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Health Care Management Science

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https://www.readbyqxmd.com/read/29995263/simulation-model-of-the-relationship-between-cesarean-section-rates-and-labor-duration
#1
Karen T Hicklin, Julie S Ivy, James R Wilson, Fay Cobb Payton, Meera Viswanathan, Evan R Myers
Cesarean delivery is the most common major abdominal surgery in many parts of the world, and it accounts for nearly one-third of births in the United States. For a patient who requires a C-section, allowing prolonged labor is not recommended because of the increased risk of infection. However, for a patient who is capable of a successful vaginal delivery, performing an unnecessary C-section can have a substantial adverse impact on the patient's future health. We develop two stochastic simulation models of the delivery process for women in labor; and our objectives are (i) to represent the natural progression of labor and thereby gain insights concerning the duration of labor as it depends on the dilation state for induced, augmented, and spontaneous labors; and (ii) to evaluate the Friedman curve and other labor-progression rules, including their impact on the C-section rate and on the rates of maternal and fetal complications...
July 11, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29982911/a-review-on-ambulance-offload-delay-literature
#2
REVIEW
Mengyu Li, Peter Vanberkel, Alix J E Carter
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions...
July 7, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29845399/patient-centric-design-of-long-term-care-networks
#3
Paul Intrevado, Vedat Verter, Lucie Tremblay
Long-term care networks may soon buckle under the weight of overwhelming demand. We present two dynamic, large-scale mixed-integer programs for long-term care network design that execute jointly strategic and tactical facility location, modular capacity acquisition, and patient-assignment decisions. The first model is an adaptive network-design model whose focus is more strategic in nature, whereas the second model focuses exclusively on the expansion of an existing long-term care network and incorporates additional tactical decisions such as patient backlogs...
May 29, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29736901/bayesian-logistic-regression-approaches-to-predict-incorrect-drg-assignment
#4
Mani Suleiman, Haydar Demirhan, Leanne Boyd, Federico Girosi, Vural Aksakalli
Episodes of care involving similar diagnoses and treatments and requiring similar levels of resource utilisation are grouped to the same Diagnosis-Related Group (DRG). In jurisdictions which implement DRG based payment systems, DRGs are a major determinant of funding for inpatient care. Hence, service providers often dedicate auditing staff to the task of checking that episodes have been coded to the correct DRG. The use of statistical models to estimate an episode's probability of DRG error can significantly improve the efficiency of clinical coding audits...
May 7, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29725895/the-self-regulating-nature-of-occupancy-in-icus-stochastic-homoeostasis
#5
Josephine Varney, Nigel Bean, Mark Mackay
As pressure on the health system grows, intensive care units (ICUs) are increasingly operating close to their capacity. This has led a number of authors to describe a link between admission and discharge behaviours, labelled variously as: 'bumping', 'demand-driven discharge', 'premature discharge' etc. These labels all describe the situation that arises when a patient is discharged to make room for the more acute arriving patient. This link between the admission and discharge behaviours, and other potential occupancy-management behaviours, can create a correlation between the arrival process and LOS distribution...
May 3, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29725894/a-study-on-the-impact-of-prioritising-emergency-department-arrivals-on-the-patient-waiting-time
#6
Ellen Van Bockstal, Broos Maenhout
In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern...
May 3, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29717401/modelling-mortality-and-discharge-of-hospitalized-stroke-patients-using-a-phase-type-recovery-model
#7
Bruce Jones, Sally McClean, David Stanford
We model the length of in-patient hospital stays due to stroke and the mode of discharge using a phase-type stroke recovery model. The model allows for three different types of stroke: haemorrhagic (the most severe, caused by ruptured blood vessels that cause brain bleeding), cerebral infarction (less severe, caused by blood clots) and transient ischemic attack or TIA (the least severe, a mini-stroke caused by a temporary blood clot). A four-phase recovery process is used, where the initial phase depends on the type of stroke, and transition from one phase to the next depends on the age of the patient...
May 1, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29411213/editorial-ima-health-2016
#8
EDITORIAL
Thierry Chaussalet, Chiristos Vasilakis, Martin Pitt
No abstract text is available yet for this article.
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29204772/a-stochastic-tabu-search-algorithm-to-align-physician-schedule-with-patient-flow
#9
Nazgol Niroumandrad, Nadia Lahrichi
In this study, we consider the pretreatment phase for cancer patients. This is defined as the period between the referral to a cancer center and the confirmation of the treatment plan. Physicians have been identified as bottlenecks in this process, and the goal is to determine a weekly cyclic schedule that improves the patient flow and shortens the pretreatment duration. High uncertainty is associated with the arrival day, profile and type of cancer of each patient. We also include physician satisfaction in the objective function...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28755175/regional-variation-in-hospitalisation-and-mortality-in-heart-failure-comparison-of-england-and-lombardy-using-multistate-modelling
#10
Alex Bottle, Chiara Maria Ventura, Kumar Dharmarajan, Paul Aylin, Francesca Ieva, Anna Maria Paganoni
Heart failure (HF) is a common, serious chronic condition with high morbidity, hospitalisation and mortality. The healthcare systems of England and the northern Italian region of Lombardy share important similarities and have comprehensive hospital administrative databases linked to the death register. We used them to compare admission for HF and mortality for patients between 2006 and 2012 (n = 37,185 for Lombardy, 234,719 for England) with multistate models. Despite close similarities in age, sex and common comorbidities of the two sets of patients, in Lombardy, HF admissions were longer and more frequent per patient than in England, but short- and medium-term mortality was much lower...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28718169/predicting-elderly-patient-length-of-stay-in-hospital-and-community-care-using-a-series-of-conditional-coxian-phase-type-distributions-further-conditioned-on-a-survival-tree
#11
Andrew S Gordon, Adele H Marshall, Mariangela Zenga
Increasing demand on hospital resources by an ageing population is impacting significantly on the number of beds available and, in turn, the length of time that elderly patients must wait for a bed before being admitted to hospital. This research presents a new methodology that models patient pathways and allows the accurate prediction of patient length of stay in hospital, using a phase-type survival tree to cluster patients based on their covariates and length of stay in hospital. A type of Markov model, called the conditional Coxian phase-type distribution is then implemented, with the probability density function for the time spent at a particular stage of care, for example, the first community discharge, conditioned on the length of stay experienced at the previous stage, namely the initial hospital admission...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28577263/modelling-for-the-proposed-roll-out-of-the-111-service-in-wales-a-case-study
#12
Mark Tuson, Tracey England, Doris Behrens, Richard Bowen, Dorothy Edwards, John Frankish, Jude Kay
NHS Direct Wales provides a single point of access where members of the public can telephone and seek medical support and/or advice. The service is provided for all the Health Boards in Wales by a single virtual call centre run from a main location in Swansea with 2 satellite locations. Patients in Wales can also access a local General Practitioner service during the evenings and at weekends, by phoning their Out of Hours service. The introduction of a '111' service is intended to combine these two operations on a pan-Wales basis using the existing NHS Direct Wales call centre and staff, with the existing Health Board Out of Hours 'hubs'...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28551859/cognitive-workload-reduction-in-hospital-information-systems-decision-support-for-order-set-optimization
#13
Daniel Gartner, Yiye Zhang, Rema Padman
Order sets are a critical component in hospital information systems that are expected to substantially reduce physicians' physical and cognitive workload and improve patient safety. Order sets represent time interval-clustered order items, such as medications prescribed at hospital admission, that are administered to patients during their hospital stay. In this paper, we develop a mathematical programming model and an exact and a heuristic solution procedure with the objective of minimizing physicians' cognitive workload associated with prescribing order sets...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28516345/performance-and-cost-evaluation-of-health-information-systems-using-micro-costing-and-discrete-event-simulation
#14
Olfa Rejeb, Claire Pilet, Sabri Hamana, Xiaolan Xie, Thierry Durand, Saber Aloui, Anne Doly, Pierre Biron, Lionel Perrier, Vincent Augusto
Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28508958/modeling-the-critical-care-pathway-for-cardiothoracic-surgery
#15
Nicolas Bahou, Claire Fenwick, Gillian Anderson, Robert van der Meer, Tony Vassalos
The west of Scotland heart and lung center based at the Golden Jubilee National Hospital houses all adult cardiothoracic surgery for the region. Increased demand for scheduled patients and fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (DES) was used to assess if an enhanced schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28488196/a-multi-state-approach-to-patients-affected-by-chronic-heart-failure-the-value-added-by-administrative-data
#16
Francesco Grossetti, Francesca Ieva, Anna Maria Paganoni
Healthcare administrative databases are becoming more and more important and reliable sources of clinical and epidemiological information. They are able to track several interactions between a patient and the public healthcare system. In the present study, we make use of data extracted from the administrative data warehouse of Regione Lombardia, a region located in the northern part of Italy whose capital is Milan. Data are within a project aiming at providing a description of the epidemiology of Heart Failure (HF) patients at regional level, to profile health service utilization over time, and to investigate variations in patient care according to geographic area, socio-demographic characteristic and other clinical variables...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28401405/patient-choice-modelling-how-do-patients-choose-their-hospitals
#17
Honora Smith, Christine Currie, Pornpimol Chaiwuttisak, Andreas Kyprianou
As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/28361346/redesigning-the-diagnostic-pathway-for-chest-pain-patients-in-emergency-departments
#18
Sebastian Rachuba, Andrew Salmon, Zhivko Zhelev, Martin Pitt
Patients presenting with chest pain at an emergency department in the United Kingdom receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, serial testing with two blood samples separated by at least six hours was necessary in order to analyse the change in troponin levels over time. New high-sensitivity troponin tests, however, allow the inter-test time to be shortened from six to three hours. Recent evidence also suggests that the new generation of troponin tests can be used to rule out AMI on the basis of a single test if patients at low risk of AMI present with very low cardiac troponin levels more than three hours after onset of worst pain...
June 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29600469/correction-to-the-use-of-data-envelopment-analysis-dea-in-healthcare-with-a-focus-on-hospitals
#19
Sebastian Kohl, Jan Schoenfelder, Andreas Fügener, Jens O Brunner
The original version of this article unfortunately contained errors. The first column of Tables 5 and 6 in the Appendix section should contain the year of publication instead of the reference number in brackets. The reference citations were then placed in the second column.
March 29, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29536293/data-driven-optimization-methodology-for-admission-control-in-critical-care-units
#20
Amirhossein Meisami, Jivan Deglise-Hawkinson, Mark E Cowen, Mark P Van Oyen
The decision of whether to admit a patient to a critical care unit is a crucial operational problem that has significant influence on both hospital performance and patient outcomes. Hospitals currently lack a methodology to selectively admit patients to these units in a way that patient health risk metrics can be incorporated while considering the congestion that will occur. The hospital is modeled as a complex loss queueing network with a stochastic model of how long risk-stratified patients spend time in particular units and how they transition between units...
March 13, 2018: Health Care Management Science
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