Rapid Application Development for Small and Medium Businesses, A Case Study

This field project is based on developing a web application model for a hypothetical small business –“Beverly Flowers.” As a small business, it did not see the need for a web presence in its initial years of operation. However its latest marketing analysis has revealed that its existing customer base wants the convenience of shopping from home. The company would like to develop a web application rapidly to gain maximum benefits; however the company lacks Information Technology resources due to budget constraints. In the current age of fast pace commerce, every Small and Medium sized Business (SMB), without e-Commerce or a Web presence is faced with similar challenges. This field project focuses on how SMBs can embark on a new initiative to build a web presence rapidly, efficiently, and cost effectively by using an industry proven open source software such as the Spring framework. The field project focuses on the benefits that small and medium companies can gain by rapidly developing web application using the open source model. There are many successful organizations that have adopted this method and have implemented successful applications. This has resulted in tremendous cost savings and increase in customer satisfaction for those companies. This field project also includes a small software development model – a prototype, to build the required web presence for Beverly Flowers using Spring framework

Changes in U.S. Hospitalization and Mortality Rates Following Smoking Bans

U.S. state and local governments are increasingly restricting smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature.

Changes in hospital mortality associated with residency work hour regulations

The health effects resulting from the Accreditation Council on Graduate Medical Education resident work-hour regulations are largely unknown. Shetty and Bhattacharya measured inpatient mortality before and after the implementation of the work-hour regulations in 1 268 738 patients admitted to 551 U.S. hospitals with medical diagnoses and 243 207 patients who were admitted with surgical diagnoses. Inpatient mortality in medical patients\u97but not surgical patients\u97decreased more in teaching hospitals than in nonteaching hospitals after the work-hour regulation

Challenges in assessing the process-outcome link in practice.

The expanded use of clinical process-of-care measures to assess the quality of health care in the context of public reporting and pay-for-performance applications has led to a desire to demonstrate the value of such efforts in terms of improved patient outcomes. The inability to observe associations between improved delivery of clinical processes and improved clinical outcomes in practice has raised concerns about the value of holding providers accountable for delivery of clinical processes of care. Analyses that attempt to investigate this relationship are fraught with many challenges, including selection of an appropriate outcome, the proximity of the outcome to the receipt of the clinical process, limited power to detect an effect, small expected effect sizes in practice, potential bias due to unmeasured confounding factors, and difficulties due to changes in measure specification over time. To avoid potentially misleading conclusions about an observed or lack of observed association between a clinical process of care and an outcome in the context of observational studies, individuals conducting and interpreting such studies should carefully consider, evaluate, and acknowledge these types of challenges

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis

ObjectiveQuality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes.Research design and methodsWe used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLit, Centre for Reviews and Dissemination, New York Academy of Medicine's Grey Literature Report, and WorldCat (January 2004 to August 2016). We extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost (studies lasting ≤3 years), incremental cost-effectiveness ratio (ICER) (studies lasting ≥20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA1c and incremental net cost.ResultsOf 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA1c declined by 0.26% (95% CI 0.17-0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting ≤3 years, incremental net costs were $116 (95$612 to $843) per patient annually. Long-term ICERs were$100,000-$115,000/quality-adjusted life year (QALY) in 3 RCTs,$50,000-$99,999/QALY in 1 RCT,$0-$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias.ConclusionsDiverse multifaceted QI interventions that lower HbA1c appear to be a fair-to-good value relative to usual care, depending on society's willingness to pay for improvements in health

Challenges in Assessing the Process–Outcome Link in Practice

The expanded use of clinical process-of-care measures to assess the quality of health care in the context of public reporting and pay-for-performance applications has led to a desire to demonstrate the value of such efforts in terms of improved patient outcomes. The inability to observe associations between improved delivery of clinical processes and improved clinical outcomes in practice has raised concerns about the value of holding providers accountable for delivery of clinical processes of care. Analyses that attempt to investigate this relationship are fraught with many challenges, including selection of an appropriate outcome, the proximity of the outcome to the receipt of the clinical process, limited power to detect an effect, small expected effect sizes in practice, potential bias due to unmeasured confounding factors, and difficulties due to changes in measure specification over time. To avoid potentially misleading conclusions about an observed or lack of observed association between a clinical process of care and an outcome in the context of observational studies, individuals conducting and interpreting such studies should carefully consider, evaluate, and acknowledge these types of challenges. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11606-014-3150-0) contains supplementary material, which is available to authorized users