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51.
    
Abstract

Aims: Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies.

Materials and methods: To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, an Excel-based decision tree model was created that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the US. First, a conceptual framework was created to identify the value components of rapid, cloud-enabled onsite testing. Second, value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements was measured, leveraging existing literature and information from an observational study. Lastly, these value components were combined to estimate the total incremental value accruing to payers per patient-year relative to centralized laboratory testing.

Results: Rapid, cloud-enabled, onsite testing is estimated to save one office and 1.81 laboratory visits during the evaluation period for the average patient. Results from an observational study found that rapid, cloud-enabled testing increased the likelihood of completing diagnostic orders from 84.5% to 97%, resulting in an increased probability of early treatment (3.5 percentage points) with disease-modifying anti-rheumatic drugs among patients eligible for treatment. The combined total value was $5,648 per evaluated patient-year. This value is primarily attributed to health benefits of early treatment ($5,048), fewer visit payments ($459), and patient time savings due to fewer office ($216) and laboratory visits ($255).

Limitations and conclusions: Data on the impact of rapid, cloud-enabled, onsite testing on patient health, care delivery, and clinical decision-making is scarce. More robust real-world data would confirm the validity of our model. Rapid, cloud-enabled, onsite testing has the potential to generate significant value to payers.  相似文献   
52.
    
Abstract

Aims: Cold agglutinin disease (CAD) is a rare subtype of autoimmune hemolytic anemia associated with increased thromboembolism risk and early mortality. Healthcare resource utilization (HRU) in CAD has not been reported. We aimed to compare HRU of patients with CAD with a matched non-CAD cohort in the United States.

Materials and methods: Patients with CAD were identified from 2006 to 2016 in the Optum-Humedica database using CAD terms in clinical notes and hematologist review. Patients were required to have Integrated Delivery Network records and ≥6 months’ follow-up before and after the first CAD mention date (index date). Patients with CAD were matched to a non-CAD cohort based on demographics. Multivariate analyses assessed inpatient hospitalizations, outpatient visits, emergency room visits, and transfusion use between cohorts 6 months before and 12 months after the index date.

Results: Of 814 patients with CAD, 410 met inclusion criteria and were matched to 3,390 patients without CAD. Mean age of patients with CAD was 68.0 years; approximately 62% were female. In the 12 months after the index date, mean inpatient hospitalizations (0.83 vs. 0.25), outpatient visits (17.26 vs. 6.77), emergency room visits (0.55 vs. 0.32), and transfusion days (1.05 vs. 0.05) were higher for patients with CAD than the matched non-CAD cohort (all p?<?.0001). Similarly, in the 6 months before the index date, patients with CAD had higher HRU than matched patients without CAD for all measures evaluated.

Limitations: Results of this study are based on patient information from the Optum-Humedica database, which is limited to commercially insured patients and may not represent the overall CAD population.

Conclusions: CAD places a substantial burden on patients and healthcare systems. In addition, the high HRU for patients with CAD observed in the 6 months before diagnosis indicates that disease awareness and better diagnostic practices may be needed.  相似文献   
53.
    
From security cameras to GPS tracking systems, nearly 80% of organizations use some type of electronic performance monitoring (EPM). EPM uses technology to gather, store, analyze, and report employee behavior (e.g., productivity, use of company time, incivility). The objective, real-time data that EPM systems collect can be used for performance appraisal, training and development, logistical tracking, wellness programs, employee safety, and more. Despite the organizational benefits of EPM, these systems can have adverse effects on employee satisfaction, organizational commitment, fairness perceptions, and employee behavior. Research provides evidence, however, that these downfalls can be mitigated by implementing these systems with employee attitudes and privacy perceptions in mind. Using theory and empirical research evidence, we offer five recommendations for maximizing the positive effects and minimizing the negative effects of EPM: (1) Be transparent with employees about EPM use, (2) be aware of all potential employee reactions to being monitored, (3) use EPM for learning and development rather than deterrence, (4) restrict EPM to only work-related behaviors, and (5) consider organizational makeup when implementing an EPM system.  相似文献   
54.
Paddle sports (kayaking, canoeing) are a growing tourism niche and an activity that can bring sustainable rural tourism development and economic regeneration. Managing sustainable paddle trail growth is complex, involving coordination among government bodies, consensus from landowners and funding acquisition for safe access sites, signage, maps and other amenities. This paper explores the paddle-trail-related literature and the many different funding options to manage the creation and maintenance of paddle trails. An Internet survey of 1851 respondents determined support for a variety of user funding mechanisms for trail development as well as paddler perceptions about trail development as a viable form of economic development. The results indicate that women and recreational paddlers are more likely to support funding mechanisms, in addition to paddlers who consider paddle trail development a form of economic development. Paddlers who did not support any user funding mechanism were male, employed in the private sector, avid paddlers, and those who owned boats. It is observed that awareness of paddle trails’ value as an economic regeneration tool increases the willingness to pay. A range of management implications from this research are discussed, including information and educational programs, marketing partnerships and targeted incentive offers to those groups that are unwilling to pay.  相似文献   
55.
56.
    
Consumer acceptability and physicochemical properties of candied osmodehydrated (OD) carambola were evaluated in an effort to increase consumption of the fruit. Fresh carambola slices (Averrhoa carambola L.) were soaked in either 15% or 20% or 25% NaCl brine for 18 h, then in 40 °Brix sucrose for 18 h, followed by 60 °Brix sucrose for 18 h and dried at 55°C for 18 h. Slices soaked in 15% NaCl were most preferred by a focus group. Decreases in pH, total soluble solids (TSS) and increase in salinity were recorded in sucrose solutions after soaking carambola. During osmosis, carambola became less green and more orange‐yellow (P < 0.05). The pH of candied OD products varied between 3.62 and 4.16, salinity 16–28 ppt, TSS of 67–70 °Brix and 18.8–20.8% moisture. There were no differences (P > 0.05) in flavour or texture for products brined in 15% NaCl and soaked in either refined white sucrose (RS) solutions or brown unrefined sucrose (URS) syrups, but differences (P < 0.05) in appearance, colour and overall acceptability. Candied RS carambola had higher (P < 0.05) overall acceptability (6.2 – liked slightly to moderately) to products from URS (5.6 – neither liked nor disliked to liked slightly), which was also supported by paired preference testing. Flavour was most liked (P < 0.05) of all sensory attributes.  相似文献   
57.
In this research, the authors propose a contagion effect of social media use across business suppliers, retailers, and consumers. After developing and validating social media usage measures at three levels—supplier, retailer, and customer—the authors test social media contagion effects and their ultimate impact on multiple performance measures. The conceptual framework and empirical results offer new insights into the contagion effects of social media usage across the channel of distribution as well as important social influence mechanisms that enhance these effects. Consistent with the predictions, social media use positively contributes to brand performance, retailer performance, and consumer–retailer loyalty. Also, the effect of supplier social media usage on retailer social media usage and in turn on customer social media usage is moderated by brand reputation and service ambidexterity. With the ever-increasing growth and adoption of social media applications and similar technologies, this research provides a framework to promote usage by supply channel partners which ultimately influences performance-related outcomes.  相似文献   
58.
    
Aims: To estimate real world healthcare costs and resource utilization of rheumatoid arthritis (RA) patients associated with targeted disease modifying anti-rheumatic drugs (tDMARD) switching in general and switching to abatacept specifically.

Materials and methods: RA patients initiating a tDMARD were identified in IMS PharMetrics Plus health insurance claims data (2010–2016), and outcomes measured included monthly healthcare costs per patient (all-cause, RA-related) and resource utilization (inpatient stays, outpatient visits, emergency department [ED] visits). Generalized linear models were used to assess (i) average monthly costs per patient associated with tDMARD switching, and (ii) among switchers only, costs of switching to abatacept vs tumor necrosis factor inhibitors (TNFi) or other non-TNFi. Negative binomial regressions were used to determine incident rate ratios of resource utilization associated with switching to abatacept.

Results: Among 11,856 RA patients who initiated a tDMARD, 2,708 switched tDMARDs once and 814 switched twice (to a third tDMARD). Adjusted average monthly costs were higher among patients who switched to a second tDMARD vs non-switchers (all-cause: $4,785 vs $3,491, p?p?p?p?=?.021), and numerically lower all-cause costs ($4,444 vs $4,741, p?=?0.188). Switchers to TNFi relative to abatacept had more frequent inpatient stays after switch (incidence rate ratio (IRR) = 1.85, p?=?.031), and numerically higher ED visits (IRR = 1.32, p?=?.093). Outpatient visits were less frequent for TNFi switchers (IRR = 0.83, p?Limitations and conclusions: Switching to another tDMARD was associated with higher healthcare costs. Switching to abatacept, however, was associated with lower RA-related costs, fewer inpatient stays, but more frequent outpatient visits compared to switching to a TNFi.  相似文献   
59.
Review of Accounting Studies - Using aggregate data from national accounts, we study whether strengthening and harmonizing securities regulation across the European Union increases household equity...  相似文献   
60.
Through an inductive, multi-case analysis of eight medical device firms, this paper maps user-centered design and development practices to product performance outcomes. First, the data highlight that designing products under variable use conditions enabled firms to optimize products for widespread use and to increase the predictability of product outcomes. Second, the study shows that product adoption relied on maximizing benefits for multiple product stakeholders with often-conflicting needs, while minimizing required changes in end user behavior. Third, the paper highlights that managing perceptions toward product use through performance data positively influenced product adoption among the cases studied to a greater degree than did market demand or regulatory clearance. Fourth, rival explanations for outcomes involving limited user involvement, indicate that competitive advantages were achieved through maintaining dominant financial and intellectual property positions. From these findings, the insight-value-perception (iVP) model for user-centered design was constructed. This model links design and development practices to outcomes, from a combination of consumer-oriented, technical, and financial perspectives. Although rooted in the experiences of device developers within early stage medical device companies, the iVP Model may be used as a theoretical framework to examine a range of complex systems involving an embedded network of product users and stakeholders.  相似文献   
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