• Korea Journal of Hospital Management
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• v.9 no.1
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• pp.66-94
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• 2004

The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.11 no.1
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• pp.5-13
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• 2004

The home health care industry has grown rapidly and can be expected to continue to grow in the foreseeable future. Home health care refers to the practice of nursing applied to clients with a health condition in the clients place of residence. clients and their designated care givers are the focus at home health nursing practice. The goal of care is to initiate. manage and evaluate the resources needed to promote the clients optimal level of well-being and function. Nursing activities necessary to achieve this goal may warrant preventive maintenance and restorative emphases to prevent potential problems from developing. Many project program were suggested home health care model for Korea's health care system and policy direction for expansion and establishment of home health care .But the aim of this paper is to provide on overview for theoretical frame work in home health care. Theories and conceptual frameworks or models are important nursing because they define and guide the boundaries of professional practice and identify key nurse-patient-caregiver relationships that emerge with caring. Following is the research with an investigation of the literature review in the University of Arizona international medline database, In conclusion, are as followers: First, many nursing theorists have had a tremendous impact on nursing practice. the following highlights those nursing theorists that are particularly helpful in understanding home health care. 1. Florence Nightingale : Our earliest theoretical legacy. Nightingale's believes are reflected in basic infection control practice such as hand washing and infectious waste disposal and are key nursing interventions in home care. 2. Martha Roger's :Science of unitary human beings theory. Rorger's believed that the focus of shared. non invasive healing modelities is the human environmental field rather than direct physical care. These modelities continue to evolve as our awareness (reflecting greater diversity, faster rhythms, motions, and ways of knowing) transcends time and space, allowing individuals to get in touch with their integral nature of unbroken wholeness. On people as ever changing energy fields have special relevance in home care especially with hospice and palliative care applications. 3. Madeline Leininger's; Transcultural nursing theory. Home care nurses move through a variety of communities and often care for patients from different cultural back grounds. Therefore Leininger's work has a good that with home care because home care nursing practice is very culturally focused. 4. Dorothea Orem's : Self care deficit theory. Orem's theory views care as something to be performed by both nurses and patients. The role of the nurse is to provide education and support that help patients acquire the necessary activities to perform self-care. Orem's theory is foundational to have care because it begins to truly acknowledge the role of the patient in managing his or her own health. which is referred to as self-care. 5. Margaret Neuman's; Health as expending consciousness theory. Neuman believes that health compasses disease and reflects an underlying pattern of person-environment interaction. A key application of 'Neuman's work to home care is for nurses to understand that health and illness do not necessarily exist at opposite ends of a continuum. 6. Jean Watson's: Theory of human caring. Watson's theory of human caring in nursing proposes human caring as the moral ideal of nursing. Nurses participate human caring to protect, enhance and preserve humanity by assisting individuals to fing meaning in illness. pain and existence and to help others gain self knowledge. self control. and self healing such thinking lends richness to theory development. as well as clinical practice in home care. Second, Robin Rice : Dynamic self determination for self care. (A theoretical framework for home care) Dynamical self determination for self care can be useful to home care nurses in a variety of ways. As research tool it can be reflected in the interview process when the home visit. The home care nurse's role is that of facilitator of patient self-determination for self care through numerous strategies. including patient education and case management.

• Journal of the Korean Institute of Landscape Architecture
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• v.38 no.3
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• pp.41-52
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• 2010

The purpose of this paper is to evaluate visitor satisfaction(VS) in waterfront parks in terms of resources, facilities, embodiment of theme(ET), site composition(SC), relaxation activity space(RAS), and dynamic activity space(DAS), which are supply-side components in the planning process of waterfront parks, in order to answer the research question; 'How is visitor satisfaction of waterfront parks determined?' After reviewing the literature on parks and the building process of waterfront parks in Korea, we constructed a conceptual framework and have ascertained a research hypothesis. We had obtained data through a questionnaire survey from 327 visitors at waterfront parks, based on the quota sampling method. We have analyzed the data using the path analysis method. We found that: 1) The direct effects of resources and facilities on VS turned out to be 0.273 and 0.306, respectively while the indirect effects are 0.114, 0.170, respectively. 2) The direct effects of SC, as a component of the planning process on VS, turned out to be 0.243 while that of ET had no affect on VS. The indirect effect of ET and SC on VS turned out to be 0.059 and 0.018, respectively. 3) The direct effects of RAS on VS turned out to be 0.129 while the indirect effects of RAS and DAS on VS turned out to be 0.002 and 0.017, respectively. 4) The size of causal effect, in order, were facilities, resources, SC, RAS, ET, and DAS. 5) Resources and facilities, as a park foundation, compose 64.84 percent of total causal effect while ET and SC have 24.04 percent and RAS and DAS have 11.12 percent, respectively. These research results imply that: 1) Existing waterfront parks should be regenerated with the embodiment of water related theme and with improved facilities for RAS and visitor programs and/or facilities for DAS. 2) The relationship among ET, SC, RAS and DAS should be increased for a significant improvement of VS, and 3) A process-oriented approach turned out to be highly useful for the development of substantive theory and methodology. It is recommended that a structural equation model on waterfront parks be developed using more empirical data and this approach be widely applied for testing its validity.

• Proceedings of the Technology Innovation Conference
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• 1997.07a
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• pp.222-223
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• 1997

By analyzing the successful innovation case of potato microtuber mass production technology, a representative case of technology-push type creative innovation in an imitation oriented research culture, this paper attempts to figure out conceptual model of creative innovation that is initiated by the public laboratories in catching-up country, Stages of creative innovation can be divided into the internal R&D stage and the external commercialization stage. Success of the internal R&D stage depended on autonomy to secure creative research idea and commitment of individual researchers. Psychological pressure evoked from sportlights of mass media and commitment of sponsor increased the intensity of research efforts of the researcher Recognition of research problem and its significance was intensified by site visits of agricultural fields, and the recognized higher impacts of expected research results and knowledge creation achieved were a fundamental source of self-motivation. In the stage of commercialization stage, various legal, socio-economic, and psychological barriers were confronted. In a catching-up country lacking of experiences of creative innovation, creative innovation process can be regarded as a barrier elimination and cultural revolution process. Among the barriers, psychological refusal of farmers to corn-sized potato seeds was critical, which finally enforced to further researches to enlarge the size of potato seeds. In addition, the researcher has concentrated his research efforts in one specialized research area by getting a series of similar research project funds rather than diversification. It was lucky for him to have a chance to carry out a series of similar researches in one research area during the last 10 years. In getting research funds from government and private companies continuously in one research area, both internal and external promoters played significant roles.

• Journal of the Korean Institute of Landscape Architecture
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• v.36 no.6
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• pp.1-11
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• 2009

This study focuses on Abstract Types in Contemporary Landscape Design. The formation and artistry of contemporary landscape design reveals many areas which Previously have not been able to be expressed in scenic landscape thanks to the deviation of the genre in contemporary landscape and the hybridization that has occurred among architecture, landscape and art genres. The focus of this study is basic research concerning "the abstract", which is used as a creative artistic theory in a variety of art fields such as landscape, architecture and painting. Through a theoretical establishment of "the abstract", its process of change, and the discovery of its contemporary principles, the relationship between each art field in landscapes and the formation of the abstract, abstract language, and abstract properties have been studied. The use of the abstract in contemporary landscape design can be classified in three ways: Inductive abstract representing conceptual transcendental symbols not logically but rather through intuition and transcendental cognition to display the inner expressions, ideas and minds of the artists. Second, a deductive abstract represents an expansive, logical model for the simplification of objects, distortion, exaggeration based on knowledge and logical reasoning about objective fact based on traditional realism. The complexity of the abstract is a concept that is bound to both the deductive & inductive abstract. As a major trend, the concept of "The abstract" in contemporary landscape has been putting forth ever-deeper roots. New trends like abstract works and landscape architecture reflecting the artist's inner expression, in particular, will provide fertile soil for landscape in the future. Further research about the concept of "the abstract" will also be necessary in the time to come.

• Journal of the Korean Geographical Society
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• v.40 no.3 s.108
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• pp.253-273
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• 2005

In recent years, there are strong social demands to characterize the spatial distribution of mountains in Korea. This study aims to develop a 'Sanjulgi-Jido(mountain ridge map)' that might be used not only to satisfy these social demands but also to effectively present the spatial distribution of mountains and drainage basins in the Korean Peninsular. The 'Sanjulgi-Jido' developed in this study is a map that presents the continuity of mountains based on the drainage divides that are delineated by a pre-defined drainage basin size and elevation. This study first validated the Bakdudaegan system through the analyses of a digital elevation model. The Bakdudaegan system has long been recognized as the Koreans traditional conceptual framework to characterize the spatial distribution of mountains. The analyses showed that the Bakdudaegan system has several problems to represent the mountain systems in Korea, which includes 1) the lack of the representativeness of drainage basins, 2) inaccuracy to depict the boundary of drainage basins, 3) the lack of representativeness of mountains, and 4) geo-polical issue that confines the spatial extent of mountain systems within the Korean Peninsular. In order to represent the mountains system in a more quantitative manner, we applied several terrain analysis techniques to understand the spatial distribution of mountains and drainage basins. Based on these analyses, we developed an hierarchical system to classify the continuity (If mountains, which are presented as the spatial distribution of drainage divides with a certain elevation. The first-order Sanjulgi is the drainage divides whose drainage basin are bigger than $5,000km^2$ and the point elevation is above 100m. The next order Sanjulgi is delineated as the size of drainage basin is successively divided by two. This kind of design is able to provide a logical framework to present the mountain systems at different details, depending on the purpose and scale of maps. We also provide several empirical functions to calculate various geomorphological indices for each order of Sanjulgi. The 'Sanjulgi Jido' is similar with the Bakdudaegan system, since it characterizes the continuity of mountains based on the spatial distribution of the drainage divide. It, however, has more scientific criteria to define the scale and continuity of mountains. It should be also noted that the 'Sanjulgi Jido' proposed has different logical and methodological background, compared with the mountain range map that explains the genesis of mountain systems in addition to the continuity of mountains.

• Journal of Service Research and Studies
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• v.10 no.3
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• pp.23-42
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• 2020

This study conceptualized the essence and propensity of modern management in service age, based on philosophy, and developed items to evaluate the conceptualized content. It was carried out as a new study to deepen the study of management philosophy and management theory by the new management framework. In order to establish the philosophical foundation of the modern management, the essence of the modern management was conceptualized based on the fundamental ideas of the East and West, and then an evaluation item was developed to put the essence and propensity of the modern management into practical use through analytical and empirical methods. After analyzing the representative ideas of mankind, it was derived that the Book of Change has the qualification as a philosophical model that can derive the essence of modern management. The Book of Change explains the reasoning of the world in the structure of two opposing parties, such as Taiji or Yin and Yang, and the process of acknowledging the contradictions within each opposing party and overcoming the contradictions through change is the central idea. Because you can see. After conducting a conceptual study, through empirical research, the essence and propensity of a modern manager should be conceptualized. The concept of essence and empirical study of the modern management using the leading role was conducted in two stages. First, a qualitative study using repetitive comparative analysis (CCM), focus group interview (FGI), and text mining was conducted to derive the essential and propensity conceptualization items that modern managers should possess. In addition, a quantitative study using factor analysis to develop sample items and develop measurement items through literature review and FGI was conducted to derive the essential concept of the modern management. Finally, the essence of modern management was derived: learning, preparation, challenge, inclusion, trust, morality, and sacrifice. In the future, it is necessary to conduct empirical research on the effectiveness of the essence of modern management for global and Korean representative companies.

• Journal of Distribution Research
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• v.17 no.1
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• pp.65-86
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• 2012

The $20^{th}$ century was the era of manufacturer brands which built higher brand equity for consumers. Consumers moved from generic products of inconsistent quality produced by local factories in the $19^{th}$ century to branded products from global manufacturers and manufacturer brands reached consumers through distributors and retailers. Retailers were relatively small compared to their largest suppliers. However, sometime in the 1970s, things began to slowly change as retailers started to develop their own national chains and began international expansion, and consolidation of the retail industry from mom-and-pop stores to global players was well under way (Kumar and Steenkamp 2007, p.2) In South Korea, since the middle of the 1990s, the bulking up of retailers that started then has changed the balance of power between manufacturers and retailers. Retailer private labels, generally referred to as own labels, store brands, distributors own private-label, home brand or own label brand have also been performing strongly in every single local market (Bushman 1993; De Wulf et al. 2005). Private labels now account for one out of every five items sold every day in U.S. supermarkets, drug chains, and mass merchandisers (Kumar and Steenkamp 2007), and the market share in Western Europe is even larger (Euromonitor 2007). In the UK, grocery market share of private labels grew from 39% of sales in 2008 to 41% in 2010 (Marian 2010). Planet Retail (2007, p.1) recently concluded that "[PLs] are set for accelerated growth, with the majority of the world's leading grocers increasing their own label penetration." Private labels have gained wide attention both in the academic literature and popular business press and there is a glowing academic research to the perspective of manufacturers and retailers. Empirical research on private labels has mainly studies the factors explaining private labels market shares across product categories and/or retail chains (Dahr and Hoch 1997; Hoch and Banerji, 1993), factors influencing the private labels proneness of consumers (Baltas and Doyle 1998; Burton et al. 1998; Richardson et al. 1996) and factors how to react brand manufacturers towards PLs (Dunne and Narasimhan 1999; Hoch 1996; Quelch and Harding 1996; Verhoef et al. 2000). Nevertheless, empirical research on factors influencing the production in terms of a manufacturer-retailer is rather anecdotal than theory-based. The objective of this paper is to bridge the gap in these two types of research and explore the factors which influence on manufacturer's private label production based on two competing theories: S-C-P (Structure - Conduct - Performance) paradigm and resource-based theory. In order to do so, the authors used in-depth interview with marketing managers, reviewed retail press and research and presents the conceptual framework that integrates the major determinants of private labels production. From a manufacturer's perspective, supplying private labels often starts on a strategic basis. When a manufacturer engages in private labels, the manufacturer does not have to spend on advertising, retailer promotions or maintain a dedicated sales force. Moreover, if a manufacturer has weak marketing capabilities, the manufacturer can make use of retailer's marketing capability to produce private labels and lessen its marketing cost and increases its profit margin. Figure 1. is the theoretical framework based on a strategic market management perspective, integrated concept of both S-C-P paradigm and resource-based theory. The model includes one mediate variable, marketing capabilities, and the other moderate variable, competitive intensity. Manufacturer's national brand reputation, firm's marketing investment, and product portfolio, which are hypothesized to positively affected manufacturer's marketing capabilities. Then, marketing capabilities has negatively effected on private label production. Moderating effects of competitive intensity are hypothesized on the relationship between marketing capabilities and private label production. To verify the proposed research model and hypotheses, data were collected from 192 manufacturers (212 responses) who are producing private labels in South Korea. Cronbach's alpha test, explanatory / comfirmatory factor analysis, and correlation analysis were employed to validate hypotheses. The following results were drawing using structural equation modeling and all hypotheses are supported. Findings indicate that manufacturer's private label production is strongly related to its marketing capabilities. Consumer marketing capabilities, in turn, is directly connected with the 3 strategic factors (e.g., marketing investment, manufacturer's national brand reputation, and product portfolio). It is moderated by competitive intensity between marketing capabilities and private label production. In conclusion, this research may be the first study to investigate the reasons manufacturers engage in private labels based on two competing theoretic views, S-C-P paradigm and resource-based theory. The private label phenomenon has received growing attention by marketing scholars. In many industries, private labels represent formidable competition to manufacturer brands and manufacturers have a dilemma with selling to as well as competing with their retailers. The current study suggests key factors when manufacturers consider engaging in private label production.

• Research in Community and Public Health Nursing
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• v.6 no.1
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• pp.5-33
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• 1995

The objective of the study are two-fold: one is to explore the relationship between environment, organizational structure, and organizational effectiveness of public health centers in Korea, and the other is to examine the validity of contingency theory for improving the organizational structure of public health care agencies, with special emphasis on public health nursing administration. Accordingly, the conceptual model of the study consisted of three different concepts: environment, organizational structure, and organizational effectiveness, which were built up from the contingency theory. Data were collected during the period from 1st of May through 30th of June, 1990. From the total of 249 health centers in the country, one hundred and five centers were sampled non proportionally, according to the geopolitical distribution. Out of 105, 73 health centers responded to mailed questionnaire. The health centers were the unit of the study, and a various statistical analysis techniques were used: Reliability analysis(Cronbach's Alpha) for 4 measurement tools; Shapiro-Wilk statistic for normality test of measured scores of 6 variables: ANOVA, Pearson Correlaion analysis, regressional analysis, and canonical correlation analysis for the test of the relationships and differences between the variables. The results were. as follows : 1. No significant differences between forma lization, decision-making authority and environmental complexity were found(F=1.383, P=.24 ; F=.801, P=.37). 2. Negative relationships between formalization and decision-making authority for both urban and rural health centers were found(r=-.470, P=.002 ; r=-.348, P=.46). 3. No significant relationship between formalization and job satisfaction for both urban and rural health centers were found (r=-.242, P=.132, r=-.060, P=.739). 4. Significant positive relationship between decision - making authority and job satisfaction were found in urban health centers (r=.504, P=.0009), but no such relationship was observed in rural health centers. Regression coefficient between them was statistically significant($\beta=1.535$, P=.0002), and accuracy of regression line was accepted (W=.975, P= .420). 5. No significant relationships among formalization and family planning services, maternal health services, and tuberculosis control services for both urban and rural health centers were found. 6. Among decision-making authority and family planning services, maternal health services, and tuberculosis control services, significant positive relationship was found between de cision-making authority and family planning services(r=.286, P=.73). 7. A significant difference was found in maternal health services by the type of health centers (F=5.13, P=.026) but no difference was found in tuberculosis control services by the type of health centers, formalization, and decision-making authority. 8. A significant positive relationships were found between family planning services and maternal health services and tuberculosis control services, and between maternal health services and tuberculosis control services (r=-.499, P=.001 ; r=.457, P=.004 ; r=.495, P=.002) in case of urban health centers. In case of rural health centers, relationships between family planning services and tuberculosis control services, and between maternal health services and tuberculosis control services were statistically significant (r=.534, P=.002 ; r=.389, P=.027). No significant relationship was found between family planning and maternal health services. 9. A significant positive canonical correlation was found between the group of independent variables consisted of formalization and de cision-making authority and the group of dependent variables consisted of family planning services, maternal health services and tuberculosis control services(Rc=.455, P=.02). In case of urban health centers, no significant canonical correlation was found between them, but significant canoncial correlation was found in rural health centers(Rc=.578, P=.069), 10. Relationships between job satisfaction and health care productivity was not found significant. Through these results, the assumed relationship between environment and organizational structure was not supported in health centers. Therefore, the relationship between the organizational effectiveness and the congruence between environment and organizational structure that contingency theory proposes to exist was not able to be tested. However decision-making authority was found as an important variable of organizational structure affecting family planning services and job satisfaction in urban health centers. Thus it was suggested that decentralized decision making among health professionals would be a valuable strategy for improvement of organizational effectiveness in public health centers. It is also recommended that further studies to test contingency theory would use variability and uncertainty to define environment of public health centers instead of complexity.

• Women's Health Nursing
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• v.4 no.2
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• pp.217-230
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• 1998

The purpose of this descriptive correlational study was to define the relationship between the experience of Sanhuujori, Korean traditional non-professional postpartal care after delivery and abortion and present health status of chronic arthritis female patient who visited to outpatient clinic of rheumatic internal medicine at a hospital located in Seoul, Korea. A convenience sample of 64 women who orally agreed to be a participant and data were collected form October 1996 to May, 1997 for sis months by way of interview with semistructured questionnaire. The data were analyzed by the SPSS pc program using t-test, ANOVA and Scheffe test as a post hoc and Pearson Correlation Coefficient. The results of the study were as follows ; Mean age of participants was 53.2 years and mean number of children was 3.1. Mean frequency of abortion was 2.1 times per woman. Seventy four percentage of respondents did not have Sanhujori after abortion. The mean period of Sanhujori after delivery was 17.7, 15.2, 13.8 days from the first child to third child and shorter than that of general woman such as 20.0, 19.0, 17.3 days in the previous study. On the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori wrongly' was the highest rank in each child where as general woman 'did Sanhujori well' at the first child, 'moderate' at the second and third child and 'did Sanhujori wrongly' at the 4th and fifth child. The health status implies both subjective health status women perceived and the rate of complaints of physical symptom distress women are experiencing presently. The respondents of 82.5% perceived them as unhealthy or sick and 68.9% of women complained more than two symptoms. Mean number of physical symptom distress women complained was 2.33. The main sites of physical symptom distress were upper & lower extremities 69.1% including knee and hand, whole body 19.1%, neck 3.7%, waist & shoulders 2.7% respectively. The characteristics of the symptoms were mostly pain 60%, swelling 19.8%, rigidity & deformity 7.9% respectively, sensation of heat 6.8% and weakness 1.7%. Women perceived the etiology of the chronic arthritis as stress 25.8%, 'did Sanhujori wrongly' & overwork 23.4% respectively, genetic 12.9%, malnutrition, 4.8%, and aging process 3.2%. There were significant positive correlation between subjective health status and the period of Sanhujori after delivery of the second child(r=-0.22) and negative correlation with the number of child at the level of 5% of significance statistically(r=0.27). There were significant negative correlation between the rate of complaints of physical symptom distress and the subjective evaluation whether she did Sanhujori well or not at the level of 5% of significance statistically(r=-0.23). And the rate of complaints of physical symptom distress in the group of women who experienced abortion was significantly higher than that of women who did not experience it at the level of 5% significance statistically(t=2.00) In conclusion, this finding reconfirmed the possible relationship between health status of chronic arthritis female patient and the experience of Sanhujori after delivery & abortion. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the crosssectional and longitudinal research for the refinement of the reality of not only as cultural phenomenon but as conceptual model for the appropriateness of intervention and quality of care for desirable health outcomes.