414 research outputs found
Digital online content package for "Cost measurement in value-based health care: a systematic review"
No full text
Objective Although value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making.
Design Two reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis.
Eligibility criteria Studies should measure the costs of an intervention, treatment or care path and label the study as ‘value based’. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making.
Results We identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24).
Conclusions Cost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.</p
Holistic Prison Ministry: Author Q&A with Maura Poston Zagrans
Full text linkMaura Poston Zagrans is an American Catholic poet, author, and photographer. Her book “Camerado, I Give You My Hand,” published by Image in August 2013, tells the non-fiction story of Father David T. Link, a Notre Dame University dean and lawyer who became a priest at 71 after his wife died and now works as a Catholic chaplain to inmates at Indiana State Prison.
Sean Salai, interviewed Mrs. Zagrans about her writing and work
Costs, Performance, and Accountability in an IVF Clinic:Digital innovations as a site of responsibilization
No full textAt the 2024 IPA conference I presented a single author working paper on the design, implementation, and social embedding of a co-created digital cost and performance dashboard at a fertility clinic. Modern healthcare strategies rely on increasingly granular cost and performance metrics, like patient-level costs or patient's satisfation scores. To steer daily behaviour, such organizations use dashboards or other digital innovations. Using a practice lense and ethnographic material, and by conceptualizing the innovative digital dashboard as a 'tertiary memory' (Stiegler, 1994) I show how doctors adjusted and shaped a co-constructed dashboard to suit their emotional and social needs, effectively embedding this technology in their daily practices. Under financial pressure, the dashboard was shaped by doctors to increasingly place cost and performance accountabilities onto the patient, and onto insurance companies. This rendered the dashboard as a site of moral reasoning and re-responsibilization
Costs, Performance, and Accountability in an IVF Clinic:Digital innovations as a site of responsibilization
No full textAt the 2024 IPA conference I presented a single author working paper on the design, implementation, and social embedding of a co-created digital cost and performance dashboard at a fertility clinic. Modern healthcare strategies rely on increasingly granular cost and performance metrics, like patient-level costs or patient's satisfation scores. To steer daily behaviour, such organizations use dashboards or other digital innovations. Using a practice lense and ethnographic material, and by conceptualizing the innovative digital dashboard as a 'tertiary memory' (Stiegler, 1994) I show how doctors adjusted and shaped a co-constructed dashboard to suit their emotional and social needs, effectively embedding this technology in their daily practices. Under financial pressure, the dashboard was shaped by doctors to increasingly place cost and performance accountabilities onto the patient, and onto insurance companies. This rendered the dashboard as a site of moral reasoning and re-responsibilization
The Parent Trap: A venture’s guide to parent choice and the determinants of increasing investments into ventures over time
No full textAccounting for the start of life:Shifting practices, costs, and value in an IVF clinic
No full textRising healthcare costs are a major societal concern. Yet, little is known about how costs or shortages impact medical practice, or how accounting systems can improve decision-making as care is increasingly personalized to individual patients. This dissertation investigates the co-creation and implementation of a cost management system in a fertility clinic as part of a value-based healthcare (VBHC) strategy, focusing on how clinicians use and shape accounting. It explores (1) how cost concerns impact daily medical decisions, (2) how cost variation can be traced and managed, and (3) how enabling cost information improves workforce wellbeing across medical domains and contexts. Using a predominantly interventionist research design and a practice-theoretical lens, the research combines ethnographic and quantitative methods across eight studies to develop and evaluate a tailored system—time-driven activity-based costing with process mining (TDABC-PM). Drawing on a decade of fertility care data (4190 pregnancy trajectories, 18 445 treatments), it shows how care pathway re-design (three care delivery changes) significantly reduced costs (€322–€4,089 per patient, about €1.3m nationally) and improved time-to-pregnancy. A national survey across medical domains further reveals how enabling cost information improves psychological wellbeing and motivation in the workforce.The research introduces the concept of teleological indeterminacy to examine how manager’s and clinician’s engagement with accounting practices impacts their situational judgments of what resource use is appropriate for specific patients. It advances understanding of how cost management systems—when designed with and for users—can improve care value, financial sustainability, and workforce wellbeing. It offers practical and theoretical contributions to tackling cost containment and workforce issues simultaneously.<br/
Accounting for the start of life:Shifting practices, costs, and value in an IVF clinic
No full textRising healthcare costs are a major societal concern. Yet, little is known about how costs or shortages impact medical practice, or how accounting systems can improve decision-making as care is increasingly personalized to individual patients. This dissertation investigates the co-creation and implementation of a cost management system in a fertility clinic as part of a value-based healthcare (VBHC) strategy, focusing on how clinicians use and shape accounting. It explores (1) how cost concerns impact daily medical decisions, (2) how cost variation can be traced and managed, and (3) how enabling cost information improves workforce wellbeing across medical domains and contexts. Using a predominantly interventionist research design and a practice-theoretical lens, the research combines ethnographic and quantitative methods across eight studies to develop and evaluate a tailored system—time-driven activity-based costing with process mining (TDABC-PM). Drawing on a decade of fertility care data (4190 pregnancy trajectories, 18 445 treatments), it shows how care pathway re-design (three care delivery changes) significantly reduced costs (€322–€4,089 per patient, about €1.3m nationally) and improved time-to-pregnancy. A national survey across medical domains further reveals how enabling cost information improves psychological wellbeing and motivation in the workforce.The research introduces the concept of teleological indeterminacy to examine how manager’s and clinician’s engagement with accounting practices impacts their situational judgments of what resource use is appropriate for specific patients. It advances understanding of how cost management systems—when designed with and for users—can improve care value, financial sustainability, and workforce wellbeing. It offers practical and theoretical contributions to tackling cost containment and workforce issues simultaneously.<br/
Demolir os muros dos pátios: a escritura de Maura Lopes Cançado como máquina de guerra, em O sofredor do ver
Full text linkO título desta dissertação, Demolir os muros dos pátios: a escritura de Maura Lopes Cançado como máquina de guerra, em O sofredor do ver, abre a trajetória desta pesquisa que percorre o espaço liso da criação. A partir da leitura da obra da autora, Hospício é Deus e O sofredor do ver, foi possível traçar uma linha para este estudo, no qual a finalidade não é a chegada, mas, sim, o percurso. Centrando-me no O sofredor do ver, o livro de contos de Maura, recorro, principalmente, aos conceitos inventados por Gilles Deleuze e Félix Guattari para afirmar a escritura da autora como uma máquina de guerra, por meio da qual ela se desterritorializa dos espaços de confinamento e se reterretorializa em um outro espaço: o literário. Nesta trajetória, constatei, e não foi surpresa, que os fatos biográficos da autora repercutem na recepção, pesquisas e críticas sobre a sua obra. Desse modo, a autora é novamente silenciada e confinada à loucura, o que desmerece a sua potência como autora. Maura Lopes Cançado não pode ser reduzida a uma escritora louca, ou a uma louca escritora. Maura, como autora, pede voz nesta trajetória – um percurso de dois corpos, o meu e o dela, é também atravessado por outros corpos, inclusive pelos leitores desta pesquisa. Façamos um rizoma. O(s) Eu(s) se desfaz(em)The title of this research, Demolish the courtyard walls: the scripture of Maura Lopes Cançado as a war machine, in O sofredor do ver, opens the path of this research that walks the smooth space of the creation. By reading the work of the author, Hospício é Deus and O sofredor do ver, it was possible to trace a line for this research, in which the aim is not the finishing line, but the path. Focusing on O sofredor do ver, the book of tales of Maura, I resort, mainly, to the concepts invented by Giles Deleuze and Félix Guattari to affirm the scripture of the author as a War machine, by which, through the writing, she deterritorializes herself from the spaces of confinement by reterritorializing in another space: the literary. In this trajectory, I noticed, and it was not a surprise, that the biographical facts of the author reverberate in reception, researches and critics about her work. Thus, the author is again silenced and confined to madness, which diminishes her potency as an author. Maura Lopes Cançado can not be reduced to a crazy writer, or a mad person. Maura, as an author, asks for voice in this trajectory - a path of two bodies, mine and hers, is also crossed by other ones, including the readers of this research. We make a rhizome. The Self(s) falls apartCoordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPE
“Hacer nuestra la existencia de un vacío”: el entramado intertextual de Los girasoles ciegos como instrumento de cohesión entre las cuatro “derrotas”
Full text linkThis article aims at tracing a map of the complex intertextual geography that can be detected in Alberto Méndez’s Los girasoles ciegos, a cycle of four interconnected short stories articulated upon the compromise of the author towards the celebration in contemporary Spain of a shared mourning. Entirely shaped in the transgenerational elaboration of an (extra)fictional system of confrontation with the collective trauma of the Spanish civil war and post-war period, the collection emphasises the –sometimes evident, some other secluded– connections among four stories of historical winners or losers of the conflict, who come to be all equally defeated by it. Through a careful journey through the intertextual crossroads which transversally join the four parts of the book, the argumentation will devote itself to the analysis of the implications, meanings and effects of a presence of the “alien” text which seems at the same time overwhelming, fascinating and loaded with implications.
Keywords: Alberto Méndez, Los girasoles ciegos, intertextuality, postmemory, ultracontemporary Spanish literature.Este artículo pretende dibujar un mapa de la compleja geografía intertextual que se aprecia en Los girasoles ciegos de Alberto Méndez, una colección de cuatro cuentos entrelazados que hace del compromiso del autor con la celebración en la España contemporánea de un duelo compartido su bandera narrativa. Enteramente centrada en la elaboración transgeneracional de un sistema (extra)ficcional de confrontación con el trauma común de la guerra civil española y de la primera postguerra, la obra enfatiza los lazos de conexión –a veces manifiestos, a veces ocultos– entre cuatro historias de vencedores y vencidos que resultan todos, inexorablemente, derrotados por el conflicto. A través de un viaje puntual por las encrucijadas intertextuales que unen transversalmente los cuatro cuentos, se intentará analizar las implicaciones, los significados y los efectos de una presencia del texto “otro” que resulta a la vez abrumadora, fascinante y cargada de significados
Fase 12. Le ricostruzioni delle case. Casa 9, pp. 63-100; Fase 15. Terze modifiche edilizie. Casa 9, pp. 133-144
No full textIl volume ‘Palatium e sacra via II’ presenta i risultati degli scavi condotti alle pendici settentrionali del Palatino tra il 1985 e il 1990, nel settore immediatamente adiacente all’arco di Tito. La fase considerata è quella che va dall’epoca tardo – repubblicana all’epoca proto – imperiale, quando il quartiere era occupato da ricche domus private. L’Autrice tratta della più grande tra queste dimore aristocratiche, caratterizzata dalla presenza di un vasto piano ipogeo in cui trovano posto un edificio termale e oltre trenta stanze di piccole dimensioni, ciascuna dotata di un letto e di una latrina, che probabilmente erano celle per alloggiare gli schiavi. Secondo le ipotesi formulate nell’ambito di questo studio, questa domus potrebbe essere identificata con la casa di M. Aemilius Scaurus il giovane, personaggio noto dalle fonti letterarie, e in particolare per le numerose citazioni nella Naturalis Historia di Plinio il Vecchio (si veda altra voce bibliografica dell’Autrice).The volume ‘Palatium e sacra via II’ presents the results of the excavations conducted between 1985 and 1990, at the northern foot of the Palatine hill, in the area immediately adjacent to the Arch of Titus. The chronological phase considered is the one that goes from the late – Republican era, until the proto – Imperial era, when the district was occupied by wealthy private domus. The Author studies the largest of these aristocratic houses, characterized by the presence of a vast underground floor, in which there are a bath complex, and over thirty small rooms, each equipped with a bed and a toilet, to be probably identified as the cells for the slaves. According to the assumption made in this study, this domus should be identified with the house of M. Aemilius Scaurus the Young, a well-known Roman politician, often mentioned in the literary sources, and in particular by Pliny the Elder in the Naturalis Historia (see other entry of bibliography of the Author)
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