Hospital costs associated with intraoperative hypotension among non-cardiac surgical patients in the US: a simulation model

Objective: Recent studies indicate intraoperative hypotension, common in non-cardiac surgical patients, is associated with myocardial injury, acute kidney injury, and mortality. This study extends on these findings by quantifying the association between intraoperative hypotension and hospital expenditures in the US.

Methods: Monte Carlo simulations (10,000 trial per simulation) based on current epidemiological and cost outcomes literature were developed for both acute kidney injury (AKI) and myocardial injury in non-cardiac surgery (MINS). For AKI, three models with different epidemiological assumptions (two models based on observational studies and one model based on a randomized control trial [RCT]) estimate the marginal probability of AKI conditional on intraoperative hypotension status. Similar models are also developed for MINS (except for the RCT case). Marginal probabilities of AKI and MINS sequelae (myocardial infarction, congestive heart failure, stroke, cardiac catheterization, and percutaneous coronary intervention) are multiplied by marginal cost estimates for each outcome to evaluate costs associated with intraoperative hypotension.

Results: The unadjusted (adjusted) model found hypotension control lowers the absolute probability of AKI by 2.2% (0.7%). Multiplying these probabilities by the marginal cost of AKI, the unadjusted (adjusted) AKI model estimated a cost reduction of $272 [95% CI?=?$223–$321] ($86 [95% CI?=?$47–$127]) per patient. The AKI model based on relative risks from the RCT had a mean cost reduction estimate of $281 (95% CI?=?–$346–$750). The unadjusted (adjusted) MINS model yielded a cost reduction of $186 [95% CI?=?$73–$393] ($33 [95% CI?=?$10–$77]) per patient.

Conclusions: The model results suggest improved intraoperative hypotension control in a hospital with an annual volume of 10,000 non-cardiac surgical patients is associated with mean cost reductions ranging from $1.2–$4.6 million per year. Since the magnitude of the RCT mean estimate is similar to the unadjusted observational model, the institutional costs are likely at the upper end of this range.     

Attention allocation to multiple goals: The case of for‐profit social enterprises

The complexity of issues firms have to attend to make it impossible for CEOs to give their full attention to all issues concurrently. Drawing on the “attention‐based view” of the firm, this paper opens the black box of attention allocation in for‐profit social enterprises by showing how attention structures and the context in which the firm operates interplay. Utilizing empirical data on 148 for‐profit social enterprises, findings show that the attention structures—other‐regarding values, utilitarian identity, and resource availability—have a significant impact on the relative attention to social goals, while past firm performance as a context variable moderates these relations. Applying the principles of structural and situated attention, this paper makes an important contribution to management theory and attention allocation in for‐profit social enterprises. Copyright © 2014 John Wiley & Sons, Ltd.     

倾销与比较优势

简单贸易模型的一个重要假设是市场完全竞争，并且贸易是源于比较优势。然而，现实中很少存在完全竞争的市场，不完全竞争市场使传统的贸易模型呈现出有趣的结果。这引起关注的一方面是不完全竞争企业在不同市场上给出不同的价格，即通常所说的“价格歧视”。在国际贸易中，最基本的价格歧视方式是“倾销”，即对于同一商品，出口商在国际市场上价格低于国内市场上的价格。如果国内企业是完全竞争的，并且在国内市场上以边际成本价格卖出，倾销就是指在国外市场上已低于边际成本价格出售。在多数的贸易模型中，商品按进口品和出口品分组，货币被认为是交换的中性媒介。对基于比较优势进行贸易的倾销的指控，主要是由于运用了与贸易不联系的汇率。我们认为，根据汇率来衡量基于比较优势的贸易获利在逻辑上是错误的，因为这种衡量往往导致明显的倾销，如果汇率市场是均衡的话。恰当的衡量方法是以贸易为基础的影子汇率。进一步来说，贸易障碍使得外汇交换和贸易不完全替代，使得汇率按接受到的价格相互高估。我们认为，只有在出口与基于比较优势的利润最大化不一致时，才能说明是倾销。     

A research framework for group support systems

Over the last decade, many methodologies and techniques have been devised to improve the efficiency and effectiveness of cooperative working. The efficacy of many of these approaches has not been rigorously assessed, causing doubt about their applicability and helping restrict their use. Additionally, research effort has been dissipated. The need is for a generally agreed framework within which research can be conducted and results determined. This article proposes such a framework, involving the identification of the context, process, and outcome variables which, a priori, are deemed important to understanding, and subsequently predicting, the appropriate forms of intervention in the workings of groups. Six major components have been identified: the organizational environment, the group context, the process context, the group process, the substantive outcomes, and process performance indicators. Within these six components, 16 macrovariables have been identified. Within these macrovariables, 90 variables have been selected that characterize an issue-handling situation and its outcomes. The framework is applicable to a very wide range of group support systems used in many contexts.     

Is it time to reboot welfare economics? Overview

The contributions of economists have long included both positive explanations of how economic systems work and normative recommendations for how they could and should work better. In recent decades, economics has taken a strong empirical turn as well as having a greater appreciation of the importance of the complexities of real-world human behaviour, institutions, the strengths and failures of markets, and interlinkages with other systems, including politics, technology, culture and the environment. This shift has also brought greater relevance and pragmatism to normative economics. While this shift towards evidence and pragmatism has been welcome, it does not in itself answer the core question of what exactly constitutes ‘better’, and for whom, and how to manage inevitable conflicts and trade-offs in society. These have long been the core concerns of welfare economics. Yet, in the 1980s and 1990s, debates on welfare economics seemed to have become marginalised. The articles in this Fiscal Studies symposium engage with the question of how to revive normative questions as a central issue in economic scholarship.