Bridging Healthcare and Health IT

Health IT （Information Technology） is new to the healthcare industry, even though the term surfaced in 2008 the true meaning of what it is and how data aggregation, evaluation, and validation of patient data and information drives a successful quality healthcare organization. Understanding of key factors, what quality is and how it is measured, helps bridge together healthcare and technology for an organization to be successful in reporting quality measures for the best patient care.

Research on the Dynamic Relationships among Taiwan’s Early Childhood Education and Its Stakeholders: The System Dynamics Perspective

In Taiwan,the low birth rate has become one of the most critical problems faced by the government and educational institutions at all levels.The enrolling student number of kindergartens perhaps is the most directly affected by such trend.The purpose of this study aims at constructing a system dynamics model to depict the relationships between the preschool children and their stakeholders for deducing the evolutionary trends of,and the interactions of,governmental policies and the operations of the early childhood education institutions.Through the interpretation of policies and simulation analysis of the twenty-year growth trend related to the child population in Taiwan,this study found that governmental policies and the promotion of education and care services have a positive effect on the growth of all levels of kindergarten classes.Besides,the relationship between the education and care service staff and the kindergarten play a causal balancing role in our proposed model.We suggest that the system dynamics model proposed by this study can help to observe the dynamic relationships formed by the stakeholders in preschool education and care system based on the“joint responsibility”of Taiwan’s early childhood education.

An exploratory study of the growth of the Accountable Care Organization and its impact on physician groups’ profit: a complex adaptive system approach

The emergence of Accountable Care Organizations(ACOs)in the landscape of the U.S.healthcare system marks a paradigm shift in healthcare operations.The potential impact of ACOs has been a topic of intense debate.Traditional analytical approaches do not lend themselves to examining the complex phenomenon of the emergence and growth of ACOs in the healthcare network.We adopt a complex adaptive system lens to examine the growth of ACOs among physician groups and explore factors that influence this growth.We also discuss the impact of ACOs on the profit of physician groups.An agent-based model was built to simulate physician groups'ACO entrance and exit based on a set of simple rules and their complex interactions with other agents.Based on the simulation results,we derive patterns of ACO expansion and contraction,following four stages of wait-and-see,rollercoaster,fast growth,and stabilizing.Findings suggest that the growth of ACOs is sensitive to the initial state of ACO membership.When the initial size of ACO membership increases,it helps to eliminate the rollercoaster stage.In addition,the growth of the ACO varies depending on the cost–quality tradeoff.When both cost and quality objectives can be met simultaneously,the growth of ACO membership follows wait-and-see and fast growth stages followed by a different stage that we term sticky state.The impact of ACOs on physician groups’cumulative profit varies by the service quality level of the physician group.Physician groups affiliated with insurance companies charging the lowest or the highest level of health insurance premiums are worse off with the ACO option.However,the ACO benefits physician groups affiliated with an insurance company charging a moderate level of premiums.

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Background:Low-and middle-income countries are facing an increasing burden of disability and death due to cardiovascular diseases.Policy makers and healthcare providers alike need resource estimation tools to improve healthcare delivery and to strengthen healthcare systems to address this burden.We estimated the direct medical costs of primary prevention,screening,and management for cardiovascular diseases in a primary healthcare center in Nepal based on the Global Hearts evidence based treatment protocols for risk-based management.Methods:We adapted the World Health Organization’s non-communicable disease costing tool and built a model to predict the annual cost of primary CVD prevention,screening,and management at a primary healthcare center level.We used a one-year time horizon and estimated the cost from the Nepal government’s perspective.We used Nepal health insurance board’s price for medicines and laboratory tests,and used Nepal government’s salary for human resource cost.With the model,we estimated annual incremental cost per case,cost for the entire population,and cost per capita.We also estimated the amount of medicines for one-year,annual number of laboratory tests,and the monthly incremental work load of physicians and nurses who deliver these services.Results:For a primary healthcare center with a catchment population of 10,000,the estimated cost to screen and treat 50%of eligible patients is USD21.53 per case and averages USD1.86 per capita across the catchment population.The cost of screening and risk profiling only was estimated to be USD2.49 per case.At same coverage level,we estimated that an average physician’s workload will increase annually by 190 h and by 111 h for nurses,i.e.,additional 28.5 workdays for physicians and 16.7 workdays for nurses.The total annual cost could amount up to USD18,621 for such a primary healthcare center.Conclusion:This is a novel study for a PHC-based,primary CVD risk-based management program in Nepal,which can provide insights for programmatic and policy planners at the Nepalese municipal,provincial and central levels in implementing the WHO Global Hearts Initiative.The costing model can serve as a tool for financial resource planning for primary prevention,screening,and management for cardiovascular diseases in other low-and middleincome country settings globally.

Country size bias in global health:crosscountry comparison of malaria policy and foreign aid

Background:Foreign aid has been shown to be favourably biased towards small countries.This study investigated whether country size bias also occurs in national malaria policy and development assistance from international agencies.Methods:Data from publicly available sources were collected with countries as observational units.The exploratory data analysis was based on the conceptual framework with socio-economic,environmental and institutional parameters.The strength of relationships was estimated by the Pearson and polychoric correlation coefficients.The correlation matrix was explored by factor analysis.Results:Malaria burden is strongly correlated with GDP per capita,total health expenditure per capita,HDI;moderately with latitude,weakly with elevation,urban population share,per capita funding from the Global Fund,PMI USAID,UK government and UNICEF.Small country status is strongly correlated with population size,land area,island status;moderately with development assistance received per capita,weakly with funding per capita from Global Fund,government NMP and PMI USAID.Policy score 1,a variable derived from our factor analysis and related to malaria endemicity,is significantly strongly correlated with the malaria burden,moderately with HDI,GDP per capita,total health expenditure per capita,PMI USAID funding;weakly with island status,urban population share,latitude,coastal population share,total government expenditure and trade openness,Global Fund funding,World Bank funding,UK government funding,and UNICEF funding per capita.Policy score 2,which captures variation not related to malaria endemicity,is significantly weakly related to the ICRG index,PMI USAID funding per capita and small country status.Conclusions:The results suggest that malaria burden and economic development are bidirectionally related.Economic development can contribute to a reduction in the malaria burden.Country size does not negatively impact malaria burden,but it does account for greater development assistance per capita from selected international agencies.National malaria policy is associated with parameters related to public governance and is modified in small countries.Small country bias is present in the distribution of socio-economic resources and the allocation of foreign aid.Small countries are characterized by distinct environmental and socio-political properties.

The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.

Clinical Study on Tuina Combined with Auricular Point Sticking for Cervical Radiculopathy

Objective: To observe the clinical effect of tuina combined with auricular point sticking on cervical radiculopathy and evaluate in health economics. Methods: Using randomized single-blind controlled clinical design, a total of 72 cases with cervical radiculopathy were randomly allocated into an observation group or a control group by the ratio of 1:1, 36 in each group. Cases in the observation group were treated with tuina combined with auricular point sticking, whereas cases in the control group were treated with tuina alone. Then the clinical effects in the two groups were observed and the cost of health economics was evaluated. Results: The drop-out, recovery, improvement and failure cases, recovery rate and total effective rate in the observation group were 1, 15, 20, 0, 42.9% and 100% respectively, versus 2, 6, 23, 5, 17.6% and 85.3% in the control group, showing significant differences in recovery rate and total effective rate(P<0.05). As for health economics, the cost-effect in the observation group was better than that in the control group. Conclusion: Compared with tuina alone, tuina combined with auricular point sticking can obtain better effect and lower cost in health economics for cervical radiculopathy.