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- Performance assessment of primary health care services using data envelopment analysis and the quality-adjusted malmquist indexPublication . De Mattos Capeletti, Nuno; Amado, Carla; Santos, SérgioPrimary Health Care (PHC) is intended to provide a comprehensive response to the patients' health needs. Considering the increasing demand to optimise the use of the available resources while keeping a high-quality standard, it is essential to investigate the health services' performance. We propose a methodology based on the Data Envelopment Analysis (DEA) technique, examining the volume of activities performed and considering the impact of these activities by using a quality indicator directly related to care outcomes. To perform a longitudinal analysis and observe the changes in quality separately, a Quality-Adjusted Malmquist Productivity Index is implemented. The methodology is illustrated by analysing the performance and the evolution in productivity and quality of the primary care services delivered by the municipalities of the Brazilian state of Santa Catarina from 2008 to 2014. Our findings reinforce the view that adequate planning and structuring of PHC services must consider not only the volume of activity but also the impact of the services delivered.
- Development and application of a composite circularity indexPublication . Garrido, Susana; Rodríguez-Antón, José; Amado, Carla; Santos, Sérgio; Dias, Luís C.Resource depletion and environmental pollution are increasingly a matter of concern for their adverse effects on ecosystems, human health, and the economy. Circular Economy (CE) practices can help us address these chal-lenges. This paper proposes a composite circularity index (CI) to assess the level of implementation of CE practices. The main advantage of the proposed index is its ability to combine multiple indicators of circularity for different units operating in a given sector (given as inputs), using a 'Benefit of the Doubt' model. This new model is innovative in the manner it deals with ordinal scales and also by considering both relative and absolute performance indices. These indices are computed using mathematical programming tools, building on ideas from Data Envelopment Analysis models.Although the model can be applied to any sector, this work addresses the hotel industry in particular. The selection of indicators for this CI was based on seven blocks of the Circular Economy Action Plan and a literature review of circular practices. An application of the proposed index is performed by using data from Portuguese and Spanish hotels. The proposed CI allows the identification of the organizations with the best and worst performance in implementing the CE practices and clarifying the benchmarks they could follow to improve their level of circularity. Moreover, the index analysis also provides specific targets for improvement, indicating which circular practices should be improved for the lower performers to reach the implementation levels of the best performers.
- Exploring the potential of Data Envelopment Analysis for enhancing pay-for-performance programme design in primary health carePublication . Kalinichenko, Olena; Amado, Carla; Santos, SérgioIn recent years, implementation of pay-for-performance (P4P) programmes in health care has become a worldwide initiative. However, most P4P programmes incorporate systems of Performance Indicators (PI) without accounting for trade-offs between indicators. This article has two objectives: (1) to develop a Data Envelopment Analysis (DEA) methodology for performance assessment of primary care providers; and (2) to propose an innovative methodology for P4P contracting based on the DEA assessment results. To achieve the first objective, we modify the standard DEA model to account for the necessary relations between the weights attributed to each PI and domain of performance and to account for the effect of the relevant environmental variables. To achieve the second objective, we combine relative and absolute performance assessments in the elaboration of several bases for reward, and then we link these assessments to a system of graduated rewards. A benchmarking programme is also proposed to contribute to the dissemination of best practices. This article contributes to the literature by proposing an enhanced methodology for performance assessment of primary care providers which can form the basis for P4P rewards planning. The applicability and advantages of the proposed methodology are illustrated with data from Portugal, but it can easily be adapted to different sets of PIs or domains, making it relevant for performance assessment and for P4P reward setting in other contexts and countries.
- Neighborhood attributes and well-being among older adults in urban areas: a mixed-methods systematic reviewPublication . Padeiro, Miguel; de Sao Jose, Jose; Amado, Carla; Sousa, Liliana; Roma Oliveira, Carla; Esteves, Alina; McGarrigle, JenniferExpanding urbanization rates have engendered increasing research examining linkages between urban environments and older adults' well-being. This mixed-methods systematic review synthesizes the evidence for the influence of urban neighborhoods' attributes on older adults' well-being. We searched for literature published up to December 2020 across six databases and performed quality assessment and thematic analysis. The results, based on 39 identified studies, showed that natural areas in neighborhoods and a sense of community are the attributes most often associated with positive effects on well-being. Transit-related variables, urban furniture, and access to healthcare are also positively related to well-being. Neighborhoods may promote well-being more effectively when these elements are considered. However, almost half of the studies did not include all environmental dimensions simultaneously, and self-reported instruments were largely preferred over more objective assessments of the environment. Future research should thus holistically examine physical, social, and service-related attributes to produce more robust evidence.
- Assessment and determinants of the quality of life in portuguese citiesPublication . Barreira, Ana; Amado, Carla; Santos, Sérgio; Andraz, Jorge; Guimaraes, Maria Helenathe quality of life (QoL) in cities has increasingly been used as a symbol of urban success. Studies addressing this issue tend to focus, however, on large cities and/or on cities from different countries. By using a set of data from a single country, comprehending cities with different population sizes and densities, observations for 11 performance dimensions, and an approach combining the Data Envelopment Analysis (DEA) technique and multivariate regression modeling, this study analyses the QoL of Portuguese cities and explores some of its determinants. the results of this analysis show that both small and large cities can offer high levels of QoL with "transport and accessibility," "safety," "housing," "education," and "culture and entertainment" being the dimensions that most contribute to the QoL assessment. While Lisbon and Oporto (the two largest Portuguese cities) are benchmark cities, some of the highly populated cities located in their Metropolitan Areas present the most potential for improvement in terms of QoL. the results also show that cities located in the hinterland tend to present higher QoL scores than those on the coast. Equally, cities with lower population size and density, those that are district capitals and those with higher per capita current public expenditures present higher levels of QoL. These findings suggest, therefore, that the cities' typology, their population size and density, and their dependence from local governments' public expenditures can significantly contribute to the differences identified in their QoL performance.
- Labor inspectorates' efficiency and effectiveness assessment as a learning path to improve work-related accident preventionPublication . Santos, Antonio J. R.; Santos, Sérgio; Amado, Carla; Rebelo, Efigénio; Mendes, JúlioLabor inspectorates, by monitoring and enforcing labor legislation, giving information and technical advice to employers and employees, promoting awareness-raising campaigns and implementing occupational risk prevention policies, play a fundamental role in promoting safer and healthier working conditions and, ultimately, in reducing the number of work-related accidents. Even so, every year, hundreds of thousands of people die from accidents at work and around 2 million die from occupational diseases, highlighting that considerable room for improvement remains. The identification and sharing of best practices in labor inspection can be a useful first step in this direction. The main purpose of this research is to propose Data Envelopment Analysis as a suitable technique for assessing the performance of labor inspectorates and identifying best practices. The potential of the proposed methodology is tested by using it to assess the efficiency and the effectiveness of the 32 local branches of the Portuguese Authority for Working Conditions, a key player of the Portuguese system of occupational risk prevention, and by exploring its value in identifying best practices and possible paths for performance improvement.
- Challenges and success factors of transnational higher education: a systematic reviewPublication . Tran, Nguyen Hai Ngan; Amado, Carla; Santos, Sérgio Pereira dosThis paper provides an analysis of the literature on transnational education to identify the key challenges and success factors for the sustainable operation of transnational higher education (TNE) programmes as perceived by key stakeholders. Probing the stakeholders' perspectives and applying a systematic approach, this study analyses 227 English-written articles retrieved from the Web of Science database published from 2000 to 2021. Key challenges identified include difficulties in managing the TNE programmes, ensuring quality assurance, adapting the curricula to the local contexts, accommodating offshore students' learning styles, creating studying environments for TNE students equivalent to those in the home institutions, ensuring preparedness of the academic staff, and facilitating the knowledge transfer in the host countries. The analysis also highlights six factors for the sustainable development of TNE programmes, including the effectiveness of the operations, the internationalization of the curricula, the transnational experience of the students, the development of the transnational staff, the existence of a proper regulatory framework in the host countries, and the development of a global systematic data collection for quality assurance. In addition, the evidence collected suggests that while the transition from domestic into a foreign programme can be rewarding, it demands appropriate planning and implementation.
- Assessing the impact of COVID-19 on the performance of organ transplant services using data envelopment analysisPublication . Manoel, Márcia N. F.; Santos, Sérgio; Amado, CarlaOrgan transplant is one of the best options for many medical conditions, and in many cases, it may be the only treatment option. Recent evidence suggests, however, that the COVID-19 pandemic might have detrimentally affected the provision of this type of healthcare services. The main purpose of this article is to use Data Envelopment Analysis and the Malmquist Index to assess the impact that the pandemic caused by the novel coronavirus SARS-CoV-2 had on the provision of solid organ transplant services. To this purpose, we use three complementary models, each focusing on specific aspects of the organ donation and transplantation process, and data from Brazil, which has one of the most extensive public organ transplant programs in the world. Using data from 17 States plus the Federal District, the results of our analysis show a significant drop in the performance of the services in terms of the organ donation and transplantation process from 2018 to 2020, but the results also indicate that not all aspects of the process and States were equally affected. Furthermore, by using different models, this research also allows us to gain a more comprehensive and informative assessment of the performance of the States in delivering this type of service and identify opportunities for reciprocal learning, expanding our knowledge on this important issue and offering opportunities for further research.
- “I Was... Put in a Cage”: The Experience of COVID-19 Home Confinement among Older Adults Living Alone in Portugal*Publication . São José, José; Timonen, Virpi; Teixeira, Ana Rita; Amado, Carla; Santos, Sérgio Pereira dos; COELHO, PATRICIAThis article presents findings of a qualitative study reporting older adults' experiences of solitary home confinement during Portugal's first COVID-19 lockdown in 2020. Home confinement was marked by negative experiences, with the exception of one participant who had a particularly favorable combination of resources and circumstances. Negative experiences involved losses in several areas, such as being deprived of out-of-home activities, independence and face-to-face social interactions. Losing out-of-home activi-ties and independence promoted a sense of imprisonment, while losing face-to-face social interactions triggered a feeling of physical loneliness. Considering the potential negative implications of these losses, it is crucial to create innovative solutions that can mitigate them in future lockdowns.