Time-driven activity-based cost analysis for outpatient anticoagulation therapy: direct costs in a primary care setting with optimal performance

Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.

Methods: A population-based cross-sectional study was conducted in conjunction with observations of patient care processes between August 2014 and January 2015. The study was conducted in an academic primary care outpatient setting at Mayo Clinic’s warfarin anticoagulation clinic, Rochester, MN. The anticoagulation clinic serves patients 18?years of age or older in Warfarin therapy management, for any indication, after referral from the patient’s primary care provider. The study included anticoagulation clinic enrollment data on a population of 5,526 patients. Time-Driven Activity-Based Costing (TDABC) technique was applied. Detailed process flow maps which showed process steps for all the anticoagulation program components and care continuum phases were created. Staff roles associated with each of the process steps were identified and displayed on the maps. Process times and costs were captured and analyzed. The main outcome was direct cost of monitoring and management of anticoagulation therapy, post-initiation of therapy.

Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. (Comparator to distinguish stability: Frequency of point-of-care visits needed by patients.) For complex anticoagulation patients, total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.

Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.     

基于视频实时交互模式的英语口语情景模拟方案探索

在网络技术高度发达的今天,视频实时交互技术已成功运用于社会各个领域。通过便捷的通讯手段,充分利用视频实时交互模式多样性和灵活性的特点,使英语口语学习者摆脱时间和空间的限制,随时随地进入平台参与英语口语实践成为可能。本文旨在探讨基于视频实时交互模式下的英语口语情景模拟方案设计以及方案推广的意义及难点。     

Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS)

Objective:

The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.

Methods:

Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010–Q12013. In the model, patients’ colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.

Results:

The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.

Conclusions:

From a payer’s perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.     

论口述历史研究中个人生命史样本采集的史学价值

口述历史研究是关于个人生命史的研究,通过对个人生命史样本的采集来理解社会历史的变迁,在研究中,对个人命运的关注成为记载和表达社会心声的方式.采集个人生命史样本是进行口述历史研究的重要组成部分,也是开展相关学术研究的基础,本篇论文就将重点对其史学价值进行探究.     

The questionnaire survey of the necessity of oral English presentation in university students

The oral presentation plays an important role in the English language teaching. However, some students seems pay lit le at ention to it. This paper attempts to elaborate the significance of the oral pr...     

计算机辅助英语口语测试的效度研究

口语测试是语言教学和语言测试的一个重要构成部分。目前,计算机辅助英语口语测试成为语言测试新的发展方向。运用口语测试的理论和方法,探讨在新形势下如何组织有效、可信、实用的大规模计算机辅助英语口语测试并使其具有高效度,是高校英语测试改革和发展的必然方向。     

探索改变口语中思维缺席现象的有效途径

英语专业学生的口语水平一般高于非英语专业学生,可是英语专业学生口语中存在的思维缺席现象已成为不争的事实。产生这种思维缺席现象的原因因人而异,但通过英语演讲课上的一系列教学活动,如三点法、广泛阅读、演讲稿的写作等可以改善这一状况,可以说英语演讲课是改善英语专业学生口语思维缺席的有效途径。     

国际视野下的纪念性历史博物馆与口述历史

纪念性历史博物馆是传播人类历史文化的圣殿,是世纪文明的窗口。口述历史是一种新的记录历史和研究历史的方法,将其运用于纪念性历史博物馆的藏品资源建设、科学研究、陈列展览、社会教育工作,将极大地推进纪念性历史博物馆事业的发展。     

浅议英语口语教学中跨文化交际能力的培养

跨文化交际能力在大学英语口语教学中体现在语言能力、语用能力、策略能力.、跨文化能力。我国传统英语教学忽视了对学生跨文化差异意识的培养,导致其跨文化交际能力普遍较低。应改变学生的思维方式,注重学生跨文化差异意识的培养,在课堂教学中把语言教学与文化教学结合起来,并把文化教学寓于语言教学之中,努力探索语言中深刻的文化内涵,增强学生对目的语文化的领悟力和敏感性。     

独立学院非英语专业学生英语口语水平现状及对策

目前独立学院非英语专业学生的英语口语水平普遍较低。为提高独立学院非英语专业学生的英语口语能力,通过对一所独立学院非英语专业学生英语口语水平现状进行问卷调查,分析了其英语口语能力滞后的原因,结果表明：要提高英语口语水平,学习者要增强学习英语口语的兴趣;教师要改进教学方法,强化语音学习,以＂听＂、＂读＂、＂写＂促进口语教学,并且努力培养学习跨文化的交流意识和理解意识;要利用演讲比赛、课堂辩论、观看电影、唱英文歌曲等多种形式的活动来提高英语口语水平。