Qualitätsmanagement in Netzwerken der Integrierten Gesundheitsversorgung

Quality management in networks of the Integrated health care. Theory and practiceSelf evaluation is one of the most important sources for the quality management in ambulatory care of integrated health care systems. The quality testing of the survey instrument itself is of outstanding importance, since only a high quality instrument is able to supply high quality data, which can serve as a reliable base for improvement strategies. The paper shows the aspects of a quality management in organizational networks for integrated health care delivery systems. The technique allows the management and the single practioner on the one hand to identify the critical areas at a glance and on the other hand to focus — where necessary — on the single aspects in order to define detailed improvement actions.     

Life cycle savings and consumption constraints

Recent tests of both the pure and the extended life cycle hypothesis have generated inconclusive results on the life cycle behavior of the elderly. We extend the life cycle model by introducing a constraint on the physical consumption opportunities of the elderly which, if binding, imposes a consumption trajectory declining in age. This explains much of the received evidence on the elderly's consumption and savings behavior, in particular declining consumption, and increasing savings and wealth with increasing age. Our analysis of German data gives additional support to our theory. We finally draw the implications of the theory on the incidence of consumption and income (wealth) taxes, and on the recent (inconclusive) tests of intergenerational altruism.Research in this paper was supported by the National Institute of Aging, Grant No 3 P01 AG 05842-01. The paper was read at the ISPE-Conference on Fiscal Implications of an Ageing Population, Vaalsbroek, The Netherlands, May/June 1990. We are grateful to the conference participants, and especially to Richard Bird, Maurice March and, Carol Popper, and Dave Wildasin for perceptive comments, and Ernst Seiler for able research assistance. Johannes Velling and two anonymous referees provided additional constructive critique.     

Structural Validation and Multiple Group Assessment of the Short Internalized Homonegativity Scale in Homosexual and Bisexual Men in 38 European Countries: Results From the European MSM Internet Survey

Internalized homonegativity (IH) is the internalization of negative attitudes and assumptions about homosexual people by homosexual people themselves. To measure IH, Smolenski, Diamond, Ross, and Rosser (2010) and Ross, Rosser, and Smolenski (2010) revised the Reactions to Homosexuality Scale (RHS) to develop the Short Internalized Homonegativity Scale (SIHS) with eight items. Using the European Men Who Have Sex With Men Internet Survey (EMIS) data, with an analytic sample of 130,718 gay and bisexual men in 38 European countries, we confirmed the validity of the SIHS scale in both training and validation data, in strata of Ross, Berg, et al.’s (2013) three “homosexual discrimination” country clusters, of age, and of education level. However, the performance was less adequate in comparison of gay versus bisexually identified individuals. The latent SIHS structure contains only minor variations across these three strata. The seven-item scale performed as well as the eight-item scale. The SIHS is a promising candidate for standard IH measures, which is invariant across cultural, age, and educational strata.     

Autocovariance Estimation in Regression with a Discontinuous Signal and m‐Dependent Errors: A Difference‐Based Approach

We discuss a class of difference‐based estimators for the autocovariance in nonparametric regression when the signal is discontinuous and the errors form a stationary m‐dependent process. These estimators circumvent the particularly challenging task of pre‐estimating such an unknown regression function. We provide finite‐sample expressions of their mean squared errors for piecewise constant signals and Gaussian errors. Based on this, we derive biased‐optimized estimates that do not depend on the unknown autocovariance structure. Notably, for positively correlated errors, that part of the variance of our estimators that depend on the signal is minimal as well. Further, we provide sufficient conditions for ‐consistency; this result is extended to piecewise Hölder regression with non‐Gaussian errors. We combine our biased‐optimized autocovariance estimates with a projection‐based approach and derive covariance matrix estimates, a method that is of independent interest. An R package, several simulations and an application to biophysical measurements complement this paper.     

Model checks for Cox-type regression models based on optimally weighted martingale residuals

We introduce directed goodness-of-fit tests for Cox-type regression models in survival analysis. “Directed” means that one may choose against which alternatives the tests are particularly powerful. The tests are based on sums of weighted martingale residuals and their asymptotic distributions. We derive optimal tests against certain competing models which include Cox-type regression models with different covariates and/or a different link function. We report results from several simulation studies and apply our test to a real dataset.     

Testing for lack of fit in inverse regression—with applications to biophotonic imaging

Summary.  We propose two test statistics for use in inverse regression problems Y = K θ + ɛ , where K is a given linear operator which cannot be continuously inverted. Thus, only noisy, indirect observations Y for the function θ are available. Both test statistics have a counterpart in classical hypothesis testing, where they are called the order selection test and the data-driven Neyman smooth test. We also introduce two model selection criteria which extend the classical Akaike information criterion and Bayes information criterion to inverse regression problems. In a simulation study we show that the inverse order selection and Neyman smooth tests outperform their direct counterparts in many cases. The theory is motivated by data arising in confocal fluorescence microscopy. Here, images are observed with blurring, modelled as convolution, and stochastic error at subsequent times. The aim is then to reduce the signal-to-noise ratio by averaging over the distinct images. In this context it is relevant to decide whether the images are still equal, or have changed by outside influences such as moving of the object table.     

Unemployment benefits, risk aversion, and migration incentives

With reference to the EU enlargement, a framework is derived which allows the study of the effect of unemployment benefits on the migration decision. While benefits simply increase the expected gain for risk neutral individuals, they work as an insurance device for risk averse migrants; the results for the two groups might differ. Thus, the migration decision is reformulated as monetary lottery. Unsurprisingly, the paper finds that risk averse individuals are less likely to engage in migration. Yet, introducing unemployment benefits also makes them select a different set of countries. The implications of selection and sorting, however, depend crucially on the link between risk aversion and economically important personal characteristics. It is also shown that unemployment benefits give rise to intertemporal trade-offs in migration returns.The author is grateful for helpful comments by Hartmut Lehmann, Christoph M. Schmidt and three anonymous referees. I also like to thank my colleagues at CERT and participants of the R.O.S.E.S. Enlargement Conference 2003 in Paris. This work has been conducted before the author joint DWP and does not reflect the opinion of the department. Responsible editor: Klaus F. Zimmermann.     

Performance as a Basis for Price-setting in the Capital Goods Industry:: Concepts and Empirical Evidence

This paper discusses a new pricing strategy, which leads to a certain variability of prices as the supplier offers to fix prices to performance parameters of long-lasting industrial goods. The underlying idea is to give a signal of the supplier’s competence and/or to conclude a contract, which contains additional value for both parties to the market. Some theoretical findings are applied to this concept and lead to 13 hypotheses, especially dealing with the perceptions of the buyer. Empirical research covered 131 German mechanical engineering companies. The data were used to evaluate the use of performance-based pricing and test the hypotheses. The results show a mixed picture. Uncertainty-reducing effects are well perceived while other assumptions could not be confirmed. Based on the results recommendations are developed on how and when to apply performance-based pricing.     

Contemporary Concerns in Family Therapy*

The literature indicates that recent clinical concerns concentrate on certain problem areas, while neglecting others. Theory building is slow; agreement on definition, indications, selection, evaluation, training programs, and a unifying conceptual schema is still lacking. Intervention and outcome evaluation remain insufficient. A need for broadness, flexibility, and avoidance of dogmatization is underlined. Resistance to a family and community intervention model continues. It is argued that strength rather than pathology needs emphasis. Some strategies to develop family therapy further are suggested and recommendations made to overcome outlined obstacles.