PHYSICIAN HOSPITAL ARRANGEMENT INFLUENCE ON NONPROFIT HOSPITAL QUALITY,FINANCIAL PERFORMANCE AND COMMUNITY BENEFIT EXPENDITURES

Federal policy has encouraged hospitals to provide certain quality outcomes and cost containment. Hospitals have responded by forming physician hospital organizations in attempts to achieve quality outcomes and capture reimbursements. At the same time, federal policy has awarded hospitals with nonprofit status with the requirement to provide community benefits in exchange for the tax exemption they receive. With the formation of physician hospital organizations, there remains the question of whether hospitals are achieving desired quality metrics and whether hospitals are financially viable. There is also public and media interest recently regarding whether nonprofit hospitals fulfill their obligations for community benefit in line with the large tax exemption they receive. This study attempted to understand whether the hospital physician arrangements within nonprofit hospitals influence the hospitals’ quality, financial health, and any unintended effects there may be on community benefit expenditures. Data from the American Hospital Association and the tax return 990 schedule H was used to understand the types of hospital physician arrangements and to assess whether there was an association with nonprofit spending on quality, financial health and community benefit expenditures. This study showed that there is an association with higher Acute Myocardial Infarction 30 day mortality rates and Central Line-Associated Blood Stream Infection scores with physician hospital organizations with high integration; an undesirable outcome. High integration involves more physician and hospital economic, administrative, and group involvement and more shared accountability. This study also showed that there is an association with these physician hospital organizations and lower Acute Myocardial Infarction 30 day readmission rates, higher operating margin, and higher community benefits. No clear direction is apparent for the federal government regarding payer policies causing unintended consequences regarding hospital community benefits spending; however, the formation of physician hospital organizations with high integration may not have the quality metrics desired. The federal government will have to consider its policy effects and downstream consequences and whether they may be counter-productive to community benefit expenditures or whether they even achieve their intended purposes

The Real-Time Control Systems Simulator -Reference manual

A Matlab / Simulink-based simulator for real-time control systems is described. The simulator facilitates co-simulation of plant dynamics, controller code execution, and real-time scheduling. Three examples are given. The kernel primitives are described in detail

Improved Scheduling of Control Tasks

The paper considers the implementation of digital controllers as real-time tasks in priority-preemptive systems. The performance of a digital feedback control system depends critically on the timing of its sampling and control actions. It is desirable to minimize the computational delay in the controller, as well as the sampling jitter and the control jitter. It is shown that by scheduling the two main parts of a control algorithm as separate tasks, the computational delay can often be reduced significantly. A heuristic method for assigning deadlines to the parts is presented. Further modifications are given to reduce the jitter and to facilitate delay compensation. The result is improved control performance under maintained schedulability

Merging Real-Time and Control Theory for Improving the Performance of Embedded Control Systems

This report describes the work carried out within the research project ``Merging Real-Time and Control Theory for Improving the Performance of Embedded Control Systems''. The overall objective of the work has been to develop integrated control and scheduling methods for improving the performance of real-time control systems with limited resources. The work has fallen into three categories. First, overrun methods for control tasks has been investigated. Specifically, a reservation-based scheduling concept called the Control Server has been further developed, and control experiments on a ball-and-place process have been performed. Second, the issue of jitter in real-time control systems has been explored. The concept of Jitter Margin has been introduced as a link between control stability theory and scheduling theory. In this context, best-case response-time analysis under earliest-deadline-first scheduling has been researched. Third, some development work on the S.Ha.R.K. real-time kernel has been performed. The rate-monotonic and earliest-deadline-first scheduling modules have been extended, and new modules for the elastic task model and the control server model have been implemented

(Re)harmonising the Academy: Integrating life-long learning and science communication in Swedish higher education

Higher education today performs a complex system of functions with a variety of goals andexpectations, including research, teaching, and disseminating research to the surroundingsociety. It is however not always clear what these functions should entail, and how they shouldbe played out. Similarly, institutions, departments, and individual researchers’ role, or roles,are multifaceted and ever-evolving and researchers are frequently expected to take on new tasksand acquire new skills as a consequence of ambitions in policy.This licentiate thesis explores how the ambitions of Swedish higher education, as expressed inpolicy and regulations such as goal statements and promotion and recruitment processes, arerealised in practice in two specific areas: students’ life-long learning and their acquisition oflearning skills—with a focus on self-regulated learning, and researchers’ engagement inscience communication. The aim is to investigate potential areas of disharmony between policyambitions and practice, as well as among individual researchers’ multiple roles.The three papers included in this thesis illustrate different facets of how policy ambitions arerealised in a Swedish STEM (Science, Technology, Engineering, and Mathematics) context.Paper 1 focuses on the extent to which students acquire learning skills, i.e., to what extent theambition that students should acquire these skills is realised. This study used a questionnaireto investigate engineering students’ learning skills in terms of learning strategies, self-regulatedlearning, and awareness of what constitutes effective learning. Paper 2 explores to what extentresearchers engage in science communication i.e., to what extent the ambition that researchersshould engage in dissemination of science is realised in practice. By analysing data from apublication repository along with corresponding full texts, this study mapped the sciencecommunication practices at a Swedish STEM university. Finally, Paper 3 focuses on whatcharacterises expert scientists’ writing process when addressing non-academic readers,providing input for training and eventual incentives that may promote science communication.Seven researchers in STEM with extensive experience of science communication wereinterviewed to pinpoint what strategies they use when writing science communication texts andhow they regulate this writing process.My thesis paints a vivid picture of how higher education in Sweden today involves acomplexity of functions and practices, and faces the challenge of integrating new tasks andskills, such as learning skills and science communication writing, into teaching and intoacademic scholarship. Taken together, the findings from the three papers align with previousresearch in Sweden and internationally, and suggest that policy ambitions in these areas arerealised to some extent—as shown by students’ awareness of the effectiveness of variouslearning skills, and the fact that some researchers do engage in science communication.However, there is clearly room for improvement: students’ need more scaffolding of learningskills, which in turn may require incentives and training for higher education teachers, andresearchers need incentives and training in science communication. In summary, this thesissuggests that there is a shortage of both incentives and training despite policy ambitionsexpressed for instance in the Swedish Higher Education Act and in regulations for promotion,tenure, and recruitment processes in Swedish and internationally. Overall, disharmonies seemto be built into the system and into individual researchers’ academic scholarship. Finally, mythesis provides some concrete suggestions about how to take small steps towards lessdisharmony, i.e., harmonising, or perhaps reharmonising, the academy

Optimal On-Line Scheduling of Multiple Control Tasks: A Case Study

We study the problem of dynamically scheduling a set of state-feedback control tasks controlling a set of linear plants. We consider an on-line non-preemptive scheduling policy that is optimal in the sense that it minimizes a quadratic performance criterion for the overall system. The optimal scheduling decision at each point in time is a function of the states of the controlled plants. To be able to solve the scheduling problem for realistic examples, we use the technique of relaxed dynamic programming to compute suboptimal solutions with error bounds. The approach is compared to earlier approaches in a case study involving simultaneous control of one ball-and-beam process and two DC-servo processes. We also show how the scheduling policy can be modified to allow for background tasks to execute when the need for control is small. 1

Optimal On-line Sampling Period Assignment for Real-Time Control Tasks Based on Plant State Information

The paper presents a feedback scheduling strategy for multiple control tasks that uses feedback from the plant states to distribute the computing resources optimally among the tasks. Linear-quadratic controllers are analyzed, and expressions relating the expected cost to the sampling period and the plant state are derived and used for on-line sample-rate adjustments. In the case of minimum-variance control of multiple integrator processes, an exact expression for the optimal sampling periods is obtained. For the general case, an on-line optimization procedure is developed. The approach is exemplified on a set of controllers for first-order systems. The issues of computational delay and the choice of the feedback scheduler period are also discussed

Jitterbug - Reference Manual

The manual describes the use of Jitterbug, a Matlab toolbox for analysis of real-time control performance. The tool facilitates the computation of a quadratic performance index for a linear control system under various timing conditions

Jitterbug: A Tool for Analysis of Real-Time Control Performance

The paper presents Jitterbug, a Matlab-basedtoolbox for real-time control performance analysis. The controlsystem is described using a number of connected continuous-time anddiscrete-time linear systems. The control performance is measured bya continuous-time quadratic cost function. A stochastic executionmodel is used to describe when the different discrete-time systemsare updated during the control period. Building different systemmodels, the tool makes it easy to investigate how controlperformance is affected by e.g. input-output delay, sampling jitter,output jitter, lost samples, period overruns, aborted computations,and jitter compensation

The Control Server Model for Co-Design of Real-Time Control Systems

The paper presents the control server, a real-time scheduling mechanism tailored to control and signal processing applications. A control server creates the abstraction of a control task with a specified period and a fixed input-output latency shorter than the period. Individual tasks can be combined into more complex components without loss of their individual guaranteed fixed-latency properties. I/O occurs at fixed predefined points in time, at which inputs are read or controller outputs become visible. The control server model is especially suited for codesign of real-time control systems. The single parameter linking the scheduling design and the controller design is the task utilization factor. The proposed server is an extension of the constant bandwidth server, which is based on the earliest-deadline-first scheduling algorithm. The server has been implemented in a real-time kernel and has also been validated in control experiments on a ball and beam process