Target the untargeted: essays in unconventional disclosures and policies

This dissertation examines how firms use voluntary disclosures to gain benefits in their product markets. I find that firms strategically announce capacity expansions when facing threats of entry and provide price increase disclosures to likely coordinate prices within their industry. In addition, I find that financial disintermediation is an effective way to stimulate SME financin

Prognostic factors for important clinical outcomes in patients with a severe infection

Patients who are admitted with a suspicion of a severe infection usually enter the hospital through the emergency department (ED). The recognition of prognostic factors in an early stage affects further treatment and might improve clinical outcomes. WE EXAMINED POSSIBLE PROGNOSTIC FACTORS FOR FOUR IMPORTANT OUTCOMES: intensive care unit (ICU) admission, positive blood cultures, mortality and re-admission. All adult patients arriving at the ED with a suspected infection for whom admittance and intravenous (iv) antibiotics were indicated were included between March and December 2006. Possible prognostic variables were obtained from medical history, physical examination and laboratory results during the ED presentation. Data were analysed using logistic regression analysis. A total of 295 ED patients were evaluated, of whom 27 were referred to the ICU, 62 had a positive blood culture, 16 died and 48 were re-admitted. In multivariate analysis, patients with a respiration rate of >25/min were at higher risk for ICU admission. Patients with a positive blood culture had a higher heart rate and a higher percentage of segmented neutrophils. Patients who died during admission were more likely to be older, confused and had lower blood pressure. Patients who were re-admitted within 30 days were more likely to be male, younger and less likely to have a positive blood culture. Routine clinical and biochemical information can be used to predict ICU admission, the presence of bacteraemia, mortality and re-admission (within 30 days) and should be taken into consideration for treatment decision

Experimental studies to improve the reliability and validity of regulatory judgments on health care in the Netherlands: a randomized controlled trial and before and after case study

Rationale, aims and objectives We examined the effect of two interventions on both the reliability and validity of regulatory judgments: adjusting the regulatory instrument and attending a consensus meeting. Method We adjusted the regulatory instrument. With a randomized controlled trial (RCT) we examined the effect of the adjustments we made to the instrument. In the consensus meeting inspectors discussed cases and had to reach consensus about the order of the cases. We used a before and after case study to assess the effect of the consensus meeting. We compared the judgments assigned in the RCT with the unadjusted instrument with the judgments assigned with the unadjusted instrument after the consensus meeting. Moreover we explored the effect of increasing the number of inspectors per regulatory visit based on the estimates of the two interventions. Results The consensus meeting improved the agreement between inspectors; the variance between inspectors was smallest (0.03) and the reliability coefficient was highest (0.59). Validity is assessed by examining the relation between the assigned judgments and the corporate standard and expressed by a correlation coefficient. This coefficient was highest after the consensus meeting (0.48). Adjustment of the instrument did not increase reliability and validity coefficients. Conclusions Participating in a consensus meeting improved reliability and validity. Increasing the number of inspectors resulted in both higher reliability and validity values. Organizing consensus meetings and increasing the number of inspectors per regulatory visit seem to be valuable interventions for improving regulatory judgment

Het ene oordeel is het andere niet: Kwantitatieve analyse van de variatie bij IGZ-Inspecteurs

DOEL\ud Onderzoek naar de variatie in oordelen tussen inspecteurs van de Inspectie voor de Gezondheidszorg (IGZ) in het systeem van gefaseerd toezicht op de verpleeghuiszorg en naar de relatie tussen het type oordeel en de aan- of afwezigheid van onderbouwing daarbij.\ud \ud OPZET \ud Descriptief, kwantitatief, retrospectief.\ud \ud METHODE\ud In totaal werden 4914 oordelen met bijbehorende onderbouwingen van 26 inspecteurs uit 182 toezichtrapporten geanalyseerd. De oordelen waren in 2005 en 2006 gegeven op 25 criteria voor verantwoorde zorg in verpleeghuizen. Om de inspecteurs en hun oordelen over verschillende instellingen te kunnen vergelijken, werd met covariantieanalyse statistisch gecorrigeerd voor instellingskenmerken.\ud \ud RESULTATEN\ud Er waren statistisch significante verschillen in beoordeling tussen de inspecteurs. Na correctie voor instellingskenmerken bleven voor 14 van de 25 criteria significante verschillen bestaan. Tevens bleek de aanwezigheid van een onderbouwing bij een oordeel zowel afhankelijk te zijn van de inspecteur als van het gegeven oordeel.\ud \ud CONCLUSIE \ud Beoordelaarsverschillen tussen inspecteurs spelen een rol in de tweede fase van het gefaseerd toezicht op de verpleeghuizen. De IGZ zal resultaten van dit onderzoek gebruiken om haar toezicht verder te ontwikkelen

Experimental studies to improve the reliability and validity of regulatory judgments on health care in the Netherlands: A randomized controlled trial and before and after case study

Rationale, aims and objectives We examined the effect of two interventions on both the reliability and validity of regulatory judgments: adjusting the regulatory instrument and attending a consensus meeting. Method We adjusted the regulatory instrument. With a randomized controlled trial (RCT) we examined the effect of the adjustments we made to the instrument. In the consensus meeting inspectors discussed cases and had to reach consensus about the order of the cases. We used a before and after case study to assess the effect of the consensus meeting. We compared the judgments assigned in the RCT with the unadjusted instrument with the judgments assigned with the unadjusted instrument after the consensus meeting. Moreover we explored the effect of increasing the number of inspectors per regulatory visit based on the estimates of the two interventions. Results The consensus meeting improved the agreement between inspectors; the variance between inspectors was smallest (0.03) and the reliability coefficient was highest (0.59). Validity is assessed by examining the relation between the assigned judgments and the corporate standard and expressed by a correlation coefficient. This coefficient was highest after the consensus meeting (0.48). Adjustment of the instrument did not increase reliability and validity coefficients. Conclusions Participating in a consensus meeting improved reliability and validity. Increasing the number of inspectors resulted in both higher reliability and validity values. Organizing consensus meetings and increasing the number of inspectors per regulatory visit seem to be valuable interventions for improving regulatory judgments