Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study

Aims: To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US.

Methods: The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred.

Results: The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p?<?.05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p?<?.001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients).

Conclusions: Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.     

Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data

Background: It is estimated that one in 10 people in the US have a diagnosis of diabetes. Type 2 diabetes accounts for 95% of all cases in the US, with annual costs estimated to be $246 billion per year. This study investigated the impact of a glucose-measuring intervention to the burden of type 2 diabetes.

Objective: This analysis seeks to understand how professional continuous glucose monitoring (professional CGM) impacts clinical and economic outcomes when compared to patients who are not prescribed professional CGM.

Methods: This study utilized a large healthcare claims and lab dataset from the US, and identified a cohort of patients who were prescribed professional CGM as identified by CPT codes 95250 and 95251. It calculated economic and clinical outcomes 1 year before and 1 year after the use of professional CGM, using a generalized linear model.

Results: Patients who utilized professional CGM saw an improvement in hemoglobin A1C. The “difference-in-difference” calculation for A1C was shown to be –0.44%. There was no statistically significant difference in growth of total annual costs for people who used professional CGM compared to those who did not ($1,270, p?=?.08). Patients using professional CGM more than once per year had a –$3,376 difference in the growth of total costs (p?=?.05). Patients who used professional CGM while changing their diabetes treatment regimen also had a difference of –$3,327 in growth of total costs (p?=?.0023).

Conclusion: Significant clinical benefits were observed for patients who used professional CGM. Economic benefits were observed for patients who utilized professional CGM more than once within a 1-year period or who used it during a change of diabetes therapy. This suggests that professional CGM may help decrease rising trends in healthcare costs for people with type 2 diabetes, while also improving clinical outcomes.     

Taking a positive approach to organizational downsizing

We drew from the literature on positive organizational behaviour (Luthans & Youssef, 2007) to test a process model relating generalized optimism (Carver & Scheier, 1999) to the cognitions, affect, and behaviour of 237 Canadian federal government managers during and following a major organizational downsizing. Our data supported a model in which generalized optimism measured 18 months prior to the downsizing (T1) associated positively with managers' cognitions, attitudes, job performance, and self‐reported coping effectiveness measured 12 months postdownsizing (T3). Analyses suggested that some of these associations were partially mediated by a positive thinking coping strategy and expectations for future career and job success reported during the downsizing (T2). We advocate for more research that draws from the positive organizational behaviour literature to study the effects of downsizing on survivors. Copyright © 2008 ASAC. Published by John Wiley & Sons, Ltd.     

Brighter prospects? Assessing the franchise advantage using census data

This paper uses Census microdata to examine how starting a business as a franchise rather than an independent business affects its survival and growth prospects. We assess factors that influence the decision to become a franchisee and use various empirical approaches to correct for selection bias in our performance analyses. We find that franchised businesses on average exhibit higher survival rates than independent businesses; but importantly, the difference is small compared with claims in the trade press. The effect is also short lived: conditional on surviving a year or two, we no longer find survival (or growth) differences. We then explore two potential sources for this small survival advantage, namely franchisors’ screening process and the benefits arising from the brand and business know‐how provided by franchisors. We find evidence that both of the sources contribute to the franchising advantage.     

The Quality of Institutions and Organizational Form Decisions: Evidence from Within the Firm

In many retail and service sectors, firms have to establish a physical presence in a geographic market to access customers there. In countries where the quality of institutions is low, this can put assets at risk. We use data on the operations of a multinational, multibrand hotel company to show that in environments where local institutions are weaker—as proxied mainly by the World Bank's Checks index—the company eschews direct ownership. Rather than increasing its reliance on franchising, as predicted by some models, the company relies more on another form of organization commonly used in this industry, namely management contracts. We explain these patterns by emphasizing how the quality of the institutional environment affects the cost of using equity‐based organizational forms, per arguments in the current literature, but also the cost of enforcing the terms of franchise contracts.     

The effects of salary and human resource accounting disclosures on small group relations and performance

When human resource accounting type information and salary data were disclosed in the experimental setting of a business game, it was determined that disclosure of salary data had no significant effect on group relations yet the HRA information disclosure tended to produce negative effects on both performance and group relations.     

Telecommunications: implications for women

Telecommunications offer benefits to women in their changing work roles, such as helping working mothers by providing more flexible schedules and facilitating the establishment of child-care, reducing the need for relocation and/or separation of members of dual- career families, and easing discomfort of male-female work interactions by helping to depersonalise the working environment. While discussion focuses on the implications for women, many of the benefits already apply to men and will become even more applicable as men take more active roles in their families and engage in more leisure-time activities.     

The deregulation of international trucking in the European Union: form and effect

We describe the regulatory regime under which international trucking operated in Western Europe until the mid-1980s, the deregulatory process that followed, and the effect of this deregulation. We find that deregulation had a large positive effect on the growth of international trucking. We also find that shippers shifted toward more outsourcing of their trucking needs, but this occurred to an even greater extent in local and national road transport. We conclude that other factors beside the deregulation of international trucking affected the organization of the industry at the time. Finally, despite concerns voiced by member countries, we find no evidence that deregulation disproportionately favored carriers of countries that were initially more (or less) involved in international trucking, nor that it has favored low-wage countries.      

The economic and fiscal consequences of immigration: highlights from the National Academies report

Business Economics - The National Academies report The Economic and Fiscal Consequences of Immigration (Blau and Mackie&nbsp;2017) summarizes recent trends in immigration numbers and...