, Steelman, & Winter, 2014) created a similar scale that may be used with Indian participants. However, due to cultural differences, it was necessary to recreate an instrument that could be used with American consumers. In fact, the scale developed by American participants did differ significantly, both in terms of length and items to measure trustworthiness of commercial pilots. Participants were used in the entire process of creating the scale, including item generation and testing. A factor analysis using principle components and a varimax rotation produced a single factor for the condition of trustworthiness. Cronbach’s Alpha and Guttman split-half tests verified the reliability of the instrument and an experimental scenario was used to test the discriminability of the scale

Simulation Challenges – Student Perception of Air Traffic Control Simulation

In the world of Air Traffic Management, words such as NextGen (NextGeneration) and SESAR (Single European Sky- ATM Research) elicit a sense of excitement or trepidation as to what this means for the world of Air Traffic Management (ATM). A number of collegiate institutions including members of the University Aviation Association (UAA), have degree programs that include air traffic control curriculum and different levels of simulation. Working in partnership with the FAA, these schools developed curriculum that met the basic needs of air traffic control, some going over and above the basic requirements to include high-fidelity simulation. What we know from the technological advancements with NextGen is that controllers will use automation more than ever; some tasks that were done manually before will now be handled by automation, and more decisions that a controller needs to make to separate aircraft will be handled by technology. The findings from the study found there were significant differences in the perceptions of students regarding air traffic control simulation based on the demographic factors investigated in the study, and with students who had prior experience with air traffic control simulators or prior experience with simulation in another training environment. This may be due to the fact that some students were more comfortable with technology and were able to capitalize on the learning experience and not worry about the technical aspects of the simulator. Recommendations from the study resulted in several areas that may need further research

Commercial Airline Pilots\u27 Attitudinal Data on Controlled Rest in Position: A Qualitative Inquiry

Fatigue is a significant contributor to accidents in aviation, in commercial, private, and military aircraft, and is defined as “extreme tiredness resulting from mental or physical exertion or illness” (Oxford Dictionary, 2017, n.p.). Typical fatigue mitigation techniques include work and rest scheduling, obtaining required minimum rest before a flight, and pharmacological countermeasures (Caldwell & Caldwell, 2005; Caldwell, Mallis, Caldwell, Paul, Miller, & Neri, 2009). However, Controlled Rest in Position (CRIP), or in-flight sleep, may be another potential way to mitigate pilot fatigue. Prior research has investigated consumer perceptions relating to CRIP, revealing unfavorable perceptions (Winter, Carryl, & Rice, 2015). However, it is likely that pilots feel differently about CRIP owing to their experience with fatigue in the cockpit and their knowledge of standard aviation practices. The purpose of this study is to understand commercial airline pilots’ attitudes regarding controlled rest in position using a qualitative method and a phenomenological approach

Influence of wet distillers grains diets on beef cattle fecal bacterial community structure

<p>Abstract</p> <p>Background</p> <p>The high demand for ethanol in the U.S. has generated large stocks of wet distillers grains (DG), a byproduct from the manufacture of ethanol from corn and sorghum grains. Little is known, however, about the potential influence of dietary DG on fecal microbial community structure. A better understanding of the microbial population in beef cattle feces could be an important monitoring tool to facilitate goals of improving nutrient management, increasing animal growth performance and decreasing odors and/or shedding of pathogens. Five diets consisting of a traditional diet fed to finishing beef cattle in the Southern High Plains of Texas-CON (steam-flaked corn control with 0% DG), and four concentrations of DG in the dietary dry matter; 10 C (10% corn-based DG), 5S (5% sorghum-based DG), 10S (10% sorghum DG), and 15S (15% sorghum DG) were fed to steers at the Texas Tech University Burnett Animal Center. Diets were essentially isonitrogenous with a formulated crude protein value of 13.5%.</p> <p>Results</p> <p>Fecal grab samples were obtained from 20 steers (n = 4 per diet) and the barcoded DNA pyrosequencing method was used to generate 127,530 16S operational taxonomic units (OTUs). A total of 24 phyla were observed, distributed amongst all beef cattle on all diets, revealing considerable animal to animal variation, however only six phyla (core set) were observed in all animals regardless of dietary treatment. The average abundance and range of abundance, respectively of the core phyla were as follows: Firmicutes (61%, 19 to 83%), Bacteroidetes (28%, 11 to 63%), Proteobacteria (3%, 0.34 to 17.5%), Tenericutes (0.15%, 0.0 to 0.35%), Nitrospirae (0.11%, 0.03 to 0.22%), and Fusobacteria (0.086%, 0.017 to 0.38%). Feeding DG-based diets resulted in significant shifts in the fecal microbial community structure compared with the traditional CON. Four low abundance phyla significantly responded to dietary treatments: Synergistetes (<it>p </it>= 0.01), WS3 (<it>p </it>= 0.054), Actinobacteria (<it>p </it>= 0.06), and Spirochaetes (<it>p </it>= 0.06).</p> <p>Conclusions</p> <p>This is, to our knowledge, the first study using this method to survey the fecal microbiome of beef cattle fed various concentrations of wet DG. Comparison of our results with other cattle DNA sequencing studies of beef and dairy cattle feces from a variety of geographical locations and different management practices identifies a core set of three phyla shared across all cattle. These three phyla, in order of relative abundance are; Firmicutes, Bacteroidetes, and Proteobacteria. The presence of large animal-to-animal variation in cattle microbiome was noted in our study as well as by others.</p

Why People Are Not Willing to Let Their Children Ride in Driverless School Buses: A Gender and Nationality Comparison

As driverless vehicles proliferate, it is possible that this technology will be applied in mass transport vehicles. School buses may be suited for autonomous operations as they follow set routes and schedules. However, a research gap exists in whether or not parents would be willing to have their children ride in autonomously operated school buses. The purpose of this study was to examine parents’ willingness to allow their child to ride in an autonomous school bus. Participant gender and nationality were also two independent variables, along with affect measures as a possible mediating variable. The research used a two-study approach. In study one, it was found that participants were less willing to have their child ride in a driverless school bus than a traditional human-operated vehicle. In study two, findings suggest a significant interaction between the type of driver, participant gender, and nationality. In general, American females were less willing than Indian females and overall, Americans were less willing than Indians in the driverless conditions. Affect was found to be a mediating variable, which suggests that emotions were playing a role in the responses of participants. The paper concludes with theoretical contributions, practical applications, and suggestions for future research