Thesis advisor: Joseph Quinn / The ease of spread of COVID-19 has posed a great challenge for governments, public health officials, and healthcare workers around the world. Leaders and officials need to make decisions that protect the health and well-being of their citizens, while balancing their rights as citizens and the stability of their economies. This study conducts a review of literature on COVID-19, the Spanish Flu, and the Swine Flu in an effort to understand the economic and health impacts of pandemics. Results show a clear trend suggesting the poor bear a greater burden of the impact of pandemics in regards to economic and health impacts. Further analysis suggests that these inequities are not limited to the United States healthcare system and remain apparent in national single-payer healthcare systems, like in the United Kingdom. To prevent similar disparities in future pandemics, governments should attempt to decrease inequality present in baseline health and economic measures. / Thesis (BA) — Boston College, 2021. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Department Honors and Scholar of the College. / Discipline: Economics.

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education - an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals' clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive.

A Gestão de Riscos Corporativos (ERM), a partir das publicações da ISO 31000 em 2009 e do guia do COSO em 2007, vem sendo aplicada e adaptada às especificidades de múltiplos mercados. O contexto hospitalar, caracterizado pela necessidade de avanços em sistemas e métodos gerenciais que permitam maior acurácia de informações e sustento na orientação à tomada de decisão, passou a, também, interessar-se pelo valor da ERM. Influenciado pelos programas de qualidade e segurança do paciente e de gestão de riscos assistencial, presentes na cultura hospitalar mundial, gestores estratégicos à frente de organizações de saúde começaram a procurar por metodologias que possam ser adaptadas à complexidade de um hospital e apoiem a implementação da ERM. A literatura prévia ao desenvolvimento desta tese não apresenta um modelo que consolida e orienta a operacionalização da ERM em organizações de saúde, mas destaca em múltiplas publicações a necessidade que os hospitais têm de atentar a metodologias que permitam gerir de forma proativa e estratégica seus negócios, que estão expostos a riscos internos e externos. Motivada pela lacuna descrita, esta tese explorou o mercado brasileiro e norte americano através de entrevistas, estudos de caso e survey, e propôs um modelo global de ERM para organizações de saúde: o E2RMhealthcare. Este sugere requisitos para a operacionalização global da ERM e é fragmentado em 4 níveis: risk baseline, education, quantitative e governance que orientam uma implementação gradual, considerando a maturidade de gestão da organização. Formas de como explorar as características do hospital e capital humano para exercer a ERM também foram estudadas, sendo proposto uma relação entre as equipes de avaliação de tecnologias de saúde hospitalar e de ERM no processo de criação de valor da organização através de um mapa de causa e efeito. Como destaque do negócio saúde, essa tese inova propondo o primeiro inventário de riscos corporativos orientado a organizações de saúde que foi validado por gestores de múltiplos países, identificando o risco de ataques cibernéticos como o principal. Por fim, o uso de métodos de análise multicriterial e de custeio por atividade são aplicados como soluções inovadoras para a priorização e avaliação econômica de riscos ao longo dos níveis Baseline e Quantitative do E2RMhealthcare. O avanço do E2RMhealthcare com estas metodologias incorporadas para um software com capacidade de inteligência artificial é deixado como sugestão de trabalhos futuros além da sua real aplicação em múltiplos casos. / Since the ISO 31000 publication in 2009 and the COSO guide in 2007 Enterprise Risk Management (ERM) has been applied and adapted to the specificities of different business markets. The hospital context characterized by the demand for advances in management systems and methods that allow to improve information accuracy and to support the decision-making process, also became interested in the value of ERM. Influenced by quality and patient safety and healthcare risk management programs presents in the global hospital culture, managers at the top of healthcare organizations started to look for methodologies that can be adapted to the hospital management complexity to support the ERM implementation. The literature, prior to the development of this thesis, does not present a model that consolidates a guide to operationalize ERM in healthcare organizations. Although emphasizes, in multiple publications, the urgency for methodologies that enable proactive and strategic management of healthcare businesses, which are exposed to internal and external risks. Motivated by the described gap, this thesis explored the Brazilian and American healthcare market through interviews, case studies and survey, and proposed a global ERM model for healthcare organizations: E2RMhealthcare. It suggests requirements for global operationalization of the ERM and is organized in 4 levels: risk baseline, education, quantitative and governance that guide a gradual implementation, considering the maturity of the organization management. Different manners to explore the features of the hospital and human capital to operate the ERM were also studied, and it was proposed a relation between the hospital healthcare technology assessment teams and the ERM in the value creation process of the organization through a cause and effect map. Focusing on the healthcare business, this thesis innovates by proposing the first enterprise risk inventory aimed at healthcare organizations that was confirmed by risk managers from different countries. Cyber-attack was identified as the main enterprise risk in healhtcare. Finally, the use of multicriterial analysis methods and activity-based costing are applied as innovative solutions for prioritization and economic assessment of risks throughout the Baseline and Quantitative levels of E2RMhealthcare. The progress of E2RMhealthcare with these incorporated methodologies for a software with artificial intelligence capacity is left as a suggestion for future studies, in addition to its actual application in multiple cases.

The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.

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