Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).

Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model

This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time. © 2009 SAGE Publications.

Overweight and obesity on the island of Ireland: an estimation of costs

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches.

Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality.

Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease.

Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

The Impacts of Variety on the Costs and Profits of a Hotel Chain’s Properties

In the hotel industry, undistributed operating expenses represent a significant portion of the operating costs for a hotel. Exactly how most of these expenses arise is not well understood. Using data from more than 40 hotels operated by a major chain, the authors examine the links between the variety of a hotel’s products and customers and its undistributed operating expenses and revenues. Their findings show that undistributed operating expenses are related to the extent of the property’s business and product-services mix. The results suggest that although increasing a property's product-service mix results in higher undistributed operating expenses, the incremental costs are compensated for by higher revenues. However, increasing business mix while increasing undistributed operating expenses does not result in higher revenues.

A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.

Co-production and co-creation using self-service technology: the application of service-dominant logic

Research on how customers engage in the co-creation processes envisaged by the Servicedominant logic paradigm is currently limited and even less work has been published on frameworks for organizations to manage the co-creation process. This conceptual paper examines a particular aspect of co-creation: co-production as a result of the application of self-service technology (SST). We propose a conceptual framework for co-production, which emphasizes the need to understand productivity from the point of view of the customer, and demonstrate how this can be applied in both consumer (b2c) and interorganizational(b2b) contexts. We conclude that service organizations might benefit from clearly identifying co-production with task-performance, and co-creation with the valueattributing aspects of the customer service experience. Both aspects generate a range of design and management challenges for suppliers particularly the need to understand the cocreation process 'outputs' desired by customers and the full costs of moving away from person to person interaction.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

Reframing reverse logistics, reducing costs

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Drivers and barriers to value creation in mobile service delivery

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Money for nothing?: The net costs of medical training

A Masters Thesis, presented as part of the requirements for the award of a Research Masters Degree in Economics from NOVA – School of Business and Economics

How to reduce the causes of call center contact by implementing web self-service at Sonae MC?

This project aims to provide feasible solutions to improve customer´s Help Area at Continente Online. The goal is to increase satisfaction and loyalty by reducing the main causes that lead customers to appeal to Call Center or abandon the website. The pursued solution is the implementation of Web Self-Service and the vision taken is focused not only on providing customers basic help tools but also innovate with international best practices to sustain Sonae MC´s present and future market leader position. Customer´s feedback, costs and impact are taken in consideration to find the best fit for the company.

Service provider switching: a study on the switching process in retail banking

In a business environment that is characterized by intense competition, building customer loyalty has become a key area of focus for most financial institutions. The explosion of the services sector, changing customer demographics and deregulation and emergence of new technology in the financial services industry have had a critical impact on consumers’ financial services buying behaviour. The changes have forced banks to modify their service offerings to customers so as to ensure high levels of customer satisfaction and also high levels of customer retention. Banks have historically had difficulty distinguishing their products from one another because of their relative homogeneity; with increasing competition,the problem has only intensified with no coherent distinguishing theme. Rising wealth, product proliferation, regulatory changes and newer technologies are together making bank switching easier for customers. In order to remain competitive, it is important for banks to retain their customer base. The financial services sector is the foundation for any economy and plays the role of mobilization of resources and their allocation. The retail banking sector in India has emerged as one of the major drivers of the overall banking industry and has witnessed enormous growth. Switching behaviour has a negative impact on the banks’ market share and profitability as the costs of acquiring customers are much higher than the costs of retaining. When customers switch, the business loses the potential for additional profits from the customer the initial costs invested in the customer by the business get . The Objective of the thesis was to examine the relationship among triggers that customers experience, their perceptions of service quality, consumers’ commitment and behavioral intentions in the contemporary India retail banking context through the eyes of the customer. To understand customers’ perception of these aspects, data were collected from retail banking customers alone for the purpose of analysis, though the banks’ views were considered during the qualitative work carried out prior to the main study. No respondent who is an employee of a banking organization was considered for the final study to avoid the possibility of any bias that could affect the results adversely. The data for the study were collected from customers who have switched banks and from those who were non switchers. The study attempted to develop and validate a multidimensional construct of service quality for retail banking from the consumer’s perspective. A major conclusion from the empirical research was the confirmation of the multidimensional construct for perceived service quality in the banking context. Switching can be viewed as an optimization problem for customers; customers review the potential gains of switching to another service provider against the costs of leaving the service provider. As banks do not provide tangible products, their service quality is usually assessed through service provider’s relationship with customers. Thus, banks should pay attention towards their employees’ skills and knowledge; assessing customers’ needs and offering fast and efficient services.

Modellbasiertes Service Level Management verteilter Anwendungssysteme

Zur Senkung von Kosten werden in vielen Unternehmen Dienstleistungen, die nicht zur Kernkompetenz gehören, an externe Dienstleister ausgelagert. Dieser Prozess wird auch als Outsourcing bezeichnet. Die dadurch entstehenden Abhängigkeiten zu den externen Dienstleistern werden mit Hilfe von Service Level Agreements (SLAs) vertraglich geregelt. Die Aufgabe des Service Level Managements (SLM) ist es, die Einhaltung der vertraglich fixierten Dienstgüteparameter zu überwachen bzw. sicherzustellen. Für eine automatische Bearbeitung ist daher eine formale Spezifikation von SLAs notwendig. Da der Markt eine Vielzahl von unterschiedlichen SLM-Werkzeugen hervorgebracht hat, entstehen in der Praxis Probleme durch proprietäre SLA-Formate und fehlende Spezifikationsmethoden. Daraus resultiert eine Werkzeugabhängigkeit und eine limitierte Wiederverwendbarkeit bereits spezifizierter SLAs. In der vorliegenden Arbeit wird ein Ansatz für ein plattformunabhängiges Service Level Management entwickelt. Ziel ist eine Vereinheitlichung der Modellierung, so dass unterschiedliche Managementansätze integriert und eine Trennung zwischen Problem- und Technologiedomäne erreicht wird. Zudem wird durch die Plattformunabhängigkeit eine hohe zeitliche Stabilität erstellter Modelle erreicht. Weiteres Ziel der Arbeit ist, die Wiederverwendbarkeit modellierter SLAs zu gewährleisten und eine prozessorientierte Modellierungsmethodik bereitzustellen. Eine automatisierte Etablierung modellierter SLAs ist für eine praktische Nutzung von entscheidender Relevanz. Zur Erreichung dieser Ziele werden die Prinzipien der Model Driven Architecture (MDA) auf die Problemdomäne des Service Level Managements angewandt. Zentrale Idee der Arbeit ist die Definition von SLA-Mustern, die konfigurationsunabhängige Abstraktionen von Service Level Agreements darstellen. Diese SLA-Muster entsprechen dem Plattformunabhängigen Modell (PIM) der MDA. Durch eine geeignete Modelltransformation wird aus einem SLA-Muster eine SLA-Instanz generiert, die alle notwendigen Konfigurationsinformationen beinhaltet und bereits im Format der Zielplattform vorliegt. Eine SLA-Instanz entspricht damit dem Plattformspezifischen Modell (PSM) der MDA. Die Etablierung der SLA-Instanzen und die daraus resultierende Konfiguration des Managementsystems entspricht dem Plattformspezifischen Code (PSC) der MDA. Nach diesem Schritt ist das Managementsystem in der Lage, die im SLA vereinbarten Dienstgüteparameter eigenständig zu überwachen. Im Rahmen der Arbeit wurde eine UML-Erweiterung definiert, die eine Modellierung von SLA-Mustern mit Hilfe eines UML-Werkzeugs ermöglicht. Hierbei kann die Modellierung rein graphisch als auch unter Einbeziehung der Object Constraint Language (OCL) erfolgen. Für die praktische Realisierung des Ansatzes wurde eine Managementarchitektur entwickelt, die im Rahmen eines Prototypen realisiert wurde. Der Gesamtansatz wurde anhand einer Fallstudie evaluiert.

User Profile Management and Selection in Context-Aware Service Platforms for Networks Beyond 3G

In recent years, progress in the area of mobile telecommunications has changed our way of life, in the private as well as the business domain. Mobile and wireless networks have ever increasing bit rates, mobile network operators provide more and more services, and at the same time costs for the usage of mobile services and bit rates are decreasing. However, mobile services today still lack functions that seamlessly integrate into users’ everyday life. That is, service attributes such as context-awareness and personalisation are often either proprietary, limited or not available at all. In order to overcome this deficiency, telecommunications companies are heavily engaged in the research and development of service platforms for networks beyond 3G for the provisioning of innovative mobile services. These service platforms are to support such service attributes. Service platforms are to provide basic service-independent functions such as billing, identity management, context management, user profile management, etc. Instead of developing own solutions, developers of end-user services such as innovative messaging services or location-based services can utilise the platform-side functions for their own purposes. In doing so, the platform-side support for such functions takes away complexity, development time and development costs from service developers. Context-awareness and personalisation are two of the most important aspects of service platforms in telecommunications environments. The combination of context-awareness and personalisation features can also be described as situation-dependent personalisation of services. The support for this feature requires several processing steps. The focus of this doctoral thesis is on the processing step, in which the user’s current context is matched against situation-dependent user preferences to find the matching user preferences for the current user’s situation. However, to achieve this, a user profile management system and corresponding functionality is required. These parts are also covered by this thesis. Altogether, this thesis provides the following contributions: The first part of the contribution is mainly architecture-oriented. First and foremost, we provide a user profile management system that addresses the specific requirements of service platforms in telecommunications environments. In particular, the user profile management system has to deal with situation-specific user preferences and with user information for various services. In order to structure the user information, we also propose a user profile structure and the corresponding user profile ontology as part of an ontology infrastructure in a service platform. The second part of the contribution is the selection mechanism for finding matching situation-dependent user preferences for the personalisation of services. This functionality is provided as a sub-module of the user profile management system. Contrary to existing solutions, our selection mechanism is based on ontology reasoning. This mechanism is evaluated in terms of runtime performance and in terms of supported functionality compared to other approaches. The results of the evaluation show the benefits and the drawbacks of ontology modelling and ontology reasoning in practical applications.

Context as a Service

In the vision of Mark Weiser on ubiquitous computing, computers are disappearing from the focus of the users and are seamlessly interacting with other computers and users in order to provide information and services. This shift of computers away from direct computer interaction requires another way of applications to interact without bothering the user. Context is the information which can be used to characterize the situation of persons, locations, or other objects relevant for the applications. Context-aware applications are capable of monitoring and exploiting knowledge about external operating conditions. These applications can adapt their behaviour based on the retrieved information and thus to replace (at least a certain amount) the missing user interactions. Context awareness can be assumed to be an important ingredient for applications in ubiquitous computing environments. However, context management in ubiquitous computing environments must reflect the specific characteristics of these environments, for example distribution, mobility, resource-constrained devices, and heterogeneity of context sources. Modern mobile devices are equipped with fast processors, sufficient memory, and with several sensors, like Global Positioning System (GPS) sensor, light sensor, or accelerometer. Since many applications in ubiquitous computing environments can exploit context information for enhancing their service to the user, these devices are highly useful for context-aware applications in ubiquitous computing environments. Additionally, context reasoners and external context providers can be incorporated. It is possible that several context sensors, reasoners and context providers offer the same type of information. However, the information providers can differ in quality levels (e.g. accuracy), representations (e.g. position represented in coordinates and as an address) of the offered information, and costs (like battery consumption) for providing the information. In order to simplify the development of context-aware applications, the developers should be able to transparently access context information without bothering with underlying context accessing techniques and distribution aspects. They should rather be able to express which kind of information they require, which quality criteria this information should fulfil, and how much the provision of this information should cost (not only monetary cost but also energy or performance usage). For this purpose, application developers as well as developers of context providers need a common language and vocabulary to specify which information they require respectively they provide. These descriptions respectively criteria have to be matched. For a matching of these descriptions, it is likely that a transformation of the provided information is needed to fulfil the criteria of the context-aware application. As it is possible that more than one provider fulfils the criteria, a selection process is required. In this process the system has to trade off the provided quality of context and required costs of the context provider against the quality of context requested by the context consumer. This selection allows to turn on context sources only if required. Explicitly selecting context services and thereby dynamically activating and deactivating the local context provider has the advantage that also the resource consumption is reduced as especially unused context sensors are deactivated. One promising solution is a middleware providing appropriate support in consideration of the principles of service-oriented computing like loose coupling, abstraction, reusability, or discoverability of context providers. This allows us to abstract context sensors, context reasoners and also external context providers as context services. In this thesis we present our solution consisting of a context model and ontology, a context offer and query language, a comprehensive matching and mediation process and a selection service. Especially the matching and mediation process and the selection service differ from the existing works. The matching and mediation process allows an autonomous establishment of mediation processes in order to transfer information from an offered representation into a requested representation. In difference to other approaches, the selection service selects not only a service for a service request, it rather selects a set of services in order to fulfil all requests which also facilitates the sharing of services. The approach is extensively reviewed regarding the different requirements and a set of demonstrators shows its usability in real-world scenarios.