Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based on this, the researcher recommended a quality improvement project and worked with a multidisciplinary team from the hospital to develop an evidence-based documentation guideline that incorporated ICD-10 standard for documenting pediatric diagnoses. Using data generated from the guideline, an artificial intelligence (AI) was developed in the form of best practice advisory alerts to engage providers at the point of documentation as well as augment provider efforts. Rosswurm and Larrabee's conceptual framework and Kotter's 8-step change model was used to develop the guideline and design the project. A descriptive data analysis using sample T-test significance indicated that financial reimbursement decreased by 25%, while case denials increased by 28% after ICD-10 implementation. This project promotes positive social change by improving safety, quality, and accountability at the project hospital.

<p>BACKGROUND AND OBJECTIVES: In 2007, the Joint Oncology Drug Review (JODR) (which ultimately evolved into a permanent body called the pan-Canadian Oncology Drug Review (pCODR)) was established to make recommendations to Canada’s provincial and territorial public drug plans regarding the funding (i.e. reimbursement) of new cancer drugs. The JODR/pCODR exists alongside Canada’s Common Drug Review, which provides reimbursement recommendations to Canada’s provincial and territorial public drug plans for drugs in all other disease areas. Using an economic perspective, this thesis (composed of three separate papers) appraised: the rationale for the JODR/pCODR’s establishment, the JODR/pCODR’s resource allocation goals, and the JODR/pCODR’s decision-making criteria and decision rules. The overarching theme linking the three thesis papers is whether the JODR/pCODR facilitates Canada’s provincial drug plans’ ability to achieve a goal of maximizing health benefits with available resources.</p> <p>METHODS: For the first two papers, a series of questions regarding the JODR’s establishment, resource allocation goals, decision-making criteria and decision rules were posed. The questions were answered by reviewing peer-reviewed literature and/or JODR/pCODR-published materials and by applying fundamental principles underlying an economic perspective. By again applying these same principles, the third paper in this thesis addressed the challenges associated with striving to simultaneously achieve the pCODR’s resource allocation goals of maximizing health benefits with available resources and striving to improve access to a more consistent standard of care across Canada.</p> <p>FINDINGS AND CONCLUSION: The various issues identified in this thesis suggest that the JODR/pCODR is unlikely to facilitate Canada’s provincial drug plans’ ability to achieve a goal of maximizing health benefits with available resources for several reasons (which are described in detail in the thesis papers). It is my hope that this thesis will encourage further debate regarding the strengths and limitations of the pCODR and regarding other possible approaches for managing the public reimbursement of cancer drugs.</p> / Doctor of Philosophy (PhD)

Name of the text, you are holding in your hands, could be well translated as "Decesion making of Czech Constitutional Court and its influence on civil procedure." It consist of three very separate parts, each of them following its own topic, linked up together only with major role of Constitutional Court (further "CC"). First chapter is dedicated to a slightly controversial case, which has been widely publicly discussed. The topic is strictly procedural, it refers to the possibilty of higher courts to remove and assign single cases to different judge/panel of judges. Although under certain circumstances allowed, in this case it seemed to be an unjustifed violation of art. 38 par. 1 of Letter of human rights and I conclude arguments, which could justify such restrictive process. Second one is following last ten years of interventions in Code of Civil Procedure, namely in regulation of review of appeal. In the first part are described reasons, why CC consider decision with missing justification unconstitutional and accordingly declares corresponding part of Code of Civil Procedure unconstitutional. In second part I analyze long-term contrary judgements of CC and Czech supreme court on admissibility of review of appeal which resulted in major part of regulation being declared unconstitutional. I...

Com o aumento da necessidade e do consumo da energia elétrica, aliado a uma maior conscientização dos consumidores acerca de seus direitos e deveres perante a sociedade, constatou-se o surgimento de um crescente número de contendas envolvendo estes últimos e as concessionárias de energia elétrica, principalmente no que tange ao setor de distribuição de energia elétrica. Isto se deve à ocorrência de danos ocasionados por falhas na prestação do serviço público de energia elétrica, destacando-se, sobremaneira, os danos em aparelhos eletroeletrônicos, que dão origem aos pedidos de indenização por danos elétricos (tecnicamente conhecidos como PIDs). Faz-se incontestável que o ordenamento jurídico vigente prima por um serviço público de qualidade e, nesse ínterim, em se vislumbrando danos ocasionados em razão da prestação do serviço público, não há dúvidas de que sobrevém o dever de indenizar pelo causador do dano, uma vez que prepondera no Brasil a teoria do risco administrativo. Assim sendo, considerando que a prestação do serviço público pode ser delegada às pessoas jurídicas de direito privado, estendeu-se a estas últimas a responsabilidade das pessoas jurídicas de direito público em relação aos danos eventualmente ocasionados a outrem, inserindo-se nesse contexto a responsabilização das concessionárias de energia elétrica por eventuais danos causados aos seus usuários. Entretanto, há que se ressaltar que não é em toda e qualquer situação que será devida a indenização por eventuais danos elétricos, uma vez que a concessionária de energia elétrica poderá ter por elidida a obrigação de indenizar em se constatando alguma das excludentes de responsabilidade. Nesse contexto e diante do crescente número de contendas envolvendo os pedidos de indenização por danos elétricos, a presente dissertação visa contribuir oferecendo subsídios para o enfrentamento da problemática, elencando aquelas situações em que de fato é devida a indenização por danos elétricos, bem como aquelas nas quais incide alguma excludente de responsabilidade da concessionária, elidindo, pois, o dever de indenizar. / With the increasing need and growing consumption of electricity, coupled with greater consumer awareness about their rights and duties towards society, there has been noticed a growing number of disputes involving customer and utilities, especially in regard to the sector of electric power distribution. This is due to the occurrence of damage caused by failures in the provision of public power, especially, above all, the damage in electronic devices, which give rise to claims for damages in customers electrical equipment (technically known as PIDs). It is undeniable that the current law envisages adequate levels of quality of service. As one glimpses damages originated in the public service concessionary, there is no doubt that the duty to indemnity befalls on the damage caused, since the theory of administrative risk prevails in Brazil. It is undeniable that the current press law by a public service quality and in the meantime, as we are glimpsing damages on grounds of public service delivery, there is no doubt that befalls the duty to indemnify the damage caused by the prevalence of the theory of administrative risk in Brazil. Thus, given that sometimes the public service delivery is delegated to legal persons of private rights, the responsibility under public law in relation to any damage caused to the consumer has been extended to the supplier authority. However, it should be noted that not in every situation that will be due compensation for any electrical damage, since the electric utility may have elided by the obligation to indemnify being observed in any of the exclusive responsibility. In this context and in view of the growing number of disputes involving claims for electrical damages, this dissertation aims to contribute by offering subsidies to face the problem, listing those situations in which in fact is due to compensation for electrical damage as well as those in which some exclusive responsibility of the utility is covered, suppressing, therefore, the duty to indemnify.

Com o aumento da necessidade e do consumo da energia elétrica, aliado a uma maior conscientização dos consumidores acerca de seus direitos e deveres perante a sociedade, constatou-se o surgimento de um crescente número de contendas envolvendo estes últimos e as concessionárias de energia elétrica, principalmente no que tange ao setor de distribuição de energia elétrica. Isto se deve à ocorrência de danos ocasionados por falhas na prestação do serviço público de energia elétrica, destacando-se, sobremaneira, os danos em aparelhos eletroeletrônicos, que dão origem aos pedidos de indenização por danos elétricos (tecnicamente conhecidos como PIDs). Faz-se incontestável que o ordenamento jurídico vigente prima por um serviço público de qualidade e, nesse ínterim, em se vislumbrando danos ocasionados em razão da prestação do serviço público, não há dúvidas de que sobrevém o dever de indenizar pelo causador do dano, uma vez que prepondera no Brasil a teoria do risco administrativo. Assim sendo, considerando que a prestação do serviço público pode ser delegada às pessoas jurídicas de direito privado, estendeu-se a estas últimas a responsabilidade das pessoas jurídicas de direito público em relação aos danos eventualmente ocasionados a outrem, inserindo-se nesse contexto a responsabilização das concessionárias de energia elétrica por eventuais danos causados aos seus usuários. Entretanto, há que se ressaltar que não é em toda e qualquer situação que será devida a indenização por eventuais danos elétricos, uma vez que a concessionária de energia elétrica poderá ter por elidida a obrigação de indenizar em se constatando alguma das excludentes de responsabilidade. Nesse contexto e diante do crescente número de contendas envolvendo os pedidos de indenização por danos elétricos, a presente dissertação visa contribuir oferecendo subsídios para o enfrentamento da problemática, elencando aquelas situações em que de fato é devida a indenização por danos elétricos, bem como aquelas nas quais incide alguma excludente de responsabilidade da concessionária, elidindo, pois, o dever de indenizar. / With the increasing need and growing consumption of electricity, coupled with greater consumer awareness about their rights and duties towards society, there has been noticed a growing number of disputes involving customer and utilities, especially in regard to the sector of electric power distribution. This is due to the occurrence of damage caused by failures in the provision of public power, especially, above all, the damage in electronic devices, which give rise to claims for damages in customers electrical equipment (technically known as PIDs). It is undeniable that the current law envisages adequate levels of quality of service. As one glimpses damages originated in the public service concessionary, there is no doubt that the duty to indemnity befalls on the damage caused, since the theory of administrative risk prevails in Brazil. It is undeniable that the current press law by a public service quality and in the meantime, as we are glimpsing damages on grounds of public service delivery, there is no doubt that befalls the duty to indemnify the damage caused by the prevalence of the theory of administrative risk in Brazil. Thus, given that sometimes the public service delivery is delegated to legal persons of private rights, the responsibility under public law in relation to any damage caused to the consumer has been extended to the supplier authority. However, it should be noted that not in every situation that will be due compensation for any electrical damage, since the electric utility may have elided by the obligation to indemnify being observed in any of the exclusive responsibility. In this context and in view of the growing number of disputes involving claims for electrical damages, this dissertation aims to contribute by offering subsidies to face the problem, listing those situations in which in fact is due to compensation for electrical damage as well as those in which some exclusive responsibility of the utility is covered, suppressing, therefore, the duty to indemnify.

School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

Walden University College of Management and Technology This is to certify that the doctoral study by Ingrid Hayes-Burrell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 â?? School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.

Ziel: Entwicklung eines gesundheitsökonomischen Evaluationskonzepts zum Nachweis einer Kostenreduktion unter gleichzeitiger Optimierung des medizinischen Nutzens durch pharmakogenetisches Screening bei Erstdiagnose einer Schizophrenie. Finale Zielsetzung ist die Aufnahme der pharmakogenetischen a priori-Diagnostik für die Indikation Schizophrenie in die GKV-Regelversorgung. Methodik: Basierend auf dem aktuellen Stand gendiagnostischer Forschung sowie der evidenzbasierten Schizophrenietherapie wurde eine prospektive, randomisierte und kontrollierte, dreiarmige, offene, multizentrische Pilotstudie im Paralleldesign über 3 Jahre konzeptioniert. Studienpopulation: 300 Patienten (1:1:1) im Alter von 18 bis 65 Jahren mit erstmaliger F20-Diagnose (ICD-10). Interventionen: pharmakogenetisches Screening und integrierte Versorgung; integrierte Versorgung; Standardversorgung. Die Erhebung des medizinischen Nutzens erfolgt durch Messung des klinischen Outcome bzgl. der patientenrelevanten Endpunkte Mortalität, Morbidität, Lebensqualität und Nebenwirkungen zu definierten Zeitpunkten. Perspektivisch relevante Kosten werden im "piggy back"-Verfahren ermittelt. Ergebnisse: Angesichts zurzeit bestehender Limitationen im deutschen Gesundheitssystem (z.B. unzureichendes intersektorales Schnittstellenmanagement bei der Arzneimittelversorgung und Informationsweitergabe) wird die Integrierte Versorgung als geeignete Versorgungsform für den Nutzennachweis eingestuft. Die Integrierte Versorgung stellt jedoch momentan nicht den allgemeinen Standard der psychiatrischen Patientenversorgung dar. Aus GKV-Perspektive wesentliche Kostentreiber der Schizophrenietherapie sind Rückfälle, Krankenhausaufenthalte, Arbeitslosigkeit und vorzeitige Verrentung. Eine Verringerung der Häufigkeit dieser Parameter könnte z.B. zu einer Reduktion der Erstjahres-Behandlungskosten (zurzeit ca. 30% der Gesamtkosten) führen. Die Kosten-Effektivitäts-Analyse erweist sich als Studienform mit der geringsten Anfälligkeit für Bias und Confounder. Trotz einer vergleichsweise hohen externen Validität ist das Studiensetting nicht uneingeschränkt übertragbar auf die Versorgungsrealität des deutschen Gesundheitssystems. Es existiert aktuell keine generelle Empfehlung für den Einsatz der Gendiagnostik zur Steuerung der Arzneimitteltherapie in Psychiatrie. Ebenso hat die integrierte Versorgung bisher keinen umfassenden Einzug in den psychiatrischen Behandlungsalltag gefunden, so dass die beschriebenen Limitationen einen positiven Nutzennachweis erschweren. Dennoch ist das Konzept als praktisch umsetzbar zu bewerten. Schlussfolgerung: Bei dieser Faktenlage ist das Interesse der GKV an der Veranlassung einer gesundheitsökonomischen Evaluation mit dem Ziel einer Erstattungsfähigkeit des a priori durchgeführten pharmakogenetischen Screenings bei Schizophrenie als eher gering einzustufen. Jedoch lassen das Update der S3-Praxisleitlinie mit dem Einbezug der strukturierten u. integrierten Versorgung sowie der Aktionsplan „Individualisierte Medizin“ des Bundesforschungsministeriums auf eine Fokussierung auf diese Fragestellung und veränderte Interessenlage bzgl. der Initiierung der Pilotstudie hoffen. Weitere Forschungstätigkeit sowie die praktische Erprobung neuer gendiagnostischen Verfahren sind, basierend auf versorgungsbezogenen Pilotstudien wie der hier konzeptionierten, fachübergreifend erforderlich, um die Relevanz der Methodik für den psychiatrischen Versorgungsalltag zu belegen. / Purpose: Development of a health-economic investigation method to study whether a cost reduction under concurrent optimisation of the medical use exists by using pharmacogenetic a- priori- screening with first diagnosis of a schizophrenia. Final objective is the reimbursement of pharmacogenetic diagnostics for the indication schizophrenia in the German health statutory insurance (GKV). Methods: A prospective, randomised and controlled, 3-armed, parallel, open, multicentre pilot study with a duration of 3 years was designed based on the actual status of genetic-diagnostic research as well as the evidence-based therapy of schizophrenia. Study population: 300 patients (1:1:1) aged 18 to 65 years with initial F20 diagnosis (ICD-10). Interventions: pharmacogenetic screening and integrated care; integrated care; standard care. For evaluation of the medical benefit the clinical outcome is measured at defined times with regard to the patients' relevant endpoints mortality, morbidity, quality of life and side effects. In perspective relevant costs are determined by "piggy back" procedure. Results: In view of actually existing limitations within the German health system (e.g., insufficient intersectional medication and information management) the integrated care is considered being a suitable setting to demonstrate the advantage of using pharmacogenetic screening. Nevertheless, the integrated care does not show the general standard of the psychiatric patient's care at the moment. From GKV perspective essential cost drivers of schizophrenia therapy are relapses, hospital stays, unemployment and untimely superannuation. Diminishing the rate of these parametres could lead, e.g., to a reduction of the first year medical costs (at the moment approx. 30% of the total expenses). The cost-effectiveness analysis seems to be the study form with the slightest susceptibility to bias and confounding. In spite of a relatively high external validity the study setting is not unconditionally transferable to the German health system. Currently no general recommendation exists for the application of the genetic diagnostics to manage medication therapy in psychiatry. Up to now also the integrated care has not found a comprehensive entry in psychiatric practice, so that the described limitations are complicating a positive use proof. Nevertheless, the investigational concept can be regarded as feasible. Conclusion: Based on the existing situation the GKV's interest in performing a health-economic evaluation, which is focussed on the reimbursement of pharmacogenetic a priori-diagnostics in schizophrenia, is considered to be low. However, the situation may change in view of the expected update of the S3-practise guideline with the focus on structured and integrated care as well as the action plan „individualised medicine“ of the German federal research ministry. Thus, there is hope for changing interests in a pilot study. Based on care-related pilot studies as presented here, further research activities and practical testing of recent gene diagnostic procedures are necessary to demonstrate the relevance of the methodology for psychiatric practice.

Providing end-to-end quality-assured services implies many challenges, which go beyond technical ones, involving as well economic and even cultural or political issues. In this thesis we first focus on a technical problem and then intent a more holistic regard to the whole problem, considering at the same time Network Service Providers (NSPs), stakeholders and buyers' behaviour and satisfaction. One of the most important problems when deploying interdomain path selection with Quality of Service (QoS) requirements is being able to rely the computations on metrics that hold for a long period of time. Our proposal for solving that problem is to compute bounds on the metrics, taking into account the uncertainty on the traffic demands. We then move to a NSP-alliance scenario, where we propose a complete framework for selling interdomain quality-assured services, and subsequently distributing revenues. At the end of the thesis we adopt a more holistic approach and consider the interactions with the monitoring plane and the buyers' behaviour. We propose a simple pricing scheme and study it in detail, in order to use QoS monitoring information as feedback to the business plane, with the ultimate objective of improving the seller's revenue.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 6 uppsatser.