Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs.

RESEARCH QUESTION: From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DESIGN: Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. RESULTS: Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. CONCLUSIONS: The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

It's Time! The Path for Nursing Reimbursement Reform.

Since the COVID-19 pandemic, nurses and nurse leaders are increasingly vocal about chronic understaffing and the impact the staffing crisis continues to have on nurses' well-being and patient outcomes. The American Nurses Association's Nurse Staffing Task Force addressed the importance of staffing standards as a critically needed step toward improving patient and population health outcomes. Against the backdrop of ongoing nursing shortages, hospital leaders have been hesitant to embrace staffing ratios, expressing concerns about their ability to hire and retain sufficient nursing staff, as operational revenue margins remain thin and nursing labor is costly. This article explicates structural issues within the current nursing reimbursement model that harms hospitals' business case for investments in nurse staffing and work environments. We argue that nurses must advocate for nursing reimbursement reform to increase the nursing workforce and improve nurse staffing and work environments. Such reform is necessary to support sustained hospital investments, financial philosophies, and approaches to meaningfully address and improve nurse staffing.

Making the leap from idea generation to implementation: Ten steps every geriatrics specialist should know.

This is an exciting time in Geriatrics, with numerous opportunities in health care for Geriatrics specialists to innovate and lead. Geriatrics specialists should know how to implement innovative care models to lead healthcare changes in their organizations and effectively facilitate change management. We highlight a 10-step framework that Geriatrics specialists can leverage to quickly move their ideas from development to implementation at a system level. This framework adapts concepts from business management to provide a step-by-step guide to move from idea generation to implementation. We provide different practical examples that a Geriatrician can correlate to in their practice, including value proposition and business canvas model. Though small components of the business canvas model may vary based on organization and program/idea-specific needs, the outlined skills will establish Geriatrics specialists as leaders of change, a resource for education, and valued consultants to a health system that is in dire need of direction to improve the quality of care, and health outcomes, for older adults.

Supply, demand and the economic effectiveness of urine-diverting technologies and products: A systematic literature review.

The broader adoption of urine-diverting technologies (UDTs) and related products has been proposed as a strategy for moving towards a more circular economy. While some studies have explored the performance of UDTs, the interconnected factors involving supply, demand, and economic feasibility of UDTs remain under-researched. Our systematic review addresses this gap. Our search identified only 64 relevant, peer-reviewed studies, 71 % of which addressed the supply side (primarily the technical aspect of UDTs) and 58 % of which addressed the demand side (focusing on consumers' perceptions). Approximately one-third (18) of these studies delved into the economic feasibility of UDTs, with only 9 employing a cost benefit analysis (CBA) framework. However, none of these studies have analysed the economic performance of UDTs that have been fully deployed, indicating a significant knowledge gap. Our review suggests that overcoming challenges in scaling up UDTs can be achieved by engaging those stakeholders driving the uptake, developing business cases that offer an overall understanding of both market and non-market benefits of UDTs, addressing technological constraints by optimising urine treatment options for efficiency and economic viability, and enhancing stakeholders' acceptance of UDTs.

Lead with speed: Recasting the forensic laboratory product line and service delivery model.

Forensic laboratories face a multitude of challenges when striving to deliver services to the criminal justice system. While many of these issues change over time, one in particular seems to endure the test of time … the need for faster results. Law enforcement wants and needs quicker response times to access critical information required to investigate their cases. One answer to this persistent problem is evolving technology. Technology not only permits a much quicker response than forensic laboratories are currently delivering, it can open the door to solving previously unsolvable cases. Along with applying new technology, an evaluation of current forensic laboratory product lines, service delivery models, and mindset regarding the role of forensic science-based investigative leads (termed forensic leads) is warranted. Resources and strategic planning are needed to realize the full potential of evolving technologies and what forensic laboratories can do to provide actionable and timely forensic leads to our criminal justice partners as a normal course of action instead of as an exception. This proposal is to establish a permanent, designated Forensic Lead Program (FLP) that resides under the umbrella of an accredited forensic laboratory and is tasked with the development and release of forensic leads. The FLP involves a focused menu of services, defined personnel roles, strict protocols, short turnaround time, standardized expectations, and targeted training, combined with the sense of urgency needed for consistent delivery of timely and actionable forensic leads. A dedicated FLP will save time and money by providing critical information for more focused investigations. 'Speed is the need' … for quick identification of those that threaten public safety and for the equally quick elimination of those wrongfully accused. Programs at two large state forensic laboratories will demonstrate how these concepts could be implemented along with their learning experiences. A business case will also be included to demonstrate the cost benefit of the Forensic Lead Program for DNA (CODIS - Combined DNA Index System) and NIBIN (National Integrated Ballistic Information Network), however other section services are expected to see similar benefits. Improving the response time by one day saves $1677.75 per $1 spent [1]. The return on investment (ROI) for applying DNA to firearms evidence returns $47.88 per $1 spent, or an 4,788 % ROI. Applying NIBIN (National Integrated Ballistic Information Network) to firearms evidence to provide investigative leads is $502.19 per $1 spent, which is a 50,219 % ROI. Recasting the forensic laboratory product line and service delivery model to 'Lead with Speed' makes both economic and investigative sense.