Does site-of-care for oncology infusion therapy influence treatment patterns,cost, and quality in the United States?

Background: The increase in hospital acquisition of community oncology clinics in the US has led to a shift in the site-of-care (SOC) for infusion therapy from the physician office (PO) to the hospital outpatient (HO) setting.

Objective: To investigate differences by SOC in treatment patterns, quality, and cost among patients with cancer undergoing first-line infusion therapy.

Research design and methods: This retrospective analysis identified adult patients from Humana medical claims who initiated infusion therapy from 2008–2012 for five common cancer types in which infusion therapy is likely, including early stage breast cancer; metastatic breast, lung, and colorectal cancers; and non-Hodgkin’s lymphoma or chronic lymphocytic leukemia. Differences by SOC in first-line treatment patterns and quality of care at end-of-life, defined as infusions or hospitalizations 30 days prior to death, were evaluated using Wilcoxon-Rank Sum and Chi-square tests where appropriate. Differences in cost by SOC were evaluated using risk-adjusted generalized linear models.

Main outcome measures: Treatment patterns, quality of care at end of life, healthcare costs.

Results: There were differences in duration of therapy and number of infusions for some therapy regimens by SOC, in which patients in the HO had shorter duration of therapy and fewer infusions. There were no differences in quality of care at end-of-life by SOC. Total healthcare costs were 15% higher among patients in HO ($55,965) compared with PO ($48,439), p?<?.0001.

Limitations: Analyses was restricted to a claims-based population of cancer patients within a health plan.

Conclusion: This study, in an older, predominantly Medicare Advantage oncology cohort, found differences by SOC in treatment patterns and cost, but not quality. Where differences were found, patients receiving care in the HO had shorter duration of therapy and fewer infusions for specific treatment regimens, but higher healthcare costs than those treated in a PO.     

Preventing premature death: tobacco treatment services for employees

This article presents a summary of current information concerning the health and financial costs of workplace smoking, with special emphasis on the costs to union workers and multiemployer health and welfare funds. It describes the potential savings from investing in tobacco cessation for workers and members, provides an overview of scientific evidence concerning the efficacy of different approaches to tobacco cessation, including behavioral services and medications, and discusses some of the benefit design and management issues involved in offering tobacco cessation services to employees and members.     

An Antitakeover Amendment for Stakeholders?

The non-financial effects (NFE) antitakeover amendment addresses the duties of company directors and management when faced with a possible takeover bid. The NFE amendment either permits or requires managers to consider the interests of the company's stakeholders during takeover bids. Other types of antitakeover devices have been viewed as protecting either stockholder or management interests. The NFE amendment would appear to protect a broad spectrum of interests including those of company employees, creditors, and the community in which the company operates. Positive market returns to the adoption of NFE amendments provide some evidence that investors approve. The percent of both management and institutional ownership are positively related to the market reaction to the NFE amendment adoption. To the extent that institutional ownership proxies for the broad spectrum of stakeholder interest, NFE devices, unlike some other amendments that have been studied, appear to be in the interests of more than a single interest group.     

Monetary valuations of university course delivery: the case for face-to-face learning activities in accounting education

Student preferences for delivery options were obtained within a monetary framework by asking students to purchase their ideal course structure. Results show that accounting students prefer to spend more on tutorials but purchase less lecture time; the difference due to the higher cost of tutorials compared to lectures. Face-to-face classes were preferred to web-based materials. Within lectures and tutorials students prefer more time devoted to teacher-centred activities than student-centred activities. Monetary valuations, where students must take into account the cost of delivery as well as effectiveness, provide insights for teaching staff and administrators, who need to simultaneously enhance teaching and learning, satisfy student preferences and operate with limited resources. Online and/or student-centred learning may not be compatible with preferences of accounting students. Teachers need to balance calls to change educational delivery and learning activities with preferences of accounting students, or ensure they educate students on why non-preferred approaches are undertaken.     

Contrasting Two Models of Wealth Redistribution

Philanthropy tries to improve the condition of people. Yet there are different models of philanthropy. American philanthropy tries to improve conditions for different people, without reference to race or language; this evolved from the notion of equality. In contrast, Chinese clans arose in Singapore, as a response to a society segmented along racial and linguistic lines; in a culture that emphasized face, rich entrepreneurs could "buy" prestige and leadership positions, by assisting their poor. This article examines philanthropy as practiced by entrepreneurs in America, and compares this to the Chinese model of wealth redistribution. The latter is centered on clan associations. In the new economy, however, these have been losing importance, as governments take on some roles previously taken care of by such associations; this includes, for instance, education and assistance to start-up entrepreneurs. We conclude that there appears to be a relationship between philanthropy, government and entrepreneurship.     

Economic incentives and the demand for accounting information: Perspectives from medieval English finance

In this paper we examine similarities that medieval English finance bears to modern systems of national finance. First, the medieval system afforded economic incentives which invited potential abuse by self-interested parties; second, while proposed solutions to such abuses were both administrative and fiscal, the fiscal monitoring solutions were largely accounting in nature. We discuss several of the medieval abuses and their accounting-based solutions instituted from, roughly, A.D. 1200 to 1375. We conclude that many of the economic factors and competing relationships of constituent groups are remarkably similar in principle and application to today’s environment. By gaining a perspective on their historical bases, we can gain a richer understanding of current practices.     

Beyond brainstorming: The effectiveness of computer-mediated communication for convergence and negotiation tasks

Although a considerable body of research in information systems has established that computer-mediated communication (CMC) is beneficial for brainstorming (idea generation) tasks, less is known about its effectiveness for more complex decision-making tasks. This paper reports the results of two experiments comparing the performance of face-to-face and CMC teams in decision-making tasks that move beyond brainstorming. In the first experiment, the performance of face-to-face and computer-mediated teams was compared in two tasks: one requiring participants to engage in convergent thinking and a second brainstorming task requiring divergent thinking. Consistent with predictions derived from McGrath's task circumplex model, the results of experiment one reveal that participants using computer-mediated communication perform significantly better than those interacting face-to-face on the divergent (brainstorming) task. On the convergent task, computer-mediated and face-to-face teams performed equally well; i.e., there was not a significant difference in their performance. In the second experiment, the performance of face-to-face and computer-mediated teams was again compared in two tasks: an integrative negotiation task and an idea-generation task. The results of the second experiment were similar to those of experiment one, in that computer-mediated teams significantly outperformed face-to-face teams in the idea-generation task, while computer-mediated and face-to-face teams performed equally well on the integrative negotiation task. These experiments contribute to the literature by shedding additional light on the conditions under which computer-mediated communication is as effective as, and in some cases more effective than, face-to-face interaction.