Definição de um modelo de incentivo de profissionais de saúde em contexto de integração vertical e financiamento capitativo de cuidados de saúde

RESUMO - Contexto Os indivíduos, tal como as instituições, não são imunes a incentivos. No entanto, enquanto os modelos de incentivos das instituições têm sido alvo de diferentes evoluções, o mesmo não se verificou ao nível dos profissionais. Esta situação não se figura compatível com a complexidade de gestão de recursos humanos, devendo ser obviada para potenciar o alinhamento entre os interesses institucionais e os dos próprios profissionais. Objectivos Estudar a atribuição de incentivos a profissionais de saúde no contexto de organizações com integração vertical de cuidados. Metodologia A metodologia adoptada compreendeu três fases. Numa primeira procedeu-se à revisão sistemática de literatura relativa à: (1) construção de modelos de incentivo a profissionais em diferentes sistemas de saúde e tipo de prestadores; e (2) identificação de medidas de custo-efectividade comprovada. Tendo por base esta evidência, a par de documentação oficial ao nível do modelo de financiamento das ULS, procedeu-se, numa segunda fase, à construção de um modelo de incentivo base com recurso à ferramenta Microsoft Excel. Por último, numa terceira etapa, procedeu-se à adaptação do modelo base construído na etapa transacta tendo por base informação obtida mediante a realização de um estudo retrospectivo in loco na ULS do Baixo Alentejo (ULSBA). Em adição, procedeu-se à estimativa do impacto na perspectiva da ULS e dos profissionais para o cenário base e diversas análises de sensibilidade. Resultados No que respeita à estrutura, o modelo base de incentivos a profissionais apresenta 44 indicadores, distribuídos por cinco dimensões de análise, sendo que 28 indicadores (63,6%) são de processo e 14 (31,8%) de resultado. Relativamente às dimensões em análise, verifica-se uma predominância de indicadores ao nível da dimensão eficiência e qualidade assistencial, totalizando 35 (i.e. 79,5% dos 44 indicadores). No que respeita ao destinatário, 14 indicadores (31,8%) apresentam uma visão holística da ULS, 17 (38,6%) encontram-se adstritos unicamente aos cuidados primários e os remanescentes 13 (29,5%) aos cuidados hospitalares. Cerca de 85% dos actuais incentivos da ULSBA decorre da unidade de pagamento salarial secundada pelo pagamento de suplementos (12%). Não obstante, o estudo retrospectivo da ULSBA confirmou o cenário expectável de ausência de um modelo de incentivo homogéneos e transversal à ULS, transparecendo importantes assimetrias entre diferentes unidades prestadoras e/ou profissionais de saúde. De forma relevante importa apontar a insuficiência de incentivos capitacionais (ao contrário do que sucede com o modelo de incentivo da própria ULSBA) ou adstritos a índices de desempenho. Tendo em consideração o modelo de incentivo concebido e adaptado à realidade da ULSBA, a par do plano de implementação, estima-se que o modelo de incentivos gere: (1) poupanças na perspectiva da ULS (entre 2,5% a 3,5% do orçamento global da ULSBA); e (2) um incremento de remuneração ao nível dos profissionais (entre 5% a 15% do salario base). O supracitado – aparentemente contraditório - decorre da aposta em medidas de custo-efectividade contrastada e um alinhamento entre o modelo proposto e o vigente para o próprio financiamento da unidade, apostando numa clara estratégia de ganhos mútuos. As análises de sensibilidade realizadas permitem conferir a solidez e robustez do modelo a significativas variações em parâmetros chave.

Pattern operators for grid

The definition and programming of distributed applications has become a major research issue due to the increasing availability of (large scale) distributed platforms and the requirements posed by the economical globalization. However, such a task requires a huge effort due to the complexity of the distributed environments: large amount of users may communicate and share information across different authority domains; moreover, the “execution environment” or “computations” are dynamic since the number of users and the computational infrastructure change in time. Grid environments, in particular, promise to be an answer to deal with such complexity, by providing high performance execution support to large amount of users, and resource sharing across different organizations. Nevertheless, programming in Grid environments is still a difficult task. There is a lack of high level programming paradigms and support tools that may guide the application developer and allow reusability of state-of-the-art solutions. Specifically, the main goal of the work presented in this thesis is to contribute to the simplification of the development cycle of applications for Grid environments by bringing structure and flexibility to three stages of that cycle through a commonmodel. The stages are: the design phase, the execution phase, and the reconfiguration phase. The common model is based on the manipulation of patterns through pattern operators, and the division of both patterns and operators into two categories, namely structural and behavioural. Moreover, both structural and behavioural patterns are first class entities at each of the aforesaid stages. At the design phase, patterns can be manipulated like other first class entities such as components. This allows a more structured way to build applications by reusing and composing state-of-the-art patterns. At the execution phase, patterns are units of execution control: it is possible, for example, to start or stop and to resume the execution of a pattern as a single entity. At the reconfiguration phase, patterns can also be manipulated as single entities with the additional advantage that it is possible to perform a structural reconfiguration while keeping some of the behavioural constraints, and vice-versa. For example, it is possible to replace a behavioural pattern, which was applied to some structural pattern, with another behavioural pattern. In this thesis, besides the proposal of the methodology for distributed application development, as sketched above, a definition of a relevant set of pattern operators was made. The methodology and the expressivity of the pattern operators were assessed through the development of several representative distributed applications. To support this validation, a prototype was designed and implemented, encompassing some relevant patterns and a significant part of the patterns operators defined. This prototype was based in the Triana environment; Triana supports the development and deployment of distributed applications in the Grid through a dataflow-based programming model. Additionally, this thesis also presents the analysis of a mapping of some operators for execution control onto the Distributed Resource Management Application API (DRMAA). This assessment confirmed the suitability of the proposed model, as well as the generality and flexibility of the defined pattern operators

Assessing the balance between biodiversity conservation and coastal and estuarine management of the Sado Estuary Natural Reserve, Portugal, using BIO-SAFE

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia do Ambiente, perfil de Engenharia Ecológica

Recursive neuro fuzzy techniques for online identification and control

Dissertação para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores

Social impact bond feasibility study

Youth unemployment is one of the most pressing social issues in Portugal, often associated to a lack of skills. Faz-Te Forward (FFWD), a Portuguese employability programme, has demonstrated great potential for impact in solving this issue, especially amongst a neglected segment of the population – those belonging to “sandwich families”. The present thesis, integrated in the SIB Research Programme from the Social Investment Lab, evaluates the feasibility of this programme to be financed through a Social Impact Bond, an innovative outcomes-based financing model. From a data analysis undertaken to FFWD’s historical information, a business case for a SIB was developed.

A systematic methodology to analyse the performance and design configurations of business interoperability in cooperative industrial networks

This thesis proposes a methodology for modelling business interoperability in a context of cooperative industrial networks. The purpose is to develop a methodology that enables the design of cooperative industrial network platforms that are able to deliver business interoperability and the analysis of its impact on the performance of these platforms. To achieve the proposed objective, two modelling tools have been employed: the Axiomatic Design Theory for the design of interoperable platforms; and Agent-Based Simulation for the analysis of the impact of business interoperability. The sequence of the application of the two modelling tools depends on the scenario under analysis, i.e. whether the cooperative industrial network platform exists or not. If the cooperative industrial network platform does not exist, the methodology suggests first the application of the Axiomatic Design Theory to design different configurations of interoperable cooperative industrial network platforms, and then the use of Agent-Based Simulation to analyse or predict the business interoperability and operational performance of the designed configurations. Otherwise, one should start by analysing the performance of the existing platform and based on the achieved results, decide whether it is necessary to redesign it or not. If the redesign is needed, simulation is once again used to predict the performance of the redesigned platform. To explain how those two modelling tools can be applied in practice, a theoretical modelling framework, a theoretical Axiomatic Design model and a theoretical Agent-Based Simulation model are proposed. To demonstrate the applicability of the proposed methodology and/or to validate the proposed theoretical models, a case study regarding a Portuguese Reverse Logistics cooperative network (Valorpneu network) and a case study regarding a Portuguese construction project (Dam Baixo Sabor network) are presented. The findings of the application of the proposed methodology to these two case studies suggest that indeed the Axiomatic Design Theory can effectively contribute in the design of interoperable cooperative industrial network platforms and that Agent-Based Simulation provides an effective set of tools for analysing the impact of business interoperability on the performance of those platforms. However, these conclusions cannot be generalised as only two case studies have been carried out. In terms of relevance to theory, this is the first time that the network effect is addressed in the analysis of the impact of business interoperability on the performance of networked companies and also the first time that a holistic approach is proposed to design interoperable cooperative industrial network platforms. Regarding the practical implications, the proposed methodology is intended to provide industrial managers a management tool that can guide them easily, and in practical and systematic way, in the design of configurations of interoperable cooperative industrial network platforms and/or in the analysis of the impact of business interoperability on the performance of their companies and the networks where their companies operate.

E-Health individual adoption - empirical model based on UTAUT 2.

The future of health care delivery is becoming more citizen-centred, as today’s user is more active, better informed and more demanding. The European Commission is promoting online health services and, therefore, member states will need to boost deployment and use of online services. This makes e-health adoption an important field to be studied and understood. This study applied the extended unified theory of acceptance and usage technology (UTAUT2) to explain patients’ individual adoption of e-health. An online questionnaire was administrated Portugal using mostly the same instrument used in UTAUT2 adapted to e-health context. We collected 386 valid answers. Performance expectancy, effort expectancy, social influence, and habit had the most significant explanatory power over behavioural intention and habit and behavioural intention over technology use. The model explained 52% of the variance in behavioural intention and 32% of the variance in technology use. Our research helps to understand the desired technology characteristics of ehealth. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt e-health systems or not.

NEGOSEIO: framework for the sustainability of model-oriented enterprise interoperability

Dissertation to obtain the degree of Doctor of Philosophy in Electrical and Computer Engineering(Industrial Information Systems)

An analysis of teachers' environmental concerns: use of a conceptual change model

Tese de doutoramento em Ciências da Educação

Component-based software engineering: a quantitative approach

Dissertação apresentada para a obtenção do Grau de Doutor em Informática pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Petri net model decomposition - a model based approach supporting distributed execution

Dissertação apresentada para obtenção do Grau de Doutor em Engenharia Electrotécnica, Especialidade de Sistemas Digitais, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Service-oriented mobility of java code in web services-based architectures

Dissertação apresentada na Faculdade de Ciências e Tecnologias da Universidade Nova de Lisboa para a obtenção do Grau de Mestre em Engenharia Informática

The adoption of cloud computing by SMEs: identifying and coping with external factors.

Comunicação apresentada na CAPSI 2011 - 11ª Conferência da Associação Portuguesa de Sistemas de Informação – A Gestão de Informação na era da Cloud Computing, Lisboa, ISEG/IUL-ISCTE/, 19 a 21 de Outubro de 2011.

Modulation of inflammatory mediators by Opuntia ficus-indica and Prunus avium bioproducts using an in vitro cell-based model of intestinal inflammation

Dissertation to obtain a Master Degree in Biotechnology

Information Systems Outsourcing Adoption

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação