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Different Barriers (different + barrier)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

Electronic health records: Use, barriers and satisfaction among physicians who care for black and Hispanic patients

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2009
Ashish K. Jha MD MPH
Abstract Objectives, Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers. Methods, We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems. Results, Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care. Conclusions, In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minority-serving providers have equal access to EHR systems, we failed to find evidence of a new digital divide. [source]

Barriers to Innovation among Spanish Manufacturing SMEs

JOURNAL OF SMALL BUSINESS MANAGEMENT, Issue 4 2009
Antonia Madrid-Guijarro
Innovation is widely recognized as a key factor in the competitiveness of nations and firms. Small firms that do not embrace innovation within their core business strategy run the risk of becoming uncompetitive because of obsolete products and processes. Innovative firms are a perquisite for a dynamic and competitive economy. This paper reports on the results of a study that examined barriers to firm innovation among a sample of 294 managers of small and medium-sized enterprises (SMEs) in Spain. The study examined the relation between (1) product, process, and management innovation and (2) 15 obstacles to innovation, which can limit a firm's ability to remain competitive and profitable. Findings of the study show that barriers have a differential impact on the various types of innovation; product, process, and management innovation are affected differently by the different barriers. The most significant barriers are associated with costs, whereas the least significant are associated with manager/employee resistance. Additionally, the results demonstrate that the costs associated with innovation have proportionately greater impact on small than on larger firms. The findings can be used in the development of public policy aimed at supporting and encouraging the innovation among SMEs in Spain. Government policies that encourage and support innovation among all firms, especially small firms, can help countries remain competitive in a global market. Public policy that encourages innovation can enable firms to remain competitive and survive, both of which have direct implications for employment and a country's economic viability. The results may also be insightful for managers who are attempting to encourage innovation. Understanding barriers can assist managers in fostering an innovative culture by supporting new ideas or by avoiding an attitude that creates resistance to new ideas. [source]

Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65

THE JOURNAL OF RURAL HEALTH, Issue 4 2010
Todd A. MacKenzie PhD
Abstract Objectives: More than 1 in 5 Veterans Affairs (VA) users lives in a rural setting. Rural veterans face different barriers to health care than their urban counterparts, but their risk of death relative to their urban counterparts is unknown. The objective of our study was to compare survival between rural and urban VA users. Methods: We linked the Large Health Survey of Veteran Enrollees conducted in 1999 to the Veterans Administration vital status registry. We used time-to-event regression models controlling for patient race, education, ZIP-code median income, and marital and smoking status. Findings: Of the 372,463 male veterans of age 65 or greater, 80,931 lived in rural settings. Age-adjusted mortality was 5.9% higher (95% CI, 4.5%-7.2%) in rural residents compared to urban residents. After adjusting for age, education, and ZIP-code median income, rural residents had 3.0% lower mortality (95% CI, 1.5%-4.4%). Compared to urban and suburban VA users, rural VA users' mortality at age 65 was 12% lower, but this advantage gradually diminished by age 75. Conclusion: Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers. However, among veterans of the same socioeconomic characteristics, rural-dwelling veterans have up to 15% better mortality than urban-dwelling veterans until the age of 75. [source]

Pension funding problem with regime-switching geometric Brownian motion assets and liabilities

APPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 2 2010
Ping Chen
Abstract This paper extends the pension funding model in (N. Am. Actuarial J. 2003; 7:37,51) to a regime-switching case. The market mode is modeled by a continuous-time stationary Markov chain. The asset value process and liability value process are modeled by Markov-modulated geometric Brownian motions. We consider a pension funding plan in which the asset value is to be within a band that is proportional to the liability value. The pension plan sponsor is asked to provide sufficient funds to guarantee the asset value stays above the lower barrier of the band. The amount by which the asset value exceeds the upper barrier will be paid back to the sponsor. By applying differential equation approach, this paper calculates the expected present value of the payments to be made by the sponsor as well as that of the refunds to the sponsor. In addition, we study the effects of different barriers and regime switching on the results using some numerical examples. The optimal dividend problem is studied in our examples as an application of our theory. Copyright © 2009 John Wiley & Sons, Ltd. [source]