<p>The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the way for a number of private enterprises in the area, causing competition between public and private providers. Adherents of the reform have argued that private providers can improve efficiency, while opponents have claimed that the chase for profit might affect the quality of the care in a negative way.</p><p>This study focused on the basis for this controversy by examining the relationship between factors such as profit, efficiency, care quality, incentives, motivation and productivity. The study was performed by interviewing thirteen employees and managers in four different care organizations (of which half were public and the other half private). Their answers were analyzed from three theoretical aspects; incentives and motivation, efficiency and productivity, and care quality.</p><p>The findings were that, since the revenue size is beyond their control, private providers can only create profits by reducing costs in a number of ways. Some of these ways, such as cutting down on education, team building activities and salaries, might be detrimental for the company in the long term (and thereby increase costs over time) and have adverse effects on quality. Others, however, such as increasing the efficiency of non-care activities (less administration and optimized scheduling, for example), avoid hiring overqualified staff and instead providing them with enough education for the task at hand, and optimizing work hours, might be more enduring over time and have none or small adverse effects on quality. More dispiritingly, it was also shown that the purchasers do not have any real knowledge about the quality of the work performed, regardless of the provider being private or public, and that in some municipalities users are denied to choose provider for themselves.</p>

The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the way for a number of private enterprises in the area, causing competition between public and private providers. Adherents of the reform have argued that private providers can improve efficiency, while opponents have claimed that the chase for profit might affect the quality of the care in a negative way. This study focused on the basis for this controversy by examining the relationship between factors such as profit, efficiency, care quality, incentives, motivation and productivity. The study was performed by interviewing thirteen employees and managers in four different care organizations (of which half were public and the other half private). Their answers were analyzed from three theoretical aspects; incentives and motivation, efficiency and productivity, and care quality. The findings were that, since the revenue size is beyond their control, private providers can only create profits by reducing costs in a number of ways. Some of these ways, such as cutting down on education, team building activities and salaries, might be detrimental for the company in the long term (and thereby increase costs over time) and have adverse effects on quality. Others, however, such as increasing the efficiency of non-care activities (less administration and optimized scheduling, for example), avoid hiring overqualified staff and instead providing them with enough education for the task at hand, and optimizing work hours, might be more enduring over time and have none or small adverse effects on quality. More dispiritingly, it was also shown that the purchasers do not have any real knowledge about the quality of the work performed, regardless of the provider being private or public, and that in some municipalities users are denied to choose provider for themselves.

Swedish healthcare is facing major challenges both today but more critically looking at predictions for the next 20 years. Healthcare costs will increase dramatically and competent personnel to support all the needs will be lacking. E-health solutions and the possibilities they open up regarding how care can be organized and administrated are seen in Sweden as the most important tool to counter those healthcare challenges. The Swedish government see this as a prioritized area and has together with Sveriges Kommuner och Landsting (SKL) signed on a vision to become the world leader in E-health by the year 2025. Studies have shown that E-health can give substantial cost savings with up to 180 billion SEK in saving yearly. We have in this thesis investigated to what extent E-health solutions in the area of chronic diseases are used by Regions/Counties as well as the outcome from a cost saving perspective. Problem formulation and the questions that have been investigated are, which E-health solutions are the different Swedish Regions/County councils (Landsting) using for chronic diseases and what are the cost (and capacity) benefits? What challenges are seen to implement new E-health solutions? We have been using the case study method in our research with interviews and questionnaires with the Regions/County councils as our main source of information. In our contacts we have explained that answers given in the general discussion will be anonymous and not to be linked to any specific Region/County council. This approach was made to get frankly and informative answers. Key findings are that there are today not many E-health solutions for chronic diseases made available by the County councils and the ones offered are generally not reaching a large percentage of the population with those diseases. The implementation curve for E-healthsolutions has been slow, but it differs considerably between regions. We can see that in the northern regions with more rural areas focus is put on solutions to solve the challenges with geographical distance to the patient. In the southern regions with more urban areas the regions more commonly use models to facilitate care for the patient in their home environment. We see a large potential to both improve quality of life for many people as well as reducing costs for healthcare by introducing digital tools in the area of chronic diseases. Especially methods easily accessed for a large part of the population through the 1177.se portal that can be used without extensive support from healthcare staff is something we see as an important area. Those methods have a potential to reach and impact a large part of the population without using much of healthcare resources. We suggest that regions collaborate in order to evaluate and introduce those systems and in the end reach a larger part of the population

No description available.

Introduktion: Våld i nära relationer är ett globalt fenomen och utgör ettåterkommande inslag i arbetet inom hälso- och sjukvården, polismyndigheten ochsocialtjänsten. Våld i nära relationer förekommer i alla samhällsklasser, åldrar,oavsett sexuell läggning och är inte relaterad till vare sig etnicitet, kulturell ellerreligiös bakgrund. Det finns flertal myndigheter som ger skydd och stöd tillvåldsutsatta. För att säkerställa ett professionellt omhändertagande av denvåldsutsatta måste de olika myndigheterna samverka. Forskning visar dock attsamverkan ofta brister vilket kan resultera i ett försämrat omhändertagande av dendrabbade individen.Syfte: Att undersöka vilka faktorer som är av betydelse för myndigheterssamverkan vid vuxnas utsatthet för våld i nära relationer, utifrån hälso- ochsjukvårdens, polismyndighetens, och socialtjänstens perspektiv.Metod: Studien är en integrativ litteraturstudie. Litteratursökningarna eftervetenskapliga artiklar genomfördes i databaserna Cinahl, Pubmed, Criminal justiceabstracts, Social services abstracts, Psycinfo och Social science premium collection.De för studien relevanta artiklarna har kvalitetsgranskats, kodats, kategoriserats ochanalyserats enligt gällande metod.Resultat: Resultatet baseras på tio vetenskapliga artiklar och visar att det finns ettflertal faktorer som har betydelse för myndigheters samverkan vid våld i närarelationer. Faktorer som kunskap, organisation, kommunikation och kultur har idenna studie visat sig vara särskilt utmärkande. Dessa faktorer kan verka bådehämmande och främjande beroende på rådande omständigheter inom respektivemyndighetSlutsats: Samverkan mellan myndigheter är en absolut förutsättning för ett adekvatomhändertagande av den individ som utsatts för våld i en nära relation. Fenomenetmedför en komplex problematik. Det finns ett uppenbart utbildningsbehov för flerayrkeskategorier, främst gällande identifikation och bemötande av den våldsutsattasamt klargörande kring de olika myndigheternas olika ansvarsområden ochbefogenheter. Arbetet bör i framtiden organiseras utifrån den drabbades behov avolika hjälpinsatser istället för att som idag utgå från de olika myndigheternasrespektive kompetensområde.

The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

Suizidale Handlungen, also Suizide und Suizidversuche, sind mit großem Schmerz, großer Trauer und auch großem Schamgefühl verbunden. Dies betrifft nicht nur die Suizidenten selbst, sondern auch Angehörige und Freunde. Weltweit sterben etwa eine Million Menschen jährlich durch Suizid und in Deutschland steht der Suizid auf Platz sieben der häufigsten Todesursachen. Schätzungen zu Folge ist die Anzahl der Suizidversuche pro Jahr, im Vergleich zu den Suiziden, bis zu 30-fach höher. Dies zeigt, dass suizidale Handlungen zusätzlich eine hohe Relevanz für das Gesundheitssystem darstellen. Diese Arbeit entstand im Zuge des OSPI-Projektes in Leipzig. Einem europäischen Projekt zur Einführung eines Präventionsprogramms gegen suizidale Handlungen. Es wurden alle Suizidenten, die innerhalb eines Zeitraums von drei Jahren im Universitätsklinikum Leipzig behandelt wurden, erfasst. Die elektronischen Patientenakten wurden dafür, unter Verwendung der entsprechenden ICD-Kodierungen für Selbstverletzungen bzw. Selbstvergiftungen, durchsucht. Ziel war es, neben der lückenlosen Erfassung und epidemiologischen Auswertung aller Fälle, Aussagen über die Art der Behandlung von Suizidenten und den damit verbundenen direkten und indirekten Kosten zu machen. Es zeigten sich, im Vergleich zu bereits bestehenden Studien aus anderen Ländern, keine signifikante epidemiologischen Unterschiede, während deutlich mehr Patienten intensivmedizinisch versorgt und psychiatrisch untersucht wurden, als dies in anderen Ländern der Fall war. Im Hinblick auf die Gesamtkosten, in Höhe von rund 3,9 Millionen Euro, konnte diese Arbeit, abgesehen vom menschlichen Aspekt, die ebenfalls wichtige gesundheits-ökonomische Bedeutung solcher Fälle aufzeigen.

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No description available.

Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening. The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making. This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations. As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design. In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.