The healthcare burden of disease progression in medicare patients with functional mitral regurgitation

Abstract

Objective: This retrospective database analysis estimated the incremental effect that disease progression from non-clinically significant functional mitral regurgitation (nsFMR) to clinically significant FMR (sFMR) has on clinical outcomes and costs.

Methods: Medicare Fee for Service beneficiaries with nsFMR were examined, defined as those with a heart failure diagnosis prior to MR. Patients were classified as ischemic if there was a history of: CAD, AMI, PCI, or CABG. The primary outcome was time to sFMR, defined as pulmonary hypertension, atrial fibrillation, mitral valve surgery, serial echocardiography, or death, using a Cox hazard regression model. Annualized hospitalizations, inpatient hospital days, and healthcare expenditures were also modeled.

Results: Patients with IHD had higher risk (Hazard Ratio?=?1.22 [1.14–1.30]) for disease progression compared to patients without. The progression cohort had significantly more annual inpatient hospitalizations (non-IHD?=?1.32; IHD?=?1.40) than the non-progression cohort (non-IHD?=?0.36; IHD?=?0.34), and significantly more annual inpatient hospital days (non-IHD?=?13.07; IHD?=?13.52) than the non-progression cohort (non-IHD?=?2.29; with IHD?=?2.08). The progression cohort had over 3.5-times higher costs vs the non-progression cohort, independent of IHD (non-IHD?=?$12,798 vs $46,784; IHD?=?$12,582 vs $49,348).

Conclusion: Treating FMR patients earlier in their clinical trajectory may prevent disease progression and reduce high rates of healthcare utilization and expenditures.     

A contemporary analysis of road traffic crashes,fatalities and injuries in Trinidad and Tobago

Road safety, in particular pedestrian safety, is a problem in Trinidad and Tobago. Data were derived from the database of the Traffic and Highway Patrol Unit of the Trinidad and Tobago Police Service. Road traffic crashes in Trinidad and Tobago are largely an urban problem. Four urban areas accounted for nearly three-quarters of reported road traffic crashes, fatalities and injuries. Pedestrians, passengers and drivers accounted for 93% of fatalities and 95% of injuries due to road traffic crashes in 2000. Pedestrians alone accounted for 42% of fatalities and 34% of injuries in 2000. Trends over time show that there has been a decline in fatality rates from 17 deaths per 100,000 population in 1960 to 10 deaths per 100,000 population in 2000, despite rapid motorization. Motorization increased four-fold from 63 registered vehicles per 1000 population in 1960 to 250 vehicles per 1000 population in 2000. In conclusion, effort should be intensified to ensure safety for all road users and, in particular, pedestrians, passengers and drivers. Improved data collection and operational research would improve monitoring and evaluation of policy interventions.     

Software firm turnarounds in the 1990s: An analysis of reversing decline in a growing,dynamic industry

Investigations into management actions that reverse organizational decline have produced inconsistent findings. Prior studies have focused on the value of retrenchment actions versus strategic actions to engineer a performance turnaround. These studies, however, have generally not controlled for the cause of firm decline, overlooking a major theoretical contingency. Examining prepackaged software firms in the 1990s, we test the association of strategic and retrenchment actions in facilitating turnarounds in a munificent industry. The results show that measures of strategic actions—new product introductions, strategic alliances, and acquisitions—were positively associated with turnarounds. Conversely, measures of retrenchment actions—layoffs, asset reductions, and product withdrawals—were negatively associated with performance recovery. Our results suggest declining firms in munificent industries cannot retrench their way back to prosperity. Copyright © 2013 John Wiley & Sons, Ltd.     

A clash of human resource management cultures: a micro-state case study

When resorting to Greek divine mythology to purchase original insights on management styles, Handy (1991) identifies Apollo and Dionysius as representative of two ideal types which can be developed and fine-tuned to highlight one relatively under-explored area of inter-cultural human resource management. This concerns the cultural interface between alien, imported management styles and local, home-grown practices in the context of small and island states. This paper argues that indigenous behaviour patterns in the unfolding of labour-management relations cannot be discounted. Indeed, these home-bred practices will both place imported 'textbook' management strategies in sharp relief as well as debilitate their purposed efficacy. Such a proposition suggests that this is one expression of how globalization will necessarily find itself textured and infected by indigenous cultural material, even that forthcoming from possibly the least expected quarter: that of micro, insular jurisdictions. Case-study material exploring and illustrating this cultural clash is drawn from seminal, empirical fieldwork carried out in the Indian Ocean island state Republic of the Seychelles.     

Ethics and Ethos: The Buffering and Amplifying Effects of Ethical Behavior and Virtuousness

Logical and moral arguments have been made for the organizational importance of ethos or virtuousness, in addition to ethics and responsibility. Research evidence is beginning to provide, empirical support for such normative claims. This paper considers the relationship between ethics and ethos in contemporary organizations by summarizing emerging findings that link virtuousness and performance. The effect of virtue in organizations derives from its buffering and amplifying effects, both of which are described.     

Measuring the Extent of Impact from Occupational Violence and Bullying on Traumatised Workers

Across the industrialised world, there is evidence that both the incidence and the severity of occupational violence and bullying are increasingly being reported over time. While there have been few substantive scientific studies in Australia, all the available evidence shows a similar increasing level of risk. It has long been assumed that those who suffer a physical assault during the course of violent events are more likely to be emotionally traumatised by the experience than are those who are merely threatened or bullied at work. However, there are no substantive data published to date. In this paper the authors aim to elucidate and quantify the extent of emotional injury/stress suffered as a result of different forms of occupational violence, based on empirical data collected during face-to-face interviewing of 800 Australian workers employed in the tertiary education, health and long-haul transport industry sectors. The authors conclude that the impact from more covert forms of occupational violence (such as bullying) can, in many instances, at least equal the emotional trauma following assaults on-the-job.     

Political cost influences on income smoothing via extraordinary item classification

Until 1990, Australian managers could classify recurring gains and losses outside the normal operations of the firm as either operating or extraordinary items. The results of this study indicate that managers of companies with highly unionised workforces, and therefore subject to labour-related political costs, attempted to affect the probability of wealth transfers by smoothing reported net operating profit via the classification of those recurring gains and losses. The degree of management ownership is associated with classificatory smoothing but interest coverage is not, indicating differential contracting influences.     

Evolving Purchasing and Supply Organizations: A contingency model for structural alternatives

Purchasing and Supply Management (PSM) is under significant pressure to find levers to further increase its contribution to corporate goals. In order to improve performance in line with expectations, Purchasing and Supply Organizations (PSOs) have to evolve continuously. To help address this challenge, a comprehensive contingency framework of PSO structures is presented. The framework is based on existing literature on PSO contingency factors as well as analysis of two case companies. The findings highlight the importance of taking a contingency perspective for understanding the PSO and combining a detailed view of macro-level structural dimensions with micro-level characteristics. These macro-level dimensions comprise category, business unit, geography and activity. The micro-level characteristics comprise centralization, formalization, specialization, participation and standardization. From a theoretical perspective, the contingency framework opens up insights that can be leveraged in future studies in the fields of hybrid PSOs, global sourcing organizations, and International Purchasing Offices (IPOs). From a practical standpoint, an assessment of external and internal contingencies and their relation to specific structural dimensions and characteristics provides the opportunity for more consciously evolving the PSO to continue to improve PSM's contribution.     

How stigmatized are dismissed chief executives? The role of character questioning causal accounts and executive capital in dismissed CEO reemployment

Research Summary: Despite the prevalence of CEO dismissal, theory only briefly explores its consequences. Past research indicates few fired CEOs regain employment. We suggest dismissal stigmatizes executives; however, stigmatization is greatest when character questioning causal accounts exist, which affect the likelihood of regaining a CEO position. Furthermore, we argue that reputational and social capital provide signals of executive quality that moderate the level of stigmatization experienced when character questioning causal accounts exist. Following 280 dismissed CEOs, we find that social capital increases the likelihood of rehiring for those with character questioning causal accounts, but negatively impacts those without causal accounts. Alternatively, we find reputational capital positively influences those without causal accounts, while having a slight negative relationship for those with causal accounts. Managerial Summary: Dismissed CEOs often desire second chances to run companies; however, few are ever afforded the opportunity. We explore what allows some dismissed CEOs to regain employment as a CEO. We find that reasons surrounding a CEO's dismissal influence such prospects depending on the CEO's prior reputation and social capital. In particular, social capital through elite education increases the likelihood of regaining a position when the CEO's character is called into question. Alternatively, a strong reputation increases the likelihood of regaining a CEO position when a CEO's character has not been called into question. These findings suggest that dismissed CEOs can regain a CEO position; however, this likelihood is strongly influenced by how others perceive the executive and their concerns about prior behavior.