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Health Care Management Science

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https://www.readbyqxmd.com/read/29143942/acknowledgement-of-referees-services
#1
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November 16, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/29124483/stochastic-integer-programming-for-multi-disciplinary-outpatient-clinic-planning
#2
A G Leeftink, I M H Vliegen, E W Hans
Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are jointly optimized. As this currently is an open question in the literature, our research is the first to address this problem. This research is motivated by a Dutch hospital, which uses a multi-disciplinary cancer clinic to communicate the diagnosis and to explain the treatment plan to their patients...
November 9, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/29080053/probabilistic-sensitivity-analysis-on-markov-models-with-uncertain-transition-probabilities-an-application-in-evaluating-treatment-decisions-for-type-2-diabetes
#3
Yuanhui Zhang, Haipeng Wu, Brian T Denton, James R Wilson, Jennifer M Lobo
Markov models are commonly used for decision-making studies in many application domains; however, there are no widely adopted methods for performing sensitivity analysis on such models with uncertain transition probability matrices (TPMs). This article describes two simulation-based approaches for conducting probabilistic sensitivity analysis on a given discrete-time, finite-horizon, finite-state Markov model using TPMs that are sampled over a specified uncertainty set according to a relevant probability distribution...
October 27, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28993965/an-optimization-model-to-determine-appointment-scheduling-window-for-an-outpatient-clinic-with-patient-no-shows
#4
Li Luo, Ying Zhou, Bernard T Han, Jialing Li
This paper investigates appointment scheduling for an outpatient department in West China Hospital (WCH), one of the largest single point of access hospitals in the world. Our pilot data analysis shows that the appointment system at WCH can be improved through leveraging the scheduling window (i.e., the number of days in advance a patient makes an appointment for future services). To gain full insight into this strategy, our study considers two cases, based on if patients are willing to wait for scheduled appointments or not...
October 9, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28887763/population-level-intervention-and-information-collection-in-dynamic-healthcare-policy
#5
Lauren E Cipriano, Thomas A Weber
We develop a general framework for optimal health policy design in a dynamic setting. We consider a hypothetical medical intervention for a cohort of patients where one parameter varies across cohorts with imperfectly observable linear dynamics. We seek to identify the optimal time to change the current health intervention policy and the optimal time to collect decision-relevant information. We formulate this problem as a discrete-time, infinite-horizon Markov decision process and we establish structural properties in terms of first and second-order monotonicity...
September 8, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28871511/nurses-work-with-interruptions-an-objective-model-for-testing-interventions
#6
Robert A Myers, Pratik J Parikh
Interruptions experienced by nurses may lead to errors as their focus and attention to multiple patient needs are disrupted. As quantitative models to understand the dynamics of interruptions are lacking, the objective of this study is a model of a nurse's work with interruptions, generating insights into the onset of interruptions and evaluating suggested interventions. We observed nurses in a US Level I trauma center for 47.3 h, including 259 interruptions (9.1% of total time) across 580 nursing activities...
September 4, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28871456/queueing-theoretic-analysis-of-labor-and-delivery-understanding-management-styles-and-c-section-rates
#7
Matthew Gombolay, Toni Golen, Neel Shah, Julie Shah
Childbirth is a complex clinical service requiring the coordinated support of highly trained healthcare professionals as well as management of a finite set of critical resources (such as staff and beds) to provide safe care. The mode of delivery (vaginal delivery or cesarean section) has a significant effect on labor and delivery resource needs. Further, resource management decisions may impact the amount of time a physician or nurse is able to spend with any given patient. In this work, we employ queueing theory to model one year of transactional patient information at a tertiary care center in Boston, Massachusetts...
September 4, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28861650/optimal-timing-of-drug-sensitivity-testing-for-patients-on-first-line-tuberculosis-treatment
#8
Sze-Chuan Suen, Margaret L Brandeau, Jeremy D Goldhaber-Fiebert
Effective treatment for tuberculosis (TB) patients on first-line treatment involves triaging those with drug-resistant (DR) TB to appropriate treatment alternatives. Patients likely to have DR TB are identified using results from repeated inexpensive sputum-smear (SS) tests and expensive but definitive drug sensitivity tests (DST). Early DST may lead to high costs and unnecessary testing; late DST may lead to poor health outcomes and disease transmission. We use a partially observable Markov decision process (POMDP) framework to determine optimal DST timing...
August 31, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28822005/a-supply-model-for-nurse-workforce-projection-in-malaysia
#9
Zuraida Abal Abas, Mohamad Raziff Ramli, Mohamad Ishak Desa, Nordin Saleh, Ainul Nadziha Hanafiah, Nuraini Aziz, Zaheera Zainal Abidin, Abdul Samad Shibghatullah, Ahmad Fadzli Nizam Abdul Rahman, Haslinda Musa
The paper aims to provide an insight into the significance of having a simulation model to forecast the supply of registered nurses for health workforce planning policy using System Dynamics. A model is highly in demand to predict the workforce demand for nurses in the future, which it supports for complete development of a needs-based nurse workforce projection using Malaysia as a case study. The supply model consists of three sub-models to forecast the number of registered nurses for the next 15 years: training model, population model and Full Time Equivalent (FTE) model...
August 18, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28795264/decreasing-patient-length-of-stay-via-new-flexible-exam-room-allocation-policies-in-ambulatory-care-clinics
#10
Vahab Vahdat, Jacqueline Griffin, James E Stahl
To address prolonged lengths of stay (LOS) in ambulatory care clinics, we analyze the impact of implementing flexible and dynamic policies for assigning exam rooms to providers. In contrast to the traditional approaches of assigning specific rooms to each provider or pooling rooms among all practitioners, we characterize the impact of alternate compromise policies that have not been explored in previous studies. Since ambulatory care patients may encounter multiple different providers in a single visit, room allocation can be determined separately for each encounter accordingly...
August 9, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28795254/an-efficient-method-for-kidney-allocation-problem-a-credibility-based-fuzzy-common-weights-data-envelopment-analysis-approach
#11
Sahar Ahmadvand, Mir Saman Pishvaee
Given the perennial imbalance and chronic scarcity between the demand for and supply of available organs, organ allocation is one of the most critical decisions in the management of organ transplantation networks. Organ allocation systems undergo rapid revisions for the sake of improved outcomes in terms of both equity and medical efficiency. This paper presents a Data Envelopment Analysis (DEA)-based model to evaluate the efficiency of possible patient-organ pairs for kidney allocation in order to enhance the fitness of organ allocation under inherent uncertainty in such problem...
August 9, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28755176/overflow-models-for-the-admission-of-intensive-care-patients
#12
Yin-Chi Chan, Eric W M Wong, Gavin Joynt, Paul Lai, Moshe Zukerman
An earlier article, inspired by overflow models in telecommunication systems with multiple streams of telephone calls, proposed a new analytical model for a network of intensive care units (ICUs), and a new patient referral policy for such networks to reduce the blocking probability of external emergency patients without degrading the quality of service (QoS) of canceled elective operations, due to the more efficient use of ICU capacity overall. In this work, we use additional concepts and insights from traditional teletraffic theory, including resource sharing, trunk reservation, and mutual overflow, to design a new patient referral policy to further improve ICU network efficiency...
July 28, 2017: 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
#13
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...
July 28, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28735459/diabetes-and-the-hospitalized-patient-a-cluster-analytic-framework-for-characterizing-the-role-of-sex-race-and-comorbidity-from-2006-to-2011
#14
Nisha Nataraj, Julie Simmons Ivy, Fay Cobb Payton, Joseph Norman
In the US, one in four adults has two or more chronic conditions; this population accounts for two thirds of healthcare spending. Comorbidity, the presence of multiple simultaneous health conditions in an individual, is increasing in prevalence and has been shown to impact patient outcomes negatively. Comorbidities associated with diabetes are correlated with increased incidence of preventable hospitalizations, longer lengths of stay (LOS), and higher costs. This study focuses on sex and race disparities in outcomes for hospitalized adult patients with and without diabetes...
July 22, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/28721549/an-expected-coverage-model-with-a-cutoff-priority-queue
#15
Soovin Yoon, Laura A Albert
Emergency medical services provide immediate care to patients with various types of needs. When the system is congested, the response to urgent emergency calls can be delayed. To address this issue, we propose a spatial Hypercube approximation model with a cutoff priority queue that estimates performance measures for a system where some servers are reserved exclusively for high priority calls when the system is congested. In the cutoff priority queue, low priority calls are not immediately served-they are either lost or entered into a queue-whenever the number of busy ambulances is equal to or greater than the cutoff...
July 19, 2017: 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
#16
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...
July 17, 2017: 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
#17
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 2, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/26810359/strategic-level-proton-therapy-patient-admission-planning-a-markov-decision-process-modeling-approach
#18
Ridvan Gedik, Shengfan Zhang, Chase Rainwater
A relatively new consideration in proton therapy planning is the requirement that the mix of patients treated from different categories satisfy desired mix percentages. Deviations from these percentages and their impacts on operational capabilities are of particular interest to healthcare planners. In this study, we investigate intelligent ways of admitting patients to a proton therapy facility that maximize the total expected number of treatment sessions (fractions) delivered to patients in a planning period with stochastic patient arrivals and penalize the deviation from the patient mix restrictions...
June 2017: Health Care Management Science
https://www.readbyqxmd.com/read/26742504/stochastic-multi-objective-auto-optimization-for-resource-allocation-decision-making-in-fixed-input-health-systems
#19
Nathaniel D Bastian, Tahir Ekin, Hyojung Kang, Paul M Griffin, Lawrence V Fulton, Benjamin C Grannan
The management of hospitals within fixed-input health systems such as the U.S. Military Health System (MHS) can be challenging due to the large number of hospitals, as well as the uncertainty in input resources and achievable outputs. This paper introduces a stochastic multi-objective auto-optimization model (SMAOM) for resource allocation decision-making in fixed-input health systems. The model can automatically identify where to re-allocate system input resources at the hospital level in order to optimize overall system performance, while considering uncertainty in the model parameters...
June 2017: Health Care Management Science
https://www.readbyqxmd.com/read/26729325/assessing-overall-technical-and-scale-efficiency-among-home-health-care-agencies
#20
Vivian G Valdmanis, Michael D Rosko, Hervé Leleu, Dana B Mukamel
While home health care agencies (HHAs) play a vital role in the production of health, little research has been performed gauging their efficiency. Employing a robust approach to data envelopment analysis (DEA) we assessed overall, technical, and scale efficiency on a nationwide sample of HHAs. After deriving the three efficiency measures, we regressed these scores on a variety of environmental factors. We found that HHAs, on average, could proportionally reduce inputs by 28 % (overall efficiency), 23 % (technical efficiency) and 6 % (scale efficiency)...
June 2017: Health Care Management Science
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