BackgroundPertussis, or “whooping cough,” is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27–36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16–61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women.MethodsOur aim was to inform new strategies to increase uptake of the Tdap vaccine among pregnant women and, ultimately, reduce pertussis-related morbidity and mortality in infants. We conducted interviews with a sample of 24 ob-gyns. We subsequently performed grounded theory analyses of transcripts using deductive and inductive coding strategies followed by intercoder reliability assessment.ResultsAll physicians interviewed were familiar with the most recent recommendation of giving the Tdap vaccine during the third trimester of every pregnancy, and the majority of physicians stated that they felt that the vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus. Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice. Implementation challenges for physicians included insurance reimbursement and other challenges (i.e., patient refusal). Tdap vaccination during pregnancy was a lower clinical priority for some physicians. Physicians recognized the benefits associated with Tdap vaccination during pregnancy.ConclusionsFindings indicate while most ob-gyns recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial concerns for the practice can outweigh the perceived benefits. This resulted in some ob-gyns reporting choosing not to stock and administer the vaccine in their practice. Recommendations to address these concerns include 1) structural support for Tdap vaccine administration in ob-gyns practices; 2) Continuing medical education-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in communicating the importance of Tdap vaccination during pregnancy.

An organization's costing system is a system that helps the management with the strategy planning while the system plays an important role in providing accurate cost information about the products and customers. In other words, the costing management system is important to provide timely and quality information to help managers in their decision making process. Producing quality graduates is the main objective of any university and the cost of quality or the cost of poor quality is one that is often difficult to measure in higher education. This can be partly attributed to the fact that most accounting systems are not structured to capture important cost-of-quality information.In order to succeed, many organizations tend to shift from conventional or traditional costing system to Activity-Based Costing (ABC). ABC provides both higher education administrators and policymakers with better information on which to base decisions. The approach provides information to universities that could help them in better projections and forecasting. Not only that, this approach provides information on different activities and identifies the high cost areas and high impact activities that can help administrators in decision making process. The use of multiple cost pools and drivers under ABC leads to more detailed and accurate product costing than that provided by traditional cost systems. The individual activities become the central cost focus with the assigning of costs to activities based on the way in which the resources are consumed by the activities. Managers can then determine whether certain activities are necessary or whether they can be eliminated. Only services that are value adding are maintained while nonvalue-adding services can be eliminated, resulting in cost savings for the university Although not trained as accountants, library managers rely on accounting information for strategic planning and operational decision-making. Increased demands for institutional accountability, with university performance and costs under increased scrutiny, place library managers under increased pressure to maintain quality services while faced with decreased funding and tighter budgets. A commitment to greater efficiency requires an understanding of cost behavior. Considering that there is no evidence of the costing systems in universities in the Kingdom of Bahrain, this paper attempts to investigate the possibilities and limitations of implementing ABC in the Royal University for Women. More specifically the paper discusses the benefits of ABC to library managers and explains the steps involved in implementing ABC in an academic library.

An organization's costing system is a system that helps the management with the strategy planning while the system plays an important role in providing accurate cost information about the products and customers. In other words, the costing management system is important to provide timely and quality information to help managers in their decision-making process. Producing quality graduates is the main objective of any university and the cost of quality or the cost of poor quality is one that is often difficult to measure in higher education. This can be partly attributed to the fact that most accounting systems are not structured to capture important cost-of-quality information. In order to succeed, many organizations tend to shift from conventional or traditional costing system to Activity-based costing (ABC). ABC provides both higher education administrators and policymakers with better information on which to base decisions. The use of multiple cost pools and drivers under ABC leads to more detailed and accurate product costing than that provided by traditional cost systems. This paper attempts to investigate the possibilities and limitations of implementing ABC in universities. More specifically the study makes use of the case study method to illustrate the implementation of activity-based costing of library services in a private university in the Kingdom of Bahrain. The research methodology of the case study is a combination of both descriptive and quantitative analyses. The study identified six categories of cost pools which are related to the activities of the library as well as 17 relevant cost drivers. Accordingly, ABC should lead to a better understanding of what drives costs and, by extension, what changes are necessary to reduce costs. Unnecessary activities that do not add value to services can be identified and eliminated. Further ABC is feasible in an academic library and that much can be gained from the process of analyzing activities. However, more work needs to be done in terms of designing accounting and other information systems to capture cost and activity transaction data in a more routine and disaggregated form for ABC analysis.

Background: Advanced age and low socioeconomic status are major risk factors for cancer among women in the United States. Beginning at age 50, the probability of developing invasive cancer increases for women for almost every major type of cancer, including breast, colon, lung, and uterine cancer. Furthermore, uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage. Safety net health care providers offer primary care as well as cancer screening services for medically underserved patients. Publicly funded programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), offer breast and cervical cancer screening services in many of these safety net settings. Little is known, however, about whether and to what extent safety net providers prepare older women for transitions to cancer care once they become eligible for Medicare and age out of publicly funded cancer screening programs like the NBCCEDP. To better inform future research, policy, and intervention programs designed to promote a coordinated transition to cancer screening and treatment among older women using safety net services, this study explored safety net provider practices about transitions to cancer care in Georgia. Study Purpose: The purpose of this study was to: 1) assess the extent to which safety net clinics in Georgia provide cancer screening services to medically underserved women ages 50 and older; and (2) explore safety net provider policies and practices for assisting older women to transition to Medicare for their cancer care services. Methods: This study applied an explanatory sequential mixed methods design. The quantitative phase included an online-survey with safety net providers who offer breast and cervical cancer screening services to older, uninsured and medically vulnerable women in Georgia. The survey addressed clinic and client characteristics, provision of cancer care services, health education and patient navigation services, and policies and practices specific to care transitions. In-depth interviews with a purposive sample of participating providers were conducted as the following explanatory qualitative phase to explore the survey results in greater detail. Results and Implications: Quantitative survey results from 193 safety net clinic providers in Georgia indicate about 20% of their clientele are uninsured women ages 50-64. A large majority of clinics offer breast and cervical cancer screening services (95%), as well as referrals for diagnostic follow-up (80%) and referrals for cancer treatment via the Georgia Women's Health Medicaid Program (82%). Most safety net clinics (57%) do not provide cancer screening services to women older than age 65 and do not have a formal policy in place to help these older women transition to Medicare for their cancer care (51%). However, about one-third of safety net clinics offer some information or informal counseling to older women about how to enroll in Medicare and find a Medicare-participating provider. Qualitative findings suggest that providers support the development of a care coordination model, such as patient navigation, to assist older women in their transition from safety net clinics to private, Medicare providers for cancer care services. Enhanced provider education and training regarding Medicare benefits and policies was also recommended. Considered together, these strategies offer an opportunity to enhance safety net provision of cancer screening services for older women and to create new models of transition cancer care for the medically underserved in Georgia Citation Format: Sarah Blake, Jonathan Hawley, Susanne Erni, Arpita Mehrotra. Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C07.