Healthcare resource utilization and costs among psoriasis patients treated with biologics,overall and by disease severity

Aims: To describe healthcare resource utilization (HCRU) and costs among biologic-treated psoriasis patients in the US, overall and by disease severity.

Materials and methods: IQVIA PharMetrics Plus administrative claims data were linked with Modernizing Medicine Data Services Electronic Health Record data and used to select adult psoriasis patients between April 1, 2010 and December 31, 2014. Eligible patients were classified by disease severity (mild, moderate, severe) using a hierarchy of available clinical measures. One-year outcomes included all-cause and psoriasis-related outpatient, emergency department, inpatient, and pharmacy HCRU and costs.

Results: This study identified 2,130 biologic-treated psoriasis patients: 282 (13%) had mild, 116 (5%) moderate, and 49 (2%) severe disease; 1,683 (79%) could not be classified. The mean age was 47.6 years; 45.4% were female. Relative to mild psoriasis patients, patients with moderate or severe disease had more median all-cause outpatient encounters (28.0 [mild] vs 32.0 [moderate], 36.0 [severe]), more median psoriasis-related outpatient encounters (6.0 [mild] vs 7.5 [moderate], 8.0 [severe]), and a higher proportion of overall claims for medications that were psoriasis-related (28% [mild] vs 37% [moderate], 34% [severe]). Relative to mild psoriasis patients, patients with moderate or severe disease had higher median all-cause total costs ($37.7k [mild] vs $42.3k [moderate], $49.3k [severe]), higher median psoriasis-related total costs ($32.7k [mild] vs $34.9k [moderate], $40.5k [severe]), higher median all-cause pharmacy costs ($33.9k [mild] vs $36.5k [moderate], $36.4k [severe]), and higher median psoriasis-related pharmacy costs ($32.2k [mild] vs $33.9k [moderate], $35.6k [severe]).

Limitations: The assessment of psoriasis disease severity may not have necessarily coincided with the timing of biologic use. The definition of disease severity prevented the assessment of temporality, and may have introduced selection bias.

Conclusions: Biologic-treated patients with moderate or severe psoriasis cost the healthcare system more than patients with mild psoriasis, primarily driven by higher pharmacy costs and more outpatient encounters.     

The effect of primed goals on employee performance: Implications for human resource management

Overwhelming evidence in the behavioral sciences shows that consciously set goals can increase an employee's performance. Thus, HR professionals have had little, if any, reason to be interested in subconscious processes. In the past decade, however, laboratory experiments by social psychologists have shown that goals can be primed. That is, people's behavior is affected by goals of which they are unaware. Because a conscious goal consumes cognitive resources, this finding has important implications for employee efficiency in the workplace. This paper discusses the results of priming a performance goal in two organizational settings. Call center employees who were primed using a photograph of a woman winning a race raised significantly more money from donors than those who were randomly assigned to a control group. A meta‐analysis revealed that a photograph can prime the subconscious to increase job performance. The results of the present study demonstrate that subconscious motivation is a concept worthy of exploration for both human resource scholars and practitioners. © 2011 Wiley Periodicals, Inc.     

The contours of employee voice in SMEs: the importance of context

This article develops a context‐sensitive approach to analyse how and why voice operates in small‐ to medium‐sized enterprises (SMEs), an area that remains under‐theorised and under‐researched. By building on a priori frameworks with proven ability to unpack complexity and take account of the wider context of SMEs, this article explores how resources (human and social capital) and constraints (product market, labour market and strategic orientation) interact to shape voice practices. The article finds significant differences between ‘reported’ compared with ‘actual’ practices in situ, and identifies different types of firms (‘strategic market regulation’, ‘strategic market‐led’ and ‘non‐strategic market‐led’) along with the factors that influence the form and practice of voice. Overall, the article argues that researchers should further pursue research that appreciates the layered nature of ontology and the role played by firm context to explain complex organisational phenomena, if we are to advance our understanding of voice practices in SMEs and beyond.     

Lean production,employee learning and workplace outcomes: a case analysis through the ability‐motivation‐opportunity framework

This study examines an implementation of lean production in fast‐moving consumer goods manufacturing, analysing how it has affected employee learning and job quality. We find major variation in these outcomes. Where line managers have relinquished significant control, and workers have had the requisite levels of literacy, more powerful forms of learning have occurred, and the outcomes are mutually beneficial. However, deeper learning has yet to take hold where production pressures are high, line managers are not enabling and workers lack self‐efficacy because of low literacy. Better outcomes depend on greater investments in the development and ongoing support of front‐line managers and in literacy development. The study shows how the ability‐motivation‐opportunity framework can be used to organise relevant theory and throw light on the systemic nature of workplace learning.     

The excess burden of tax evasion—An experimental detection-concealment contest

Tax evasion may cause social welfare losses due to the incentives of taxpayers to invest in the concealment and of tax authorities to invest in the detection of tax evasion. Reducing the investment of both parties at the same time would then lead to a Pareto improvement. Given that concealment and detection costs are hardly measurable in reality, we show in a controlled laboratory experiment that the welfare losses from a concealment-detection contest depend positively on the prevailing tax rate, but not on the penalty which is imposed in case of detected tax evasion. Hence, policy makers who are concerned about socially inefficient concealment and enforcement costs should focus on tax rates rather than penalty rates.     

Self-admissible sets

Best-response sets (Pearce, 1984 [28]) characterize the epistemic condition of “rationality and common belief of rationality.” When rationality incorporates a weak-dominance (admissibility) requirement, the self-admissible set (SAS) concept (Brandenburger, Friedenberg, and Keisler, 2008 [17]) characterizes “rationality and common assumption of rationality.” We analyze the behavior of SAS's in some games of interest—Centipede, the Finitely Repeated Prisoner's Dilemma, and Chain Store. We then establish some general properties of SAS's, including a characterization in perfect-information games.     

Health club use and ‘lifestyle’: exploring the boundaries between work and leisure

In this article I investigate the relationship between work and leisure for professional employees. Drawing on qualitative research I explore the motivation behind premier club use – a sector within the wider health club industry – to show that rather than being an activity firmly located within the domain of ‘leisure’, it is a complex activity, influenced by a person's occupation and experience within the workplace. Through the empirical discussion I show that professionals working within the city are often committed to a ‘project of the self’, fuelled by a desire to create a professional identity whereby the development and maintenance of a fit and healthy body symbolises characteristics that are valued within the professional workplace. Accordingly I propose the concept of a ‘workstyle’ as opposed to ‘lifestyle’, to suggest that the motivation behind premier club use is defined according to the social and cultural experience of working in the city and in turn, certain individuals may be consuming premier club membership for the benefit of their overall career. To this end, premier club use is portrayed as an activity defined according to the principles of work rather than as a definitive ‘leisure’ pursuit, thus blurring and mediating the boundaries between work and leisure.     

Mother and child constructions of risk in outdoor play

Managing the risks to which children are exposed in contemporary Britain is complex, requiring parents to balance opportunities for a child’s development with an appropriate concern for the potential consequences. Managing risk is particularly an issue for mothers, who, despite societal changes, tend to retain overall responsibility for the care of children. This paper explores the meanings mothers attach to risk and how this influences their children’s outdoor play. It also extends the scope of much existing literature by including children’s own perspectives on risk in outdoor play. Semi-structured interviews were undertaken with 12 mothers who had children aged between 9 and 11 years old who attended a north-east school. Two focus groups were also held, each with six of the children. Findings are analysed in relation to mother and child constructions of risk; mothers and children as risk managers; and negotiating mothering choices. The paper pays particular attention to the way in which mothers’ decisions were framed within risk cultures and dominant views of ‘good’ and ‘bad’ mothering.     

On the relationship between hierarchy and type morphisms

Here, we establish a relationship between hierarchy and type morphisms. Both concepts have been used to relate the types in one structure to types in a second “larger” structure. In general, the two concepts may differ, in the sense that a hierarchy morphism need not be a type morphism. We provide a necessary and sufficient condition under which the two concepts coincide. We go on to provide situations under which this condition must be satisfied.     

Great Expectations: Benchmarking for Best Value

Many local authorities have embarked on benchmarking as one way of satisfying the Government's requirement that local authorities provide 'best value' services. This article suggests that the Government's initial enthusiasm for benchmarking was based on an incomplete understanding of the previous experiences of benchmarking in the local government sector. The most recent pronouncements make little mention of benchmarking, but there has been no explicit statement that it is no longer a key feature of best value. Local authorities are investing in developing benchmarking technology that may well fail to pay back in terms of meeting best value stipulations or in satisfying the authorities' own internal management needs. The authors suggest how local authority benchmarking efforts might be redirected to better effect.