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BACKGROUND: The burden of patient safety incidents (PSIs) is often characterized by their impact on mortality, morbidity, and treatment costs. Few studies have attempted to estimate the impact of PSIs on patients' health-related quality of life (HRQoL) and the studies that have made such estimates primarily focus on a narrow set of incidents. The aim of this paper is to estimate the impact of PSIs on HRQoL of patients undergoing elective hip and knee surgery in England. PATIENTS AND METHODS: A unique linked longitudinal data set consisting of patient-reported outcome measures for patients with hip and knee replacements linked to Hospital Episode Statistics (HES) collected between 2013/14 and 2016/17 was examined. Patients with any of nine US Agency for Healthcare Research and Quality (AHRQ) PSI indicators were identified. HRQoL was measured using the general EuroQol five dimensions questionnaire (EQ-5D) before and after surgery. Exploiting the longitudinal structure of the data, exact matching was combined with difference in differences to estimate the impact of experiencing a PSI on HRQoL and its individual dimensions, comparing HRQoL improvements after surgery in similar patients with and without a PSI in a retrospective cohort study. This design compares the change in HRQoL before and after surgery in patients who experience a PSI to those who do not. RESULTS: The sample comprised 190 697 and 204 649 observations for patients undergoing hip replacement and knee replacement respectively. For six out of nine PSIs, patients who experienced a PSI reported improvements in HRQoL that were 14-23% lower than those who did not experience a PSI during surgery. Those who experienced a PSI were also more likely to report worse health states after surgery than those without a PSI on all five dimensions of HRQoL. CONCLUSION: PSIs are associated with a substantial negative impact on patients' HRQoL.

Purpose Organizational wicked problems are ill-defined phenomena arising in complex environments with intertwined and evolving interests. This paper aims to use a nonlinear epistemological approach to explore how multiple management decision tools work together to form configurational paths to deal with organizational wicked problems and to propose some heuristic toolkits for tackling them. Design/methodology/approach Based on interviews with 53 senior executives dealing with 62 organizational wicked problems, this paper uses grounded theory to construct an antecedent theoretical framework and then uses qualitative comparative analysis (QCA) to conduct configuration analysis on the strategy portfolios that can tackle organizational wicked problems. Findings This paper used grounded theory to identify six theoretical dimensions as management decision tools for dealing with organizational wicked problems: change adaptation, goal performing, administration, mechanical integration, organic integration and entrepreneuring. In addition, this paper used QCA to explore and propose three heuristic toolkits – synergy oriented, institution oriented and innovation oriented – as multiple equivalent paths to help deal with organizational wicked problems. Originality/value This paper uses configuration analysis instead of the net effect analysis of the traditional econometric method and captures multiple antecedent conditions for decision-makers to deal with organizational wicked problems from a holistic perspective. This paper constructs three heuristic toolkits and matches each of them with the most suitable type of organizational wicked problem, constructing a complete research chain of “identifying–tackling” the organizational wicked problem and providing a reference for organizations facing similar situations in future practice.

Background Non-pharmaceutical interventions (NPIs) are the cornerstone of infectious disease outbreak response in the absence of effective pharmaceutical interventions. Outbreak strategies often involve combinations of NPIs that may change according to disease prevalence and population response. Little is known with regard to how costly each NPI is to implement. This information is essential to inform policy decisions for outbreak response. Objective To address this gap in existing literature, we conducted a systematic review on outbreak costings and simulation studies related to a number of NPI strategies, including isolating infected individuals, contact tracing and quarantine, and school closures. Methods Our search covered the MEDLINE and EMBASE databases, studies published between 1990 and 24 March 2020 were included. We included studies containing cost data for our NPIs of interest in pandemic, epidemic, and outbreak response scenarios. Results We identified 61 relevant studies. There was substantial heterogeneity in the cost components recorded for NPIs in outbreak costing studies. The direct costs of NPIs for which costing studies existed also ranged widely: isolating infected individuals per case: US$141.18 to US$1042.68 (2020 values), tracing and quarantine of contacts per contact: US$40.73 to US$93.59, social distancing: US$33.76 to US$167.92, personal protection and hygiene: US$0.15 to US$895.60. Conclusion While there are gaps and heterogeneity in available cost data, the findings of this review and the collated cost database serve as an important resource for evidence-based decision-making for estimating costs pertaining to NPI implementation in future outbreak response policies. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-021-00659-z.

INTRODUCTION: As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings.METHODS: Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups.RESULTS: In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis.CONCLUSION: In the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

There is a worldwide epidemic of obesity. We are just beginning to understand its consequences for child obesity. This paper addresses one important component of the crisis; namely the extent to which adiposity, or more specifically, BMI, is passed down from one generation to the next. We find that the intergenerational elasticity of BMI is very similar across countries and relatively constant – at 0.2 per parent. Our substantive finding is that this elasticity is very comparable across time and countries – even if these countries are at very different stages of economic development. Quantile analysis suggests that this intergenerational transmission mechanism is substantively different across the distribution of children’s BMI; more than double for the most obese children what it is for the thinnest children. These findings have important consequences for the health of the world’s children.

Based on the China Health and Nutrition Survey longitudinal data from 1989 to 2009 and using BMI z-score as the measure of adiposity, we estimate the intergenerational transmission of BMI in China. The OLS estimates suggest that a one standard deviation increase in father's or mother's BMI is associated with an increase of around 20% in child's Body Mass Index (BMI) z-score. These estimates decrease to around 14% when we control for family fixed effects. We examine the heterogeneity of this BMI intergenerational transmission process across family income, parental occupation and poverty status and also find this intergenerational correlation tends to be higher among children of higher BMI levels, though this tendency becomes weaker as children approach adulthood.

Introduction: The economic burden of hearing impairment is an area of increased interest. In this paper we examine the relationship between hearing impairment and service use in 14 European countries. Methods: Based on the Survey of Health Ageing and Retirement in Europe (SHARE) undertaken in 2013, Poisson regression models are used to analyse the relationship between the number of visits/number of nights in hospital, and hearing impairment controlling for a number of covariates. Results: We find that hearing impairment is generally associated with increased use of primary and secondary healthcare services when other aspects of health have been controlled. Comparative analysis revealed that where access to hearing assistive technology was greatest the additional use of services was least. Conclusions: The comparative analysis suggests that variations exist across countries in respect of the additional healthcare use occasioned by hearing impairment. They may also provide valuable insights into how the burden of illness might be reduced.