Analysis on outsourcing service behavior of rice pest and disease control based on Heckman selection model-A case study of ten counties in Fujian Province.

Under the background of relatively slow agricultural labor transfer and land circulation, agricultural production outsourcing has become the main means of agricultural modernization. In order to provide a beneficial perspective for appropriately expanding the scale of rice control outsourcing services, we investigated the situation of rice control outsourcing in ten counties of Fujian Province, and analyzed the factors influencing rice farmers' decision-making and control degree by using Heckman model. First of all, the main factors affecting farmers' participation in outsourcing are agricultural labor force, whether family members are cooperative members, planting area, proportion of grain income, degree of organization of outsourcing team, region and so on. Secondly, agricultural labor force, cooperative members, planting area, part-time behavior, mechanical efficiency of prevention and control organization, and region are the main factors affecting the scale of control outsourcing. Thirdly, from a regional perspective, the rice farmers in northern and Western Fujian are more dependent on outsourcing services consumption compared with the rice farmers in Southern Fujian. These results have a clear impact on policymakers, indicating that policy and measures should encourage the prevention and control of the nature of cooperation, and improve the advanced nature of outsourcing facilities of plant protection equipment, thereby effectively improving the professional level of rice pest and disease control.

Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?

BACKGROUND: Providing timely access to care has been a long-standing priority for the Veterans Affairs Healthcare System. Recent strategies to reduce long wait times have focused on purchasing community care by a fee-for-service model. Whether outsourcing Veterans Affairs (VA) specialty care to the community improves access is unclear. OBJECTIVES: We compared time from referral to treatment among Veterans whose care was provided by VA versus community care purchased by the VA, using obstructive sleep apnea as an example condition. METHODS: This was a retrospective cohort study of Northern California Veterans seeking sleep apnea care through the San Francisco VA Healthcare System between 2012 and 2018. We used multivariable linear regression with propensity score matching to investigate the relationship between time to care delivery and care setting (VA provided vs. VA-purchased community care). A total of 1347 Northern California Veterans who completed sleep apnea testing within the VA and 88 Veterans who completed sleep apnea testing in the community had complete data for analysis. RESULTS: Among Northern California Veterans with obstructive sleep apnea, outsourcing of care to the community was associated with longer time from referral to therapy (mean±SD, 129.6±82.8 d with VA care vs. 252.0±158.8 d with community care, P<0.001) and greater loss to follow-up. CONCLUSIONS: These findings suggest that purchasing community care may lead to care fragmentation and not improve wait times nor improve access to subspecialty care for Veterans.

[Significant Changes Associated with the Transition from Outsourcing to In-hospital Therapeutic Drug Monitoring of Novel Antiepileptics].

For many of the novel antiepileptics, immunoassays, used for routine therapeutic drug monitoring (TDM), cannot be used. We could monitor eight novel antiepileptics using an LC/MS method since July 2017. The purpose of this study was to evaluate the significant changes associated with the transition from outsourcing to in-hospital monitoring of novel antiepileptics. The number of measurements of novel antiepileptics was significantly increased during the first (p<0.01) and second (p<0.001) years of in-hospital monitoring as compared to that one year prior to in-hospital monitoring which was outsourced. The proportion of measurements of novel antiepileptics to all antiepileptics was 19.7%, 31.1%, and 38.4% during outsourcing, and first, and second years of in-hospital monitoring, respectively. The measurement cost was significantly reduced during the first (p<0.001) and second (p<0.001) years of in-hospital monitoring as compared to that during outsourcing. In addition, the revenue from TDM of antiepileptic drugs was significantly increased during the first (p<0.05) and second (p<0.01) years of in-hospital monitoring as compared with that during outsourcing. In conclusion, the switch from outsourcing to in-hospital monitoring led to an increase in the number of orders, a reduction in the measurement-related expenses of novel antiepileptics, and an increase in the revenue from TDM of antiepileptic drugs, which could promote the proper use of novel antiepileptics through TDM.

Self-esteem and consumption of alcohol, tobacco, and other substances in outsourced workers. / Autoestima e o consumo de álcool, de tabaco e de outras substâncias em trabalhadores terceirizados.

OBJECTIVE: to evaluate self-esteem, the consumption of alcohol, tobacco and other substances in outsourced workers of a public university. METHOD: a descriptive-analytical, cross-sectional, quantitative study developed with 316 outsourced workers from a municipality in the Southeast of Brazil. Data was collected through a characterization tool, the Rosenberg Self-Esteem Scale and the Alcohol, Smoking and Substance Involvement Screening Test. For data analysis, we used descriptive statistics, Pearson's chi-square test, Fisher's exact test, odds ratio and logistic regression. RESULTS: the majority of workers had high self-esteem and some used alcohol, tobacco, marijuana and inhalants. A significant association between gender, age group and work shift with self-esteem; between the risk of developing problems related to alcohol consumption with sex, age group, marital status, religious belief and number of children; between the practice of physical activity and the risk of developing problems related to the consumption of tobacco products was found. CONCLUSION: this study contributes to the increase of knowledge due to the small number of researches involving this subject and to contribute to the nurses to have subsidies to work with this population using strategies to combat the triggers of psychic disorders.

[Primary health care and Social Organizations in capitals in the Southeast Region of Brazil: 2009 and 2014]. / Atenção primária à saúde e Organizações Sociais nas capitais da Região Sudeste do Brasil: 2009 e 2014.

This study focuses on the primary health care (PHC) performance of the four capitals of the Southeast Region of Brazil in the years 2009 and 2014 in terms of the indicators of the 2013-2015 Guidelines and Goals Pact (PDM, in Portuguese). Two capitals turned to Social Organizations (OS, in Portuguese) and two kept the provision and administration of PHC through Direct Administration (AD, in Portuguese), configuring distinct management models. Freely accessible secondary data and research on websites subsidized the characterization of the cities and their PHC performance. The characterization was based on demographic and socioeconomic data, PHC management model, health and PHC spending, importance of the Municipal Participation Fund for the budget and percentage of Executive Branch spending on personnel. In order to measure PHC performance, we calculated 13 indicators for 2009 and 2014, in three PDM guidelines: (i) access, (ii) integral care for women and children's health and (iii) reduction of health risks and harms. The comparative performance analysis considered the year 2014 and each capital's evolution during the period we analyzed. The capitals São Paulo and Rio de Janeiro, with OS management, did not have a better performance in the set of indicators than the capitals than maintained a direct administration. We highlight the rapid expansion in PHC coverage in Rio de Janeiro through OS. In the performance evolution, there was improvement in indicators such as child mortality and hospital admissions due to conditions sensible to PHC in all capitals. The cities are different with regard to many parameters that can influence PHC performance. We did not intend to establish a direct relationship between the administration model and performance.

Este estudo focaliza o desempenho das quatro capitais da Região Sudeste do Brasil na atenção primária à saúde (APS), nos anos de 2009 e 2014, em relação a indicadores do Pacto de Diretrizes e Metas (PDM) 2013-2015. Duas capitais recorreram a Organizações Sociais (OS) e duas mantiveram a prestação e a gerência da APS mediante a Administração Direta (AD), configurando modelos distintos de gestão. Dados secundários de acesso livre e pesquisa em sítios eletrônicos subsidiaram a caracterização das cidades e o seu desempenho em APS. A caracterização foi baseada em dados demográficos e socioeconômicos, modelo de gestão da APS, gastos com saúde e APS, importância do Fundo de Participação Municipal no orçamento e percentual de despesas do Poder Executivo com pessoal. Para medir o desempenho em APS, 13 indicadores foram calculados para 2009 e 2014, em três diretrizes do PDM: (i) acesso, (ii) atenção integral à saúde da mulher e da criança, e (iii) redução dos riscos e agravos à saúde. A análise comparativa do desempenho considerou o ano de 2014 e a evolução de cada capital no período analisado. As capitais São Paulo e Rio de Janeiro, de gestão por OS, não obtiveram melhor desempenho no conjunto de indicadores em relação às que mantiveram a gestão por AD. Destaca-se a rápida expansão de cobertura de APS no Rio de Janeiro mediante OS. Na evolução do desempenho houve melhoria em indicadores como mortalidade infantil e internações por condições sensíveis à APS em todas as capitais. As cidades são distintas em relação a diversos parâmetros que podem influenciar o desempenho em APS e não se pretendeu estabelecer relação direta entre o modelo de gestão adotado e o desempenho medido.

Este estudio se centra en el desempeño de las cuatro capitales de la región sudeste en lo que se refiere a la atención primaria de salud (APS), durante los años 2009 y 2014, respecto a los indicadores del Pacto de Directrices y Metas (PDM) 2013-2015. Dos capitales recurrieron a organizaciones sociales (OS) y dos mantuvieron la prestación y la gerencia de la APS, mediante la Administración Directa (AD), configurando modelos distintos de gestión. Los datos secundarios de acceso libre e investigación en sitios electrónicos ayudaron en la caracterización de las cedads y su desempeño en la APS. La caracterización se basó en datos demográficos y socioeconómicos, modelo de gestión de la APS, gastos de salud y APS, importancia del Fondo de Participación Municipal en el presupuesto y porcentaje de gastos del Poder Ejecutivo en personal. Para medir el desempeño de la APS, se calcularon 13 indicadores para 2009 y 2014, en tres directrices del PDM: acceso, atención integral a la salud de la mujer y del niño, así como reducción de riesgos y efectos dañinos para la salud. El análisis comparativo del desempeño consideró el año 2014 y la evolución de cada capital durante el período analizado. Las capitales São Paulo y Río de Janeiro, de gestión mediante OS, no obtuvieron mejor desempeño en el conjunto de indicadores referentes a las que mantuvieron la gestión vía AD. Se destacó la rápida expansión de cobertura de APS en Río de Janeiro mediante OS. En la evolución del desempeño hubo una mejoría en indicadores como mortalidad infantil e internamientos por condiciones sensibles a la APS en todas las capitales. Las cedads son distintas, en relación con diversos parámetros que pueden influenciar en el desempeño de la APS y no se pretendió establecer relación directa entre el modelo de gestión adoptado y el desempeño medido.

Atenção primária à saúde e Organizações Sociais nas capitais da Região Sudeste do Brasil: 2009 e 2014 / Primary health care and Social Organizations in capitals in the Southeast Region of Brazil: 2009 and 2014 / Atención primaria de salud y Organizaciones Sociales en las capitales de la región sudeste de Brasil: 2009 y 2014

Este estudo focaliza o desempenho das quatro capitais da Região Sudeste do Brasil na atenção primária à saúde (APS), nos anos de 2009 e 2014, em relação a indicadores do Pacto de Diretrizes e Metas (PDM) 2013-2015. Duas capitais recorreram a Organizações Sociais (OS) e duas mantiveram a prestação e a gerência da APS mediante a Administração Direta (AD), configurando modelos distintos de gestão. Dados secundários de acesso livre e pesquisa em sítios eletrônicos subsidiaram a caracterização das cidades e o seu desempenho em APS. A caracterização foi baseada em dados demográficos e socioeconômicos, modelo de gestão da APS, gastos com saúde e APS, importância do Fundo de Participação Municipal no orçamento e percentual de despesas do Poder Executivo com pessoal. Para medir o desempenho em APS, 13 indicadores foram calculados para 2009 e 2014, em três diretrizes do PDM: (i) acesso, (ii) atenção integral à saúde da mulher e da criança, e (iii) redução dos riscos e agravos à saúde. A análise comparativa do desempenho considerou o ano de 2014 e a evolução de cada capital no período analisado. As capitais São Paulo e Rio de Janeiro, de gestão por OS, não obtiveram melhor desempenho no conjunto de indicadores em relação às que mantiveram a gestão por AD. Destaca-se a rápida expansão de cobertura de APS no Rio de Janeiro mediante OS. Na evolução do desempenho houve melhoria em indicadores como mortalidade infantil e internações por condições sensíveis à APS em todas as capitais. As cidades são distintas em relação a diversos parâmetros que podem influenciar o desempenho em APS e não se pretendeu estabelecer relação direta entre o modelo de gestão adotado e o desempenho medido.

This study focuses on the primary health care (PHC) performance of the four capitals of the Southeast Region of Brazil in the years 2009 and 2014 in terms of the indicators of the 2013-2015 Guidelines and Goals Pact (PDM, in Portuguese). Two capitals turned to Social Organizations (OS, in Portuguese) and two kept the provision and administration of PHC through Direct Administration (AD, in Portuguese), configuring distinct management models. Freely accessible secondary data and research on websites subsidized the characterization of the cities and their PHC performance. The characterization was based on demographic and socioeconomic data, PHC management model, health and PHC spending, importance of the Municipal Participation Fund for the budget and percentage of Executive Branch spending on personnel. In order to measure PHC performance, we calculated 13 indicators for 2009 and 2014, in three PDM guidelines: (i) access, (ii) integral care for women and children's health and (iii) reduction of health risks and harms. The comparative performance analysis considered the year 2014 and each capital's evolution during the period we analyzed. The capitals São Paulo and Rio de Janeiro, with OS management, did not have a better performance in the set of indicators than the capitals than maintained a direct administration. We highlight the rapid expansion in PHC coverage in Rio de Janeiro through OS. In the performance evolution, there was improvement in indicators such as child mortality and hospital admissions due to conditions sensible to PHC in all capitals. The cities are different with regard to many parameters that can influence PHC performance. We did not intend to establish a direct relationship between the administration model and performance.

Este estudio se centra en el desempeño de las cuatro capitales de la región sudeste en lo que se refiere a la atención primaria de salud (APS), durante los años 2009 y 2014, respecto a los indicadores del Pacto de Directrices y Metas (PDM) 2013-2015. Dos capitales recurrieron a organizaciones sociales (OS) y dos mantuvieron la prestación y la gerencia de la APS, mediante la Administración Directa (AD), configurando modelos distintos de gestión. Los datos secundarios de acceso libre e investigación en sitios electrónicos ayudaron en la caracterización de las cedads y su desempeño en la APS. La caracterización se basó en datos demográficos y socioeconómicos, modelo de gestión de la APS, gastos de salud y APS, importancia del Fondo de Participación Municipal en el presupuesto y porcentaje de gastos del Poder Ejecutivo en personal. Para medir el desempeño de la APS, se calcularon 13 indicadores para 2009 y 2014, en tres directrices del PDM: acceso, atención integral a la salud de la mujer y del niño, así como reducción de riesgos y efectos dañinos para la salud. El análisis comparativo del desempeño consideró el año 2014 y la evolución de cada capital durante el período analizado. Las capitales São Paulo y Río de Janeiro, de gestión mediante OS, no obtuvieron mejor desempeño en el conjunto de indicadores referentes a las que mantuvieron la gestión vía AD. Se destacó la rápida expansión de cobertura de APS en Río de Janeiro mediante OS. En la evolución del desempeño hubo una mejoría en indicadores como mortalidad infantil e internamientos por condiciones sensibles a la APS en todas las capitales. Las cedads son distintas, en relación con diversos parámetros que pueden influenciar en el desempeño de la APS y no se pretendió establecer relación directa entre el modelo de gestión adoptado y el desempeño medido.

Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries.

BACKGROUND: Contracting out of governmental health services is a financing strategy that governs the way in which public sector funds are used to have services delivered by non-governmental health service providers (NGPs). It represents a contract between the government and an NGP, detailing the mechanisms and conditions by which the latter should provide health care on behalf of the government. Contracting out is intended to improve the delivery and use of healthcare services. This Review updates a Cochrane Review first published in 2009. OBJECTIVES: To assess effects of contracting out governmental clinical health services to non-governmental service provider/s, on (i) utilisation of clinical health services; (ii) improvement in population health outcomes; (iii) improvement in equity of utilisation of these services; (iv) costs and cost-effectiveness of delivering the services; and (v) improvement in health systems performance. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, NHS Economic Evaluation Database, EconLit, ProQuest, and Global Health on 07 April 2017, along with two trials registers - ClinicalTrials.gov and the International Clinical Trials Registry Platform - on 17 November 2017. SELECTION CRITERIA: Individually randomised and cluster-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies, comparing government-delivered clinical health services versus those contracted out to NGPs, or comparing different models of non-governmental-delivered clinical health services. DATA COLLECTION AND ANALYSIS: Two authors independently screened all records, extracted data from the included studies and assessed the risk of bias. We calculated the net effect for all outcomes. A positive value favours the intervention whilst a negative value favours the control. Effect estimates are presented with 95% confidence intervals. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and we prepared a Summary of Findings table. MAIN RESULTS: We included two studies, a cluster-randomised trial conducted in Cambodia, and a controlled before-after study conducted in Guatemala. Both studies reported that contracting out over 12 months probably makes little or no difference in (i) immunisation uptake of children 12 to 24 months old (moderate-certainty evidence), (ii) the number of women who had more than two antenatal care visits (moderate-certainty evidence), and (iii) female use of contraceptives (moderate-certainty evidence).The Cambodia trial reported that contracting out may make little or no difference in the mortality over 12 months of children younger than one year of age (net effect = -4.3%, intervention effect P = 0.36, clustered standard error (SE) = 3.0%; low-certainty evidence), nor to the incidence of childhood diarrhoea (net effect = -16.2%, intervention effect P = 0.07, clustered SE = 19.0%; low-certainty evidence). The Cambodia study found that contracting out probably reduces individual out-of-pocket spending over 12 months on curative care (net effect = $ -19.25 (2003 USD), intervention effect P = 0.01, clustered SE = $ 5.12; moderate-certainty evidence). The included studies did not report equity in the use of clinical health services and in adverse effects. AUTHORS' CONCLUSIONS: This update confirms the findings of the original review. Contracting out probably reduces individual out-of-pocket spending on curative care (moderate-certainty evidence), but probably makes little or no difference in other health utilisation or service delivery outcomes (moderate- to low-certainty evidence). Therefore, contracting out programmes may be no better or worse than government-provided services, although additional rigorously designed studies may change this result. The literature provides many examples of contracting out programmes, which implies that this is a feasible response when governments fail to provide good clinical health care. Future contracting out programmes should be framed within a rigorous study design to allow valid and reliable measures of their effects. Such studies should include qualitative research that assesses the views of programme implementers and beneficiaries, and records implementation mechanisms. This approach may reveal enablers for, and barriers to, successful implementation of such programmes.

Outsourcing within the Nordic context: Care services for older people in Finland.

The early 1990s economic setback brought significant reforms favoring the outsourcing of care in Finnish municipalities. Here, outsourcing refers to the practice of municipalities employing private organizations through different means (e.g., open tendering) to deliver public care services. In this context, this study examines the growth in the outsourcing of service housing and home-help services in 311 municipalities from 2001 to 2015 and investigates the municipal factors associated with outsourcing using four dimensions: care needs, population size, economic situation, and political ideology of the municipality. The findings reveal a steep increase in the outsourcing of home-help and service housing. Care needs of older people are the most influential factor for outsourcing, particularly for service housing. Overall, the findings show a growing trend in private care provision in Finnish municipalities.

Neck-Shoulder Pain and Work Status among Former Sewing Machine Operators: A 14-year Follow-up Study.

Purpose A total of 243 Danish female sewing machine operators lost their jobs in 1996 because of outsourcing. The aim was to investigate the employment status during follow-up from 1996 to 2008, and to estimate to what extent former neck-shoulder pain had an impact on later work participation. Methods Assessment of neck-shoulder pain was based on questionnaires completed in 1994. The Danish Register-Based Evaluation of Marginalization (DREAM) register was used to describe employment status during the follow-up period. Register data were explored by sequence analyses and graphics, and the association between neck-shoulder pain and work participation was analyzed by logistic regression analysis. Results In all, 987 working years were lost during follow-up, and a sequence index plot revealed interrupted and heterogeneous courses of incomes. The odds ratio between neck and shoulder pain and a work participation score less than 75% was 1.49 (95% CI 0.84-2.67). Conclusions After outsourcing of the textile industry, the former sewing machine operators had decreased work participation and frequent transitions between different income types. Previous neck-shoulder pain tended to be associated with poor work participation. The results suggest that increased attention should be to given to dismissed workers from other industries that become outsourced, especially unskilled workers with similar work-related health limitations. Additionally, we concluded that time-to-event measures in research involving employment status are insufficient because of the many transitions that take place in working life.

Outsourcing in bioanalysis: a CRO perspective.

Steve Lowes from Q2 Solutions speaks to Sankeetha Nadarajah, Managing Commissioning Editor: about outsourcing strategy implementation. Steve started his industrial career at VG Biotech in the UK that became the LC-MS instrument entity of Waters Corporation. Since joining the CRO group that became Advion and then Q2 Solutions, his career has focused on regulated bioanalysis with particular emphasis on LC-MS. He is a founding member of the Global Bioanalysis Consortium and a past-chair of the AAPS Bioanalytical Focus Group. At Q2 Solutions, Steve leads the scientific disciplines around LC-MS bioanalysis for both small molecule and biomolecule applications including biomarker assays. Steve has over 40 peer-reviewed publications on bioanalysis and is a frequent speaker at national and international conferences.

Outsourcing bioanalytical services at Janssen Research and Development: the sequel anno 2017.

The strategy of outsourcing bioanalytical services at Janssen has been evolving over the last years and an update will be given on the recent changes in our processes. In 2016, all internal GLP-related activities were phased out and this decision lead to the re-orientation of the in-house bioanalytical activities. As a consequence, in-depth experience with the validated bioanalytical assays for new drug candidates is currently gained together with the external partner, since development and validation of the assay and execution of GLP preclinical studies are now transferred to the CRO. The evolution to externalize more bioanalytical support has created opportunities to build even stronger partnerships with the CROs and to refocus internal resources. Case studies are presented illustrating challenges encountered during method development and validation at preferred partners when limited internal experience is obtained or with introduction of new technology.

Current status of bioanalytical outsourcing: a pharma perspective.

Eric Woolf, Ajai Chaudhary and Sheila Breidinger from Merck, spoke to Sankeetha Nadarajah (Managing Commissioning Editor, Bioanalysis) about outsourcing strategy implementation.

Current practice and perspectives in CRO oversight based on a survey performed among members of the German Association of Research-Based Pharmaceutical Companies (vfa).

In recent years, the number and scope of outsourced activities in the pharmaceutical industry have increased heavily. In addition, also the type of outsourcing has changed significantly in that time. This raises the question of whether and how sponsors retain the capability to select and to control the contract research organizations (CROs) involved and what expertise still has to be present in the development department as well as other relevant departments to ensure adequate oversight, also in line with the expectations of regulators and health authorities. In order to answer these questions, a survey was conducted among the German vfa member companies. The survey describes the latest developments and experiences in outsourcing by 18 German vfa member companies. It concentrates on measures how to implement Quality Assurance (QA) when performing outsourced clinical studies. This study shows that the majority of companies apply a full-outsourcing, preferred-provider model of clinical trial services, with the clinical research department playing the major role in this process. A large amount of guiding documents, processes and tools are used to ensure an adequate oversight of the services performed by the CRO(s). Finally the guiding principles for all oversight processes should be transparent communication, a clearly established expectation for quality, a precise definition of accountability and responsibility while avoiding silo mentality, and a comprehensive documentation of the oversight's evidence. For globally acting and outsourcing sponsors, oversight processes need to be aligned with regards to local and global perspectives. This survey shows that the current implementation of oversight processes in the participating companies covers all relevant areas to ensure highest quality and integrity of the data produced by the outsourced clinical trial.

Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit.

OBJECTIVE: Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor. METHODS: Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012. RESULTS: Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P < .001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P = .6, and mean referrals were similar, 186 to 203, P = .8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P < .03, but similar to baseline in the maintenance phase, mean 20/year, P = .07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability. CONCLUSION: In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost-benefit and quality of care as health-care systems focus on population management.

Hospital support services and the impacts of outsourcing on occupational health and safety.

BACKGROUND: Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. OBJECTIVES: This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. METHODS: Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. RESULTS: Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. CONCLUSIONS: This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.

Data Science Solution to Event Prediction in Outsourced Clinical Trial Models.

Late phase clinical trials are regularly outsourced to a Contract Research Organisation (CRO) while the risk and accountability remain within the sponsor company. Many statistical tasks are delivered by the CRO and later revalidated by the sponsor. Here, we report a technological approach to standardised event prediction. We have built a dynamic web application around an R-package with the aim of delivering reliable event predictions, simplifying communication and increasing trust between the CRO and the in-house statisticians via transparency. Short learning curve, interactivity, reproducibility and data diagnostics are key here. The current implementation is motivated by time-to-event prediction in oncology. We demonstrate a clear benefit of standardisation for both parties. The tool can be used for exploration, communication, sensitivity analysis and generating standard reports. At this point we wish to present this tool and share some of the insights we have gained during the development.