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International Journal of Production Research ; 61(14):4934-4950, 2023.
Article in English | ProQuest Central | ID: covidwho-20244424


Because of the Covid-19 pandemic, urgent surging demand for healthcare products such as personal protective equipment (PPE) has caused significant challenges for multi-tier supply chain management. Although a given firm may predominantly focus on an arms-length solution by targeting the first-tier supplier, the firm can still struggle with extended multi-tier suppliers it cannot choose which use unsustainable practices. One key goal is compliance across various dimensions with production, environmental and labour standards across the multi-tier supply chain, a goal that blockchain technology can be applied to manage. Based on a comprehensive literature review, this research develops a system architecture of blockchain-based multi-tier sustainable supply chain management in the PPE industry designed to identify and coordinate standards in production and social and environmental sustainability in multi-tier PPE supply chains. The architecture was validated by theoretical basis, expert opinions and technical solutions. We conclude with managerial implications for implementing blockchain technology to advance sustainable multi-tier supply chain practices.

JAMA Netw Open ; 5(6): e2218730, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1905756


Importance: Access to specialty mental health care remains challenging for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Whether expansion of telemedicine is associated with improved access and quality of care for these patients is unclear. Objective: To assess whether greater telemedicine use in a nonmetropolitan county is associated with quality measures, including use of specialty mental health care and medication adherence. Design, Setting, and Participants: In this cohort study, the variable uptake of telemental health visits was examined across a national sample of fee-for-service claims from Medicare beneficiaries in 2916 nonmetropolitan counties between January 1, 2010, and December 31, 2018. Beneficiaries with schizophrenia and related psychotic disorders and/or bipolar I disorder during the study period were included. For each year of the study, each county was categorized based on per capita telemental health service use (none, low, moderate, and high). The association between telemental health service use in the county and quality measures was tested using a multivariate model controlling for both patient characteristics and county fixed effects. Analyses were conducted from January 1 to April 11, 2022. Before the COVID-19 pandemic, telemedicine reimbursement was limited to nonmetropolitan beneficiaries. Main Outcomes and Measures: Receipt of a minimum of 2 specialty mental health service visits (telemedicine or in-person) in the year, number of months per year with medication, hospitalization rate, and outpatient follow-up visits after a mental health hospitalization in a year. Results: In 2018, there were 2916 counties with 118 170 patients (77 068 [65.2%] men; mean [SD] age, 58.3 [15.6] years) in the sample. The fraction of counties that had high telemental health service use increased from 2% in 2010 to 17% in 2018. In 2018 there were 1.08 telemental health service visits per patient in the high telemental health counties. Compared with no telemental health care in the county, patients in high-use counties were 1.2 percentage points (95% CI, 0.81-1.60 percentage points) (8.0% relative increase) more likely to have a minimum number of specialty mental health service visits, 13.7 percentage points (95% CI, 5.1-22.3 percentage points) (6.5% relative increase) more likely to have outpatient follow-up within 7 days of a mental health hospitalization, and 0.47 percentage points (95% CI, 0.25-0.69 percentage points) (7.6% relative increase) more likely to be hospitalized in a year. Telemental health service use was not associated with changes in medication adherence. Conclusions and Relevance: The findings of this study suggest that greater use of telemental health visits in a county was associated with modest increases in contact with outpatient specialty mental health care professionals and greater likelihood of follow-up after hospitalization. No substantive changes in medication adherence were noted and an increase in mental health hospitalizations occurred.

Bipolar Disorder , COVID-19 , Telemedicine , Aged , Bipolar Disorder/epidemiology , Bipolar Disorder/therapy , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Female , Humans , Male , Medicare , Middle Aged , Pandemics , United States/epidemiology
Non-conventional | Homeland Security Digital Library | ID: grc-740483


From the Abstract: "In response to the COVID-19 [coronavirus disease 2019] pandemic, many temporary policies were introduced to encourage telemedicine use. There is ongoing debate on what policies should be made permanent. [...] Telemedicine policy in the form of both regulation and payment must balance the goals of increasing access to care and limiting overuse and fraud."