Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

Life Cycle Modelling and Design Knowledge Development in 3D Virtual Environments

Experience plays an important role in building management. “How often will this asset need repair?” or “How much time is this repair going to take?” are types of questions that project and facility managers face daily in planning activities. Failure or success in developing good schedules, budgets and other project management tasks depend on the project manager's ability to obtain reliable information to be able to answer these types of questions. Young practitioners tend to rely on information that is based on regional averages and provided by publishing companies. This is in contrast to experienced project managers who tend to rely heavily on personal experience. Another aspect of building management is that many practitioners are seeking to improve available scheduling algorithms, estimating spreadsheets and other project management tools. Such “micro-scale” levels of research are important in providing the required tools for the project manager's tasks. However, even with such tools, low quality input information will produce inaccurate schedules and budgets as output. Thus, it is also important to have a broad approach to research at a more “macro-scale.” Recent trends show that the Architectural, Engineering, Construction (AEC) industry is experiencing explosive growth in its capabilities to generate and collect data. There is a great deal of valuable knowledge that can be obtained from the appropriate use of this data and therefore the need has arisen to analyse this increasing amount of available data. Data Mining can be applied as a powerful tool to extract relevant and useful information from this sea of data. Knowledge Discovery in Databases (KDD) and Data Mining (DM) are tools that allow identification of valid, useful, and previously unknown patterns so large amounts of project data may be analysed. These technologies combine techniques from machine learning, artificial intelligence, pattern recognition, statistics, databases, and visualization to automatically extract concepts, interrelationships, and patterns of interest from large databases. The project involves the development of a prototype tool to support facility managers, building owners and designers. This Industry focused report presents the AIMMTM prototype system and documents how and what data mining techniques can be applied, the results of their application and the benefits gained from the system. The AIMMTM system is capable of searching for useful patterns of knowledge and correlations within the existing building maintenance data to support decision making about future maintenance operations. The application of the AIMMTM prototype system on building models and their maintenance data (supplied by industry partners) utilises various data mining algorithms and the maintenance data is analysed using interactive visual tools. The application of the AIMMTM prototype system to help in improving maintenance management and building life cycle includes: (i) data preparation and cleaning, (ii) integrating meaningful domain attributes, (iii) performing extensive data mining experiments in which visual analysis (using stacked histograms), classification and clustering techniques, associative rule mining algorithm such as “Apriori” and (iv) filtering and refining data mining results, including the potential implications of these results for improving maintenance management. Maintenance data of a variety of asset types were selected for demonstration with the aim of discovering meaningful patterns to assist facility managers in strategic planning and provide a knowledge base to help shape future requirements and design briefing. Utilising the prototype system developed here, positive and interesting results regarding patterns and structures of data have been obtained.

Using data mining to improve building life cycle

The building life cycle process is complex and prone to fragmentation as it moves through its various stages. The number of participants, and the diversity, specialisation and isolation both in space and time of their activities, have dramatically increased over time. The data generated within the construction industry has become increasingly overwhelming. Most currently available computer tools for the building industry have offered productivity improvement in the transmission of graphical drawings and textual specifications, without addressing more fundamental changes in building life cycle management. Facility managers and building owners are primarily concerned with highlighting areas of existing or potential maintenance problems in order to be able to improve the building performance, satisfying occupants and minimising turnover especially the operational cost of maintenance. In doing so, they collect large amounts of data that is stored in the building’s maintenance database. The work described in this paper is targeted at adding value to the design and maintenance of buildings by turning maintenance data into information and knowledge. Data mining technology presents an opportunity to increase significantly the rate at which the volumes of data generated through the maintenance process can be turned into useful information. This can be done using classification algorithms to discover patterns and correlations within a large volume of data. This paper presents how and what data mining techniques can be applied on maintenance data of buildings to identify the impediments to better performance of building assets. It demonstrates what sorts of knowledge can be found in maintenance records. The benefits to the construction industry lie in turning passive data in databases into knowledge that can improve the efficiency of the maintenance process and of future designs that incorporate that maintenance knowledge.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.

Whole of life cycle cost analysis in bridge rehabilitation

The report presents a methodology for whole of life cycle cost analysis of alternative treatment options for bridge structures, which require rehabilitation. The methodology has been developed after a review of current methods and establishing that a life cycle analysis based on a probabilistic risk approach has many advantages including the essential ability to consider variability of input parameters. The input parameters for the analysis are identified as initial cost, maintenance, monitoring and repair cost, user cost and failure cost. The methodology utilizes the advanced simulation technique of Monte Carlo simulation to combine a number of probability distributions to establish the distribution of whole of life cycle cost. In performing the simulation, the need for a powerful software package, which would work with spreadsheet program, has been identified. After exploring several products on the market, @RISK software has been selected for the simulation. In conclusion, the report presents a typical decision making scenario considering two alternative treatment options.

Preliminary report on data mining techniques for life prediction

This project is an extension of a previous CRC project (220-059-B) which developed a program for life prediction of gutters in Queensland schools. A number of sources of information on service life of metallic building components were formed into databases linked to a Case-Based Reasoning Engine which extracted relevant cases from each source. In the initial software, no attempt was made to choose between the results offered or construct a case for retention in the casebase. In this phase of the project, alternative data mining techniques will be explored and evaluated. A process for selecting a unique service life prediction for each query will also be investigated. This report summarises the initial evaluation of several data mining techniques.

Final Report : learning system for life prediction of infrastructure

The project has further developed two programs for the industry partners related to service life prediction and salt deposition. The program for Queensland Department of Main Roads which predicts salt deposition on different bridge structures at any point in Queensland has been further refined by looking at more variables. It was found that the height of the bridge significantly affects the salt deposition levels only when very close to the coast. However the effect of natural cleaning of salt by rainfall was incorporated into the program. The user interface allows selection of a location in Queensland, followed by a bridge component. The program then predicts the annual salt deposition rate and rates the likely severity of the environment. The service life prediction program for the Queensland Department of Public Works has been expanded to include 10 common building components, in a variety of environments. Data mining procedures have been used to develop the program and increase the usefulness of the application. A Query Based Learning System (QBLS) has been developed which is based on a data-centric model with extensions to provide support for user interaction. The program is based on number of sources of information about the service life of building components. These include the Delphi survey, the CSIRO Holistic model and a school survey. During the project, the Holistic model was modified for each building component and databases generated for the locations of all Queensland schools. Experiments were carried out to verify and provide parameters for the modelling. These included instrumentation of a downpipe, measurements on pH and chloride levels in leaf litter, EIS measurements and chromate leaching from Colorbond materials and dose tests to measure corrosion rates of new materials. A further database was also generated for inclusion in the program through a large school survey. Over 30 schools in a range of environments from tropical coastal to temperate inland were visited and the condition of the building components rated on a scale of 0-5. The data was analysed and used to calculate an average service life for each component/material combination in the environments, where sufficient examples were available.

Citizen journalism and everyday life : A case study of Germany’s myHeimat.de

Much recent research into citizen journalism has focussed on its role in political debate and deliberation. Such research examines important questions about citizen participation in democratic processes – however, it perhaps places undue focus on only one area of journalistic coverage, and presents a challenge which only a small number of citizen journalism projects can realistically hope to meet. A greater opportunity for broad-based citizen involvement in journalistic activities may lie outside of politics, in the coverage of everyday community life. A leading exponent of this approach is the German-based citizen journalism Website myHeimat.de, which provides a nationwide platform for participants to contribute reports about events in their community. myHeimat takes a hyperlocal approach but also allows for content aggregation on specific topics across multiple local communities; Hannover-based newspaper publishing house Madsack has recently acquired a stake in the project. Drawing on extensive interviews with myHeimat CEO Martin Huber and Madsack newspaper editors Peter Taubald and Clemens Wlokas during October 2008, this paper analyses the myHeimat project and examines its applicability beyond rural and regional areas in Germany; it investigates the question of what role citizen journalism may play beyond the political realm.

Strategies for minimising the whole of life cycle cost of reinforced concrete bridge exposed to aggressive environments

n design of bridge structures, it is common to adopt a 100 year design life. However, analysis of a number of case study bridges in Australia has indicated that the actual design life can be significantly reduced due to premature deterioration resulting from exposure to aggressive environments. A closer analysis of the cost of rehabilitation of these structures has raised some interesting questions. What would be the real service life of a bridge exposed to certain aggressive environments? What is the strategy of conducting bridge rehabilitation? And what are the life cycle costs associated with rehabilitation? A research project funded by the CRC for Construction Innovation in Australia is aimed at addressing these issues. This paper presents a concept map for assisting decision makers to appropriately choose the best treatment for bridge rehabilitation affected by premature deterioration through exposure to aggressive environments in Australia. The decision analysis is referred to a whole of life cycle cost analysis by considering appropriate elements of bridge rehabilitation costs. In addition, the results of bridges inspections in Queensland are presented

Challenges in residual service life assessment for refurbishment

A need for an efficient life care management of building portfolio is becoming increasingly due to increase in aging building infrastructure globally. Appropriate structural engineering practices along with facility management can assist in optimising the remaining life cycle costs for existing public building portfolio. A more precise decision to either demolish, refurbish, do nothing or rebuilt option for any typical building under investigation is needed. In order to achieve this, the status of health of the building needs to be assessed considering several aspects including economic and supply-demand considerations. An investment decision for a refurbishment project competing with other capital works and/or refurbishment projects can be supported by emerging methodology residual service life assessment. This paper discusses challenges in refurbishment projects of public buildings and with a view towards development of residual service life assessment methodology