Medicare's prospective payment system : strategies for evaluating cost, quality, and medical technology.

"OTA-H-262"--P. [4] of cover.

Enhancing governmental productivity through competition : a new way of doing business within the government, to provide quality government at least cost : a progress report on OMB circular no. A-76, "performance of commercial activities."

Mode of access: Internet.

Illinois state transportation plan, 2007 : safety, cost effective, quality of life, economic prosperity, environment.

"12/07"--Colophon.

Water resources availability, quality, and cost in northeastern Illinois /

Bibliography: p. 88-90.

Coastal recreation water quality monitoring and notification : report (to accompany H.R. 1721) (including cost estimate of the Congressional Budget Office).

"November 14, 2005."

Quality of surgical care [microform] : hearings before the Subcommittee on Oversight and Investigations of the Committee on Interstate and Foreign Commerce, House of Representatives, Ninety-fifth Congress, first session, on important cost and quality issues of health care ....

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

Teledermatology can produce high-quality care at low cost

Teledermatology can provide both accurate and reliable specialist care at a distance. This article reviews current data on the quality of care that teledermatology provides, as well as the societal cost benefits involved in the implementation of the technique. Teledermatology is most suited to patients unable to access specialist. services for geographical or social reasons. Patients are generally satisfied with the overall care that teledermatology provides. Real-time teledermatology is more expensive than conventional care for health services. However, significant savings can be expected from the patient's perspective due to reduced travel. Appropriate patient selection, improved technology and adequate clinical workloads may improve both the quality and cost effectiveness of this service.

Achieving low cost and high quality aero structure assembly through integrated digital metrology systems

Measurement assisted assembly (MAA) has the potential to facilitate a step change in assembly efficiency for large structures such as airframes through the reduction of rework, manually intensive processes and expensive monolithic assembly tooling. It is shown how MAA can enable rapid part-to-part assembly, increased use of flexible automation, traceable quality assurance and control, reduced structure weight and improved aerodynamic tolerances. These advances will require the development of automated networks of measurement instruments; model based thermal compensation, the automatic integration of 'live' measurement data into variation simulation and algorithms to generate cutting paths for predictive shimming and drilling processes. This paper sets out an architecture for digital systems which will enable this integrated approach to variation management. © 2013 The Authors.

Costs, quality of life and cost-effectiveness of open and arthroscopic repair for rotator cuff tears : economic evaluation alongside the UKUFF trial

FUNDING & ACKNOWLEDGEMENTS This project was funded by the NIHR Health Technology Assessment programme (project number 05/47/02) and is published in full in Health Technology Assessment; Vol. 19, No. 80. Further information available at: http://www.nets.nihr.ac.uk/projects/hta/054702 This paper presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HTA programme or the Department of Health. Due to the confidential nature of the trial data supporting this publication not all of the data can be made accessible to other researchers. Please contact the UKUFF study principal investigator Andrew Carr (andrew.carr@ndorms.ox.ac.uk) for more information. The authors wish to thank the UKUFF trial collaborators for their contribution in managing the conduct of the trial, and for their comments on the interim economic results: Marion Campbell and Hannah Bruhn (Centre for Healthcare Randomised Trials, HSRU, University of Aberdeen), Jonathan Rees MD and David Beard (NDORMS, University of Oxford; NIHR Oxford Biomedical Research Centre), Jane Moser (NDORMS, University of Oxford), Raymond Fitzpatrick and Jill Dawson (NDPH, University of Oxford).

A cost-efficiency and health benefit approach to improve urban air quality

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

Thermal and air quality modeling of an electric vehicle cabin with low-cost sensors and reinforcement learning

The design process of any electric vehicle system has to be oriented towards the best energy efficiency, together with the constraint of maintaining comfort in the vehicle cabin. Main aim of this study is to research the best thermal management solution in terms of HVAC efficiency without compromising occupant’s comfort and internal air quality. An Arduino controlled Low Cost System of Sensors was developed and compared against reference instrumentation (average R-squared of 0.92) and then used to characterise the vehicle cabin in real parking and driving conditions trials. Data on the energy use of the HVAC was retrieved from the car On-Board Diagnostic port. Energy savings using recirculation can reach 30 %, but pollutants concentration in the cabin builds up in this operating mode. Moreover, the temperature profile appeared strongly nonuniform with air temperature differences up to 10° C. Optimisation methods often require a high number of runs to find the optimal configuration of the system. Fast models proved to be beneficial for these task, while CFD-1D model are usually slower despite the higher level of detail provided. In this work, the collected dataset was used to train a fast ML model of both cabin and HVAC using linear regression. Average scaled RMSE over all trials is 0.4 %, while computation time is 0.0077 ms for each second of simulated time on a laptop computer. Finally, a reinforcement learning environment was built in OpenAI and Stable-Baselines3 using the built-in Proximal Policy Optimisation algorithm to update the policy and seek for the best compromise between comfort, air quality and energy reward terms. The learning curves show an oscillating behaviour overall, with only 2 experiments behaving as expected even if too slow. This result leaves large room for improvement, ranging from the reward function engineering to the expansion of the ML model.

Decision theory applied to image quality control in radiology

Background: The present work aims at the application of the decision theory to radiological image quality control ( QC) in diagnostic routine. The main problem addressed in the framework of decision theory is to accept or reject a film lot of a radiology service. The probability of each decision of a determined set of variables was obtained from the selected films. Methods: Based on a radiology service routine a decision probability function was determined for each considered group of combination characteristics. These characteristics were related to the film quality control. These parameters were also framed in a set of 8 possibilities, resulting in 256 possible decision rules. In order to determine a general utility application function to access the decision risk, we have used a simple unique parameter called r. The payoffs chosen were: diagnostic's result (correct/incorrect), cost (high/low), and patient satisfaction (yes/no) resulting in eight possible combinations. Results: Depending on the value of r, more or less risk will occur related to the decision-making. The utility function was evaluated in order to determine the probability of a decision. The decision was made with patients or administrators' opinions from a radiology service center. Conclusion: The model is a formal quantitative approach to make a decision related to the medical imaging quality, providing an instrument to discriminate what is really necessary to accept or reject a film or a film lot. The method presented herein can help to access the risk level of an incorrect radiological diagnosis decision.

Life-cycle preferences over consumption and health: when is cost-effectiveness analysis equivalent to cost-benefit analysis?

This paper studies life-cycle preferences over consumption and health status. We show that cost-effectiveness analysis is consistent with cost-benefit analysis if the Lifetime utility function is additive over time, multiplicative in the utility of consumption and the utility of health status, and if the utility of consumption is constant over time. We derive the conditions under which the lifetime utility function takes this form, both under expected utility theory and under rank-dependent utility theory, which is currently the most important nonexpected utility theory. If cost-effectiveness analysis is consistent with cost-benefit analysis, it is possible to derive tractable expressions for the willingness to pay for quality-adjusted life-years (QALYs). The willingness to pay for QALYs depends on wealth, remaining life expectancy, health status, and the possibilities for intertemporal substitution of consumption. (C) 1999 Elsevier Science B.V. All rights reserved.