The marketability of nurse practitioners in New York City

Until recently nurse practitioners (NPs) in independent practices have almost exclusively served Medicaid populations, and, most NP care has been provided by NP employees in physicians' offices or HMOs. The author explores the willingness of affluent or insured private pay patients to choose NPs as their primary care providers by using both focus groups and telephone interviews of adults between 25 and 50 years of age. Findings included the common perception that physicians were best prepared by education at diagnosing illness and valued for their overall expertise and likelihood to treat patients with respect. Nurses were most liked for their "compassion and caring," their willingness to listen to client concerns, and focus on disease management and health promotion. Nurses were least liked for having "bad attitudes" and being overworked. Only 23% of the survey participants were familiar with the term "advanced practice nurse" while 76% had heard of NPs.     

The role of quality standards in innovative service companies: An empirical analysis for Germany

Proceeding from theoretical hypotheses, driving forces for the introduction of the ISO 9000ff series in innovative service companies are analysed. Based on the European Community Innovation Survey (CIS), a probit model is estimated with different explanatory variables based on a sample of innovative German service companies. The first analysis of the role of the quality standard ISO 9000ff in German innovative service companies, based on general hypotheses concerning the role of quality standards, produced elucidating results. Besides sector- and size-specific differences, the use of “risky” technologies positively influences the probability of introducing ISO 9000ff. This quality standard has another twofold impact: First, as expected, it is a quality seal for the customers of the service company, especially in markets with homogeneous products and average qualities. Second, the introduction of ISO 9000ff has impacts on the internal processes of the service companies. In contrast to a conventional product standard, it supports the management in being flexible, especially towards the preferences of the customers and in reaching project deadlines. However, the introduction may also increase the pressure on the employees who are therefore evidently more reluctant about its introduction. Consequently, the empirical results underpin most of the theoretical hypotheses on the role of quality standards in service companies.     

Evolution of the chronic care role of the registered nurse in primary care

High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.     

An online portal to support the role of the nurse manager

To encourage retention in nursing administration while building leadership capacity, efforts must be made to support the manager's practice and professional development. Functions and duties of the nurse manager need to be simplified and supplemental development materials need to be readily available. Innovations that organize necessary document templates and ease access to materials that enhance their leadership skills have real value. One institution's innovation to build nurse manager capacity was an online portal for nurse managers. The site offers information that enriches the role of nurse manager and represents one supplemental pathway to continuous leadership development.     

Water accounting for the Orange River Basin: An economic perspective on managing a transboundary resource

The framework for water accounting is applied to an international river basin, the Orange River Basin, which is shared among Botswana, Namibia, Lesotho and South Africa. Each of the riparian states faces water constraints and relies increasingly on shared international water resources. The countries have adopted the principle of an economic approach to water management, once basin human needs are met, and all but Lesotho have constructed national water accounts to assist in water management. The water accounts for the Orange River Basin bring an economic perspective to water management at the regional level. The accounts include supply and use tables, which are used to compare the contribution to water supply from each riparian state to the amount used. The water accounts are then linked to economic data for each country to calculate water use and productivity by industry and country. There are considerable disparities in water productivity among the countries, which should be taken into account in future decisions about water allocation, pricing and infrastructure development.     

The moderating role of power asymmetry on the relationships between alliance and innovative performance in the high-tech industry

This study outlines a model of why and how the respective influence of alliance learning and alliance experience on innovative performance is likely to be moderated by the level of power asymmetry. The results are based on a sample of 316 high technology firms' alliances. By testing our model using hierarchical regression, the results generally support the proposed hypotheses, in that power asymmetry has a significant negative moderating effect on the impact of alliance learning on innovative performance. In contrast, we find that power asymmetry has a significant positive moderating effect on the impact of alliance experience on innovative performance. Implications for management theory and practice are discussed.     

An inquiry into the state's role in marriage

The role of the state in the institution of marriage is explored. The author argues that government intervention in marriage is a means of avoiding large transaction costs between men and women. Such intervention is successful because marriage creates incentives that make private enforcement relatively costly and because marriages tend to be homogenous. The hypothesis is tested by examining U.S. state responses to changing divorce laws. The author concludes that such responses are consistent with the state increasing the social value of marriage by mitigating transaction costs.     

Technological interdependence and knowledge diffusion in the building of national innovative capacity: The role of Taiwan's chemical industry

While the significance and effectiveness of patents in the chemical industry has been demonstrated in many industrialized countries, this study examines the role of the chemical industry and knowledge diffusion in building the innovative capacity of a nation in latecomer country Taiwan. The development of process innovation plays an integral role in the strategic industries of Taiwan, but few attempts have been made to address how the efficiency of process development can be enhanced. As a latecomer, Taiwan has built its national innovative capability on strategic industries such as semiconductors, consumer electronics and flat panel displays. Through patent data analysis, this study demonstrates the significant and indispensable role played by the chemical industry in technological interdependence and knowledge diffusion with other Taiwanese strategic industries. This study suggests that while the public resources of Taiwan are focused on accelerating the development of emerging sectors and technologies, the chemical industry serves as an effective linkage and catalyst in problem-solving.     

American Academy of Ambulatory Care Nursing position statement: the role of the registered nurse in ambulatory care

Ambulatory care nurses are leaders in their practice settings and across the continuum of care. They are uniquely qualified to influence organizational standards related to patient safety and care delivery in the ambulatory care setting. The current ambulatory care setting is diverse and multifaceted, requiring nurses highly skilled in patient assessment and with the ability to implement a broad range of nursing interventions in a variety of settings. The future of the American health care system depends upon our ability to utilize RNs to the fullest extent of their expertise, licensure, and certification.     

The vanishing role of money in the macro-economy: An empirical investigation for India

The recent de-emphasizing of the role of “money” in both theoretical macroeconomics as well as in the practical conduct of monetary policy sits uneasily with the idea that inflation is a monetary phenomenon. Empirical evidence has, however, been accumulating pointing to an important leading indicator role for money and credit aggregates with respect to long term inflationary trends. Such a role could arise from monetary aggregates furnishing a nominal anchor for inflationary expectations, from their influence on the term structure of interest rates and from their affecting transaction costs in markets. Our paper attempts to assess the informational content role of money in the Indian economy by a separation of these effects across time scales and frequency bands, using the techniques of wavelet analysis and band spectral analysis respectively. Our results indicate variability of causal relations across frequency ranges and time scales, as also occasional causal reversals.     

An industrial strategy for Britain: the nature and role of planning

It is argued that Britain has reached a turning point in its industrial history and that a sharp change in the way industrial policy is approached is now necessary. A primarily regulatory role for the state has to be transformed into a primarily developmental one. The market will continue as a crucial part of the system, but it will work within long-term parameters set by government. A system rather similar to the Japanese approach is advocated, but a straight transplant is seen to be infeasible and undesirable. Issues of democratic control and the power of the transnationals receive particular attention.     

Costs of inpatient and emergency department care for chronic obstructive pulmonary disease in an elderly Medicare population

Objective:

Treatment in the hospital setting accounts for the largest portion of healthcare costs for COPD, but there is little information about components of hospital care that contribute most to these costs. The authors determined the costs and characteristics of COPD-related hospital-based healthcare in a Medicare population.

Methods

Using administrative data from 602 hospitals, 2008 costs of COPD-related care among Medicare beneficiaries age ≥65 years were calculated for emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, and intensive care/intubation) in a cross-sectional study. Rates of death at discharge and trends in costs, length of stay and readmission rates from 2005 to 2008 also were examined.

Main results:

There were 45,421 eligible healthcare encounters in 2008. Mean costs were $679 (SD, $399) for ED visits (n = 10,322), $7,544 ($8,049) for simple inpatient admissions (n = 25,560), and $21,098 ($46,160) for complex admissions (n = 2,441). Intensive care/intubation admissions (n = 460) had the highest costs ($45,607, SD $94,794) and greatest length of stay (16.3 days, SD 13.7); intubation/no ICU admissions had the highest inpatient mortality (42.1%). In 2008, 15.4% of patients with a COPD-related ED visit had a repeat ED visit and 15.5–16.5% of those with a COPD-related admission had a readmission within 60 days. From 2005 to 2008, costs of admissions involving intubation increased 10.4–23.5%. Study limitations include the absence of objective clinical data, including spirometry and smoking history, to validate administrative data and permit identification of disease severity.

Conclusions:

In this Medicare population, COPD exacerbations and related inpatient and emergency department care represented a substantial cost burden. Admissions involving intubation were associated with the highest costs, lengths of stay and inpatient mortality. This population needs to be managed and treated adequately in order to prevent these severe events.     

Healthcare costs associated with nephrology care in pre-dialysis chronic kidney disease patients

Abstract

Objective:

To compare the healthcare costs of pre-dialysis chronic kidney disease (CKD) patients cared for in a nephrology clinic setting versus other care settings.

Methods:

An analysis of health claims between 01/2002 and 09/2007 from the Ingenix Impact Database was conducted. Inclusion criteria were ≥18 years of age, ≥1 ICD-9 claim for CKD, and ≥1 estimated glomerular filtration rate (eGFR) value of <60?mL/min/1.73?m². Patients were classified in the nephrology care cohort if they were treated in a nephrology clinic setting at least once during the study period. Univariate and multivariate analyses were conducted to compare average annualized healthcare costs of patients in nephrology care versus other care settings.

Results:

Among the 20,135 patients identified for analysis, 1,547 patients were cared for in a nephrology clinic setting. Nephrology care was associated with lower healthcare costs with an unadjusted cost savings of $3,049 ($11,303 vs. $14,352, p?=?0.0014) and a cost ratio of 0.8:1 relative to other care settings. After adjusting for covariates, nephrology care remained associated with lower costs (adjusted cost savings: $2,742, p?=?0.006).

Limitations:

Key limitations included potential inaccuracies of claims data, the lack of control for patients’ ethnicity in the calculation of eGFR values, and the presence of potential biases due to the observational design of the study.

Conclusions:

The current study demonstrated that pre-dialysis CKD patients treated in nephrology clinics were associated with significantly lower healthcare costs compared with patients treated in other healthcare settings.     

工科院校机械类学生实施创新素质教育的实践探讨

本文通过分析本院实施创新素质教育课程体系的实践过程,阐述了对工科院校机械类学生实施创新素质教育的具体思路,建立了机械类工科大学生创新素质培养的实施理念与模式。     

Comparing variations in labor costs for two vs. one full-time nurse manager

Labor costs for two versus one full-time nurse manager were compared. Results revealed reductions in nursing costs per patient day. These results suggest that innovative models may hold promise as organizations struggle to retain nurses and decrease costs.