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Health Care Management Science

Ting-Yu Ho, Shan Liu, Zelda B Zabinsky
Dynamic resource allocation for prevention, screening, and treatment interventions in population disease management has received much attention in recent years due to excessive healthcare costs. In this paper, our goal is to design a model and an efficient algorithm to optimize sequential intervention policies under resource constraints to improve population health outcomes. We consider a discrete-time finite-horizon budget allocation problem with disease progression within a closed birth-cohort population...
September 7, 2018: Health Care Management Science
Ronald G McGarvey, Andreas Thorsen, Maggie L Thorsen, Rohith Madhi Reddy
Over 1300 federally-qualified health centers (FQHCs) in the US provide care to vulnerable populations in different contexts, addressing diverse patient health and socioeconomic characteristics. In this study, we use data envelopment analysis (DEA) to measure FQHC performance, applying several techniques to account for both quality of outputs and heterogeneity among FQHC operating environments. To address quality, we examine two formulations, the Two-Model DEA approach of Shimshak and Lenard (denoted S/L), and a variant of the Quality-Adjusted DEA approach of Sherman and Zhou (denoted S/Z)...
August 26, 2018: Health Care Management Science
Saied Samiedaluie, Vedat Verter
We study the impact of specialization on the operational efficiency of a multi-hospital system. The mixed outcomes of recently increasing hospital mergers and system re-configuration initiatives have raised the importance of studying such organizational changes from all the relevant perspectives. We consider two configuration scenarios for a multi-hospital system. The first scenario assumes that all the hospitals in the system are general, which implies they can provide care to all types of patients. In the alternative configuration, we specialize each hospital in certain level of care, which means they serve only specific types of patients...
August 9, 2018: Health Care Management Science
Christopher N Gross, Jens O Brunner, Manfred Blobner
Physicians are a scarce resource in hospitals. In order to minimize physician attrition, schedulers incorporate individual physician preferences when creating the physicians' duty roster. The manual creation of a roster is very time-consuming and often produces suboptimal results. Many schedulers therefore use model-based software to assist in planning. The planning horizon for duty schedules is usually a single month. Many models optimize the plan for the current planning horizon, without taking into account data on preference fulfillment and work load distribution from previous months...
July 25, 2018: Health Care Management Science
Tristan Becker, Pia Mareike Steenweg, Brigitte Werners
In workforce scheduling for emergency medical services, it is important to ensure sufficient coverage at all time. Thus, planning has to consider unpredictable employee absences. To hedge against this type of uncertainty, on-call duties can be assigned to employees. In practice, these are often assigned ex-post based on the regular schedule. Little literature on workforce scheduling for ambulances or the planning of on-call duties exists. We present new set covering based integer programming formulations for cyclic stint-based staff scheduling with on-call duties...
July 19, 2018: Health Care Management Science
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
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
Adam Diamant, Joseph Milner, Fayez Quereshy, Bo Xu
We investigate the inventory management practices for reusable surgical instruments that must be sterilized between uses. We study a hospital that outsources their sterilization services and model the inventory process as a discrete-time Markov chain. We present two base-stock inventory models, one that considers stockout-based substitution and one that does not. We derive the optimal base-stock level for the number of reusable instruments to hold in inventory, the expected service level, and investigate the implied cost of a stockout...
September 2018: Health Care Management Science
Lukas Kwietniewski, Jonas Schreyögg
This is the first study to use stochastic frontier analysis to simultaneously estimate the technical, cost and profit efficiency of physician practices for different physician specialist groups. We base our analysis on a unique panel data set of 4964 physician practices in Germany for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician characteristics and practice characteristics. Additionally we consider a wide range additional variables not previously analyzed in this context (e...
September 2018: Health Care Management Science
Rajendra Dulal
This study investigates associations between five-star quality ratings and technical efficiency of nursing homes. The sample consists of a balanced panel of 338 nursing homes in California from 2009 through 2013 and uses two-stage data envelopment (DEA) analysis. The first-stage applies an input oriented variable returns to scale DEA analysis. The second-stage uses a left censored random-effect Tobit regression model. The five-star quality ratings i.e., health inspections, quality measures, staffing available on the Nursing Home Compare website are divided into two categories: outcome and structure form of quality...
September 2018: Health Care Management Science
Daniel M Walker
The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear...
September 2018: Health Care Management Science
Necmi Kemal Avkiran
Partial least squares structural equation modeling (PLS-SEM) has become more popular across many disciplines including health care. However, articles in health care often fail to discuss the choice of PLS-SEM and robustness testing is not undertaken. This article presents the steps to be followed in a thorough PLS-SEM analysis, and includes a conceptual comparison of PLS-SEM with the more traditional covariance-based structural equation modeling (CB-SEM) to enable health care researchers and policy makers make appropriate choices...
September 2018: Health Care Management Science
Diogo Ferreira, Rui Cunha Marques
Healthcare systems are facing a resources scarcity so they must be efficiently managed. On the other hand, it is commonly accepted that the higher the consumed resources, the higher the hospital production, although this is not true in practice. Congestion on inputs is an economic concept dealing with such situation and it is defined as the decreasing of outputs due to some resources overuse. This scenario gets worse when inpatients' high severity requires a strict and effective resources management, as happens in Intensive Care Units (ICU)...
September 2018: Health Care Management Science
Hejer Khlif Hachicha, Farah Zeghal Mansour
This paper deals with an Integrated Elective Surgery-Scheduling Problem (IESSP) that arises in a privately operated healthcare facility. It aims to optimize the resource utilization of the entire surgery process including pre-operative, per-operative and post-operative activities. Moreover, it addresses a specific feature of private facilities where surgeons are independent service providers and may conduct their surgeries in different private healthcare facilities. Thus, the problem requires the assignment of surgery patients to hospital beds, operating rooms and recovery beds as well as their sequencing over a 1-day period while taking into account surgeons' availability constraints...
September 2018: Health Care Management Science
Shiovan Ni Luasa, Declan Dineen, Marta Zieba
This article provides methodological and empirical insights into the estimation of technical efficiency in the nursing home sector. Focusing on long-stay care and using primary data, we examine technical and scale efficiency in 39 public and 73 private Irish nursing homes by applying an input-oriented data envelopment analysis (DEA). We employ robust bootstrap methods to validate our nonparametric DEA scores and to integrate the effects of potential determinants in estimating the efficiencies. Both the homogenous and two-stage double bootstrap procedures are used to obtain confidence intervals for the bias-corrected DEA scores...
September 2018: Health Care Management Science
Yasin Gocgun
We study radiation therapy scheduling problem where dynamically and stochastically arriving patients of different types are scheduled to future days. Unlike similar models in the literature, we consider cancellation of treatments. We formulate this dynamic multi-appointment patient scheduling problem as a Markov Decision Process (MDP). Since the MDP is intractable due to large state and action spaces, we employ a simulation-based approximate dynamic programming (ADP) approach to approximately solve our model...
September 2018: Health Care Management Science
Daniel A Asamoah, Ramesh Sharda, Howard N Rude, Derek Doran
Long queues and wait times often occur at hospitals and affect smooth delivery of health services. To improve hospital operations, prior studies have developed scheduling techniques to minimize patient wait times. However, these studies lack in demonstrating how such techniques respond to real-time information needs of hospitals and efficiently manage wait times. This article presents a multi-method study on the positive impact of providing real-time scheduling information to patients using the RFID technology...
September 2018: Health Care Management Science
Thierry Chaussalet, Chiristos Vasilakis, Martin Pitt
No abstract text is available yet for this article.
June 2018: Health Care Management Science
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
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
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