Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions

Background:

Financial pressures have limited the ability of providers to use medication that may improve clinical outcomes and patient satisfaction. New interventions are often fraught with resistance from individual cost centers. A value realization tool (VRT) is essential for separate cost centers to communicate and comprehend the overall financial and clinical implications of post-surgical pain management medication interventions (PSMI). The goal was to describe development of a VRT.

Methods:

An evaluation of common in-patient PSMI approaches, impacts, and costs was performed. A multidisciplinary task force guided development of the VRT to ensure appropriate representation and relevance to clinical practice. The main outcome was an Excel-based tool that communicates the overall cost/benefit of PSMI for the post-operative patient encounter.

Results:

The VRT aggregated input data on costs, clinical impact, and nursing burden of PSMI assessment and monitoring into two high-level outcome reports: Overall Cost Impact and Nurse & Patient Impact. Costs included PSMI specific medication, equipment, professional placement, labor, overall/opioid-related adverse events, re-admissions, and length of stay. Nursing impact included level of practice interference, job satisfaction, and patient care metrics. Patient impact included pain scores, opioid use, PACU time, and satisfaction. Reference data was provided for individual institutions that may not collect all variables included in the VRT.

Conclusions:

The VRT is a valuable way for administrators to assess PSMI cost/benefits and for individual cost centers to see the overall value of individual interventions. The user-friendly, decision-support tool allows the end-user to use built-in referenced or personalized outcome data, increasing relevance to their institutions. This broad picture could facilitate communication across cost centers and evidence-based decisions for appropriate use and impacts of PSMI.     

Overreaction to extreme market events and investor sentiment

This article investigates the role of investor psychology, captured here by investor sentiment index, in driving individual stock price reactions to extreme movements in the broader market. In addition to confirming prior evidence of overreaction, we find much stronger overreaction when investor sentiment is low rather than high. This is consistent with the role of the contrast dimension of an uncommon event, suggested in the psychology literature, over and above the emotion of surprise it brings about. In a low sentiment environment, the contrast is sharper and hence leads to stronger overreaction.     

Anticipating special events in Emergency Department forecasting

Accurate daily forecast of Emergency Department (ED) attendance helps roster planners in allocating available resources more effectively and potentially influences staffing. Since special events affect human behaviours, they may increase or decrease the demand for ED services. Therefore, it is crucial to model their impact and use them to forecast future attendance to improve roster planning and avoid reactive strategies. In this paper, we propose, for the first time, a forecasting model to generate both point and probabilistic daily forecast of ED attendance. We model the impact of special events on ED attendance by considering real-life ED data. We benchmark the accuracy of our model against three time-series techniques and a regression model that does not consider special events. We show that the proposed model outperforms its benchmarks across all horizons for both point and probabilistic forecasts. Results also show that our model is more robust with an increasing forecasting horizon. Moreover, we provide evidence on how different types of special events may increase or decrease ED attendance. Our model can easily be adapted for use not only by EDs but also by other health services. It could also be generalised to include more types of special events.     

“双循环”场域特征下我国体育用品制造业的机遇、挑战与应对

借助 CiteSpace 软件工具,以中国知网收录的 CSSCI 来源期刊论文为数据来源,绘制知识图谱,对我国城市社区自治相关研究的基本情况、研究热点和研究发展态势进行可视化分析。研究结果表明,以我国城市社区自治为主题的理论研究虽未一直保持较高的增长率但总体发表量仍保持较高水平;研究主题主要涉及我国城市社区自治主体及其关系、当前自治过程中所面临的困境和相应的自治策略与模式的探索;我国城市社区自治的研究从宏观层面的自治思想研究逐渐过渡到微观自治问题的讨论,研究内容与国家政策和社会现状紧密结合,但研究预见性还有待加强,在党建引领、数据治理和服务创新等方面仍有较大研究发展空间。     

Leveraging accessible tourism development through mega-events,and the disability-attitude gap

Able-bodied, and increasingly people with disabilities, represent a key audience for mega-events; occasions that act as crucibles where social problems endemic to host destinations can be exposed and tackled through targeted social policy. Drawing on the social model of disability, the paper examines how Japan utilised Tokyo 2020 as a field configuring event to disrupt systems of ableist thinking and tackle physical and attitudinal barriers restricting Persons with Disabilities (PwD) to accessible tourism. Qualitative evidence reveals national commitments to relegitimise, improve accessibility for - and acceptance toward - PwD in Japanese society, through transformations to the built environment, national awareness, and educational campaigns in the build up to Tokyo 2020. An over-emphasis on physical as opposed to social structural change mean negative attitudes often persist, where disability remains stigmatised, leading to PwD immobility and social exclusion. Our policy recommendations and managerial implications, alongside research directions attend to this disability-attitude gap.     

Penalized maximum likelihood estimation of logit-based early warning systems

Panel logit models have proved to be simple and effective tools to build early warning systems (ews) for financial crises. But because crises are rare events, the estimation of ews does not usually account for country-specific fixed effects, so as to avoid losing all the information relative to countries that never face a crisis. I propose using a penalized maximum likelihood estimator for fixed-effects logit-based ews where all the observations are retained. I show that including country effects, while preserving the entire sample, improves the predictive performance of ews, both in simulation and out of sample, with respect to the pooled, random-effects and standard fixed-effects models.     

The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy

Objective:

To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients.

Methods:

An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources.

Results:

There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR?=?0.61, 95% CI?=?0.39–0.95, p?=?0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR?=?0.29, 95% CI?=?0.15–0.55, p?=?0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR?=?1.97, 95% CI?=?1.74–2.23, p?<?0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR?=?1.47, 95% CI?=?1.32–1.64, p?<?0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations.

Conclusion:

Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.     

Institutional investors' attention to environmental information,trading strategies,and market impacts: Evidence from China

Using a large proprietary database of intraday high‐frequency trading, we investigate the trading strategies of institutional investors in dealing with the negative environmental event disclosure of listed companies and their impact on markets, aiming to reveal the mechanism of the lack of “green efficiency” in China's capital market from the perspective of institutional investors. The results show that institutional investors react to negative environmental events prior to the announcements, indicating premature information leakage in the market; in addition, their trading behaviors mitigate the immediate effect of negative environmental event announcements on stock price. After the event is disclosed, institutional investors engage in short‐term selling and long‐term buy and hold. This trading strategy undermines the irrational selling of individual investors in the event of disclosure, short‐term decline in stock price, and long‐term reversal of market overreaction. In a China context, institutional investors generally take environmental information into consideration. However, they fail to recognize the long‐term value effect of negative environmental events and instead cater to trading strategies towards market volatility.     

Generating socially responsible events at ski resorts

This study examines how ski resorts can manage events that are sustainable, while also balancing the needs of consumers and local workers. Using a mixed-method approach, quantitative results (from 710 ski tourists) highlight the influence of community-centric Corporate Social Responsibility (CSR) and Orientation towards Sporting Events (OSE) on the involvement and satisfaction of visitors in sponsorship-linked events within Iranian ski resorts. Qualitative results (from 38 local resort workers) suggest local resort workers desire community engagement, personal well-being, and rejuvenation. The implications this has for hospitality development are discussed alongside the theoretical implications for future research exploring community-based CSR and Event Social Responsibility (ESR).