Staff Time and Motion Assessment for Administration of Erythropoiesis-Stimulating Agents: A Two-Phase Pilot Study in Clinical Oncology Practices

BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are used for the management of anaemia in patients with non-myeloid malignancies where anaemia is due to the effect of concomitant myelosuppressive chemotherapy. Assessing the impact of different ESA dosing regimens on office staff time and projected labour costs is an important component of understanding the potential for optimization of oncology practice efficiencies. OBJECTIVES: A two-phase study was conducted to evaluate staff time and labour costs directly associated with ESA administration in real-world oncology practice settings among cancer patients undergoing chemotherapy. The objective of Phase 1 was to determine the mean staff time required for the process of ESA administration in patients with anaemia due to concomitantly administered chemotherapy. The objective of Phase 2 was to quantify and compare the mean staff time and mean labour costs of ESA administered once weekly (qw) with ESA once every 3 weeks (q3w) over an entire course of chemotherapy. METHODS: Phase 1 was a prospective, cross-sectional time and motion study conducted in six private oncology practices in the US based on nine steps associated with ESA administration. Using findings from Phase 1, Phase 2 was conducted as a retrospective chart review to collect data on the number and types of visits in two private oncology practices for patients receiving a complete course of myelosuppressive chemotherapy. RESULTS: In Phase 1, the mean total time that clinic staff spent on ESA administration was 23.2 min for patient visits that included chemotherapy administration (n(chemo) = 37) and 21.5 min when only ESA was administered (n(ESAonly) = 36). In Phase 2, the mean duration of treatment was significantly longer for q3w than qw (53.84 days for qw vs. 113.38 for q3w, p < 0.0001); thus, analyses were adjusted using analysis of covariance (ANCOVA) for episode duration for between-group comparisons. Following adjustment by ANCOVA, qw darbepoetin alfa (DA) patients (n(qw) = 83) required more staff time for ESA + chemotherapy visits and ESA-only visits than q3w patients (n(q3w) = 118) over a course of chemotherapy. Overall, mean total staff time expended per chemotherapy course was greater for patients receiving qw versus q3w DA. Weekly DA dosing was associated with greater projected mean labour costs ($US38.16 vs.$US31.20 [average for 2007–2010]). CONCLUSIONS: The results from this real-world study demonstrate that oncology practices can attain staff time and labour costs savings through the use of q3w ESA. The degree of savings depends on the individual oncology practice’s staffing model and ESA administration processes, including those that allow for optimized synchronization of patient visits for ESA and chemotherapy administration. These findings indicate that additional research using standard ESA administration protocols for longer periods of time with a larger number of oncology practices and patients should be conducted to confirm these findings

Idelalisib addition has neutral to beneficial effects on quality of life in bendamustine/rituximab-treated patients: results of a phase 3, randomized, controlled trial

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Essays on modeling limited dependent variables applied to industrial organization and labor markets

My dissertation research includes three essays that utilize limited dependent modeling applied to problems in industrial organization and labor markets. The first one asks what affects child care providers' duration of employment. The child care industry commonly experiences difficulties in retaining employees. The extremely high employee turnover rate is a threat to quality of care. The data used in this analysis is from surveys by participating child care center directors regarding both individual employees and child care center characteristics. Factors considered include an employee's wages, benefits, position description, age-group assignment, education, center characteristics, and other employee demographic variables. The second paper in this dissertation examines the retirement decisions of university faculty. Approximately one-half of all U.S. faculty in higher education are older than 50 years, and more than two-thirds of payrolls are tied up with these faculty. Since the removal of mandatory faculty retirement in 1994, it is difficult to make precise predictions of when an individual faculty member will retire. This study investigates the phased retirement decisions of faculty using survey data. The estimation results suggest that investment in social security decreases the likelihood of acceptance of early phased retirement programs. This analysis has important implications for both individual faculty members and the University as an employer. The third paper provides a new explanation for the existence of quantity surcharges that occur in some food products. Quantity surcharges occur when a larger sized package of a product has a higher per-unit price then its smaller-sized counterpart. I hypothesize that different size the same product are imperfect substitutes and thus are differentiated products. To test this hypothesis, I utilize grocery store scanner data with canned tuna of varying sizes. I estimate the demand for each type of tuna and the associated cross-price elasticities. A random coefficients logit demand approach to calculate elasticities. There is evidence to support the hypothesis that quantity surcharges in canned tuna are driven by firms catering to heterogeneous consumer preferences. All the three papers are presented as separate chapters in this dissertation

Do Bilateral Investment Treaties Deliver the Goods? Evidence from Developing Countries.

Bilateral investment treaties (BITs), signed by developing countries explicitly state the objective of promoting foreign direct investment (FDI). The rapid increase in the number of BITs and the concurrent increase in worldwide flows of FDI between 1980 and 2003 suggest that BITs are an effective strategy toward this goal. Recent studies provide some empirical support for this link. However, FDI flows into specific countries from 1980 to 2003 reveals the puzzling behavior for flows to increase soon after country starts signing BITs, followed by fluctuations with either a downward trend or no noticeable trend at all. Our main contribution is to explain this behavior by explicitly incorporating the impact of treaty violations, as evidenced by treaty disputes arbitrated by the International Centre for Settlement of Investment Disputes, on FDI flows. We find that while BITs are effective in attracting investment, disputes tend to decrease future investment flows

Efficiency of U.S. Dialysis Centers: An Updated Examination of Facility Characteristics That Influence Production of Dialysis Treatments

Objective To explore the relative efficiency of dialysis facilities in the United States and identify factors that are associated with efficiency in the production of dialysis treatments. Data Sources/Study Setting Medicare cost report data from 4,343 free‐standing dialysis facilities in the United States that offered in‐center hemodialysis in 2010. Study Design A cross‐sectional, facility‐level retrospective database analysis, utilizing data envelopment analysis (DEA) to estimate facility efficiency. Data Collection/Extraction Methods Treatment data and cost and labor inputs of dialysis treatments were obtained from 2010 Medicare Renal Cost Reports. Demographic data were obtained from the 2010 U.S. Census. Principal Findings Only 26.6 percent of facilities were technically efficient. Neither the intensity of market competition nor the profit status of the facility had a significant effect on efficiency. Facilities that were members of large chains were less likely to be efficient. Cost and labor savings due to changes in drug protocols had little effect on overall dialysis center efficiency. Conclusions The majority of free‐standing dialysis facilities in the United States were functioning in a technically inefficient manner. As payment systems increasingly employ capitation and bundling provisions, these institutions will need to evaluate their efficiency to remain competitive