Health Care Management Science最新文献

Measuring the effect of deprivation on primary health care performance using data envelopment analysis and Malmquist Indices. 利用数据包络分析和Malmquist指数测量剥夺对初级卫生保健绩效的影响。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-07 DOI: 10.1007/s10729-025-09715-9

Holly Bea Merelie, Carla Alexandra Filipe Amado, Sérgio Pereira Dos Santos

{"title":"Measuring the effect of deprivation on primary health care performance using data envelopment analysis and Malmquist Indices.","authors":"Holly Bea Merelie, Carla Alexandra Filipe Amado, Sérgio Pereira Dos Santos","doi":"10.1007/s10729-025-09715-9","DOIUrl":"https://doi.org/10.1007/s10729-025-09715-9","url":null,"abstract":"Life expectancy is typically shorter in areas with higher deprivation, highlighting the need for policymakers and health care managers to focus on reducing health inequalities through efficient and effective care. This study aims to assess the impact of deprivation on primary health care performance using data from the National Health Service (NHS) in England. Two methods are applied: Data Envelopment Analysis (DEA) to evaluate the performance of 188 Clinical Commissioning Groups (CCGs), whose duties were recently taken on by the new Integrated Care Systems (ICSs), and the Malmquist Index (MI) to assess deprivation's effect on performance. The DEA results reveal significant variation among CCGs in equity, efficiency, and effectiveness, indicating substantial room for improvement. The MI results show that while CCGs in more deprived areas had more resources per capita and higher efficiency, they were generally less effective than those in less deprived areas. This emphasizes the need to enhance health and social policies to address persistent health inequalities due to deprivation, a critical challenge for the new ICSs. This study illustrates how DEA and the MI can support policymakers and managers in this effort.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal quality oversight in kidney transplantation and its impact on transplant centers' waitlist management. 肾移植的最佳质量监督及其对移植中心候补名单管理的影响。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-06 DOI: 10.1007/s10729-025-09713-x

Zahra Gharibi, Hung T Do, Michael Hahsler, Mehmet U S Ayvaci

{"title":"Optimal quality oversight in kidney transplantation and its impact on transplant centers' waitlist management.","authors":"Zahra Gharibi, Hung T Do, Michael Hahsler, Mehmet U S Ayvaci","doi":"10.1007/s10729-025-09713-x","DOIUrl":"https://doi.org/10.1007/s10729-025-09713-x","url":null,"abstract":"This paper studies the effects of quality oversight in the context of assessing kidney transplantation-related outcomes and possible unintended consequences (e.g., cherry-picking of organs and selection of healthier transplant candidates). In this context, we propose a stochastic economic model that identifies socially optimal kidney transplant choices given the inherent trade-off between the expected wait time and the quality of the received donor kidney for a given patient. Socially optimal decisions seek to maximize the utilitarian welfare function defined as the sum of all patients' post-transplant expected utilities. To determine the social loss, we compare the socially optimal decisions to those taken by a transplant program that maximizes its utility. We derive the optimal quality oversight policy that minimizes social loss and examine how decisions are impacted due to the changes introduced by the new Kidney Allocation System. Our empirical analysis using data from the Scientific Registry of Transplant Recipients and United States Renal Data System indicates that current quality oversight imposed through Conditions of Participation results in inefficient transplant decisions for 56% of recipients, and the performance is inconsistent across different regions and parameters. We propose that the risk-adjusted post-transplant performance assessment policy considers the factors impacting demand-supply parameters such as organ availability in the 11 US transplant regions, candidates' blood type, and the newly introduced Kidney Allocation System. Policymakers and providers can utilize insights from our findings to design effective oversight mechanisms and make informed decisions regarding transplant and waitlist management that yield desired outcomes.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Data in ambulatory care logistics: What modelers need and what practice can offer. 门诊护理物流中的数据：建模者需要什么，实践可以提供什么。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-04 DOI: 10.1007/s10729-025-09714-w

Anne Zander, Melanie Reuter-Oppermann

引用次数: 0

A change-point method for multi-lead electrocardiogram monitoring using weighted multivariate functional principal component analysis. 基于加权多元功能主成分分析的多导联心电图监测变点方法。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-04 DOI: 10.1007/s10729-025-09712-y

Hesam Hafezalseheh, Mohammad Fathian, Rassoul Noorossana, Yaser Zerehsaz, Kamran Heidari

{"title":"A change-point method for multi-lead electrocardiogram monitoring using weighted multivariate functional principal component analysis.","authors":"Hesam Hafezalseheh, Mohammad Fathian, Rassoul Noorossana, Yaser Zerehsaz, Kamran Heidari","doi":"10.1007/s10729-025-09712-y","DOIUrl":"https://doi.org/10.1007/s10729-025-09712-y","url":null,"abstract":"Cardiovascular diseases (CVDs) are one of the primary reasons for death worldwide. These diseases often occur due to the occlusion of coronary arteries, thereby leading to insufficient blood and oxygen supply that damages cardiac muscle cells. Electrocardiogram (ECG) signals which reflect heart electrical activity are being used for diagnosing various cardiac diseases. Typically, a standard ECG consists of 12 channels referred to as leads which enable practitioners to monitor heartbeats through different channels where each heartbeat lasts approximately 600 ms. The majority of studies focus on the classification and early diagnosis of arrhythmias. Although the current studies on change-point methods have acquired massive accuracy in detecting potential shifts during a multi-channel process, they lack flexibility in manually assigning more weights to the channels, which are of more importance for experts. This could be addressed by implementing the weighted multivariate functional principal component analysis (WMFPCA). The objective of this study is to develop a novel change-point detection method to monitor long-term cardiovascular treatment. A third-order tensor structure was employed to represent the 12-lead ECG data in three dimensions (beats × samples × leads). Exploiting intra-beat, inter-beat, and inter-lead correlations along with channel significance in the third-order tensor, the WMFPCA is incorporated into Hotelling's <math> <msup><mrow><mi>T</mi></mrow> <mn>2</mn></msup> </math> statistic to construct monitoring schemes. Simulation results show that the proposed approach outperforms the existing methods in monitoring multi-channel processes. Finally, applying the suggested model on a real-world dataset containing Myocardial Infarction (MI) subjects verifies the model.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reinforcement learning for healthcare operations management: methodological framework, recent developments, and future research directions. 用于医疗运营管理的强化学习：方法框架、最新发展和未来研究方向。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-04-09 DOI: 10.1007/s10729-025-09699-6

Qihao Wu, Jiangxue Han, Yimo Yan, Yong-Hong Kuo, Zuo-Jun Max Shen

引用次数: 0

A comparative inpatient care efficiency analysis of safety-net vs. non-safety-net hospitals: an analysis using Massachusetts inpatient claims data from 2015 to 2019. 安全网与非安全网医院住院病人护理效率的比较分析：使用马萨诸塞州2015年至2019年住院病人索赔数据的分析

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-04-25 DOI: 10.1007/s10729-025-09704-y

Jiaye Shen, Dominic Hodgkin, Jennifer Perloff

{"title":"A comparative inpatient care efficiency analysis of safety-net vs. non-safety-net hospitals: an analysis using Massachusetts inpatient claims data from 2015 to 2019.","authors":"Jiaye Shen, Dominic Hodgkin, Jennifer Perloff","doi":"10.1007/s10729-025-09704-y","DOIUrl":"10.1007/s10729-025-09704-y","url":null,"abstract":"This study examines the inpatient service efficiency of safety-net and non-safety-net hospitals using a two-stage approach at both the hospital and physician levels. For the hospital-level analysis, we conducted 430 Data Envelopment Analysis (DEA) models at the first stage to measure efficiency at the Diagnosis-Related Groups (DRG) level. In the second stage, Tobit and logistic regression models were applied to compare safety-net hospitals to non-safety-net hospitals. For the physician-level analysis, we conducted 386 DEA models to measure individual physician efficiency within specific DRGs. In the second stage, we compared the performance of the same physicians working in safety-net versus non-safety-net hospitals. The findings reveal that non-safety-net hospitals demonstrate significantly higher efficiency than safety-net hospitals. However, comparisons of the same physicians across settings show no significant differences in individual efficiency. This suggests that the efficiency gap arises not from the support or motivation provided by hospitals but from differences in the quality of physicians employed. These results underscore the need for policies that help safety-net hospitals attract and retain high-quality physicians to bridge the efficiency gap and better serve vulnerable populations.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"178-190"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Streamlining emergency department workflow: reducing length of stay with congestion-triggered standing orders. 简化急诊科的工作流程：减少因拥堵引发的住院时间。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-04-26 DOI: 10.1007/s10729-025-09705-x

Saied Samiedaluie, Vera Tilson, Armann Ingolfsson

{"title":"Streamlining emergency department workflow: reducing length of stay with congestion-triggered standing orders.","authors":"Saied Samiedaluie, Vera Tilson, Armann Ingolfsson","doi":"10.1007/s10729-025-09705-x","DOIUrl":"10.1007/s10729-025-09705-x","url":null,"abstract":"Standing orders allow triage nurses in emergency departments (EDs) to order tests for target patients prior to a physician evaluation. Standing orders specify the medical conditions for which a triage nurse is permitted to order tests but typically do not specify the operational conditions under which ordering tests is desirable, from either a system or a patient point of view. We examine the operational impacts of standing orders on the ED as a whole, and propose a threshold policy for activating standing orders as a function of ED congestion. To parameterize the threshold policy we develop three simplified models: 1) an infinite-server model to derive an easily-computed feature for predicting whether activating standing orders would be beneficial, 2) a Jackson network model, to demonstrate that standing orders can lead to diverse outcomes for different patient populations, and 3) a Markov decision process model, to quantify the optimality gap for our threshold policy. We confirm the tentative findings from the simplified models in a more realistic setting using a simulation model that is calibrated with real data. We find that the threshold policy, with a threshold that is a simple function of the aforementioned feature, performs well across a wide range of parameter values. We demonstrate potential unintended consequences of the use of standing orders, including overtesting and spillover effects on non-target patients. Medical studies demonstrate that the use of standing orders decreases average ED length of stay (LOS) for target patients. Our research shows the importance of investigating the impact of standing orders on the ED as a whole.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"143-159"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ambulance location and relocation under budget constraints: investigating coverage-maximization models and ambulance sharing to improve emergency medical services performance. 预算限制下的救护车位置和重新安置：调查覆盖最大化模型和救护车共享以提高紧急医疗服务绩效。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-05-21 DOI: 10.1007/s10729-025-09708-8

Youness Frichi, Lina Aboueljinane, Fouad Jawab

{"title":"Ambulance location and relocation under budget constraints: investigating coverage-maximization models and ambulance sharing to improve emergency medical services performance.","authors":"Youness Frichi, Lina Aboueljinane, Fouad Jawab","doi":"10.1007/s10729-025-09708-8","DOIUrl":"10.1007/s10729-025-09708-8","url":null,"abstract":"Ambulance location in Emergency Medical Services (EMS) is a widely studied problem requiring efficient resource allocation within budgetary constraints. The literature has focused on enhancing EMS performance with limited attention given to their economic performance. This study addresses EMS performance with an emphasis on budget constraints by revising three coverage maximization models: the time-dependent Maximum Expected Coverage Location Problem (time-dependent MEXCLP), the multi-period Double Standard Model (mDSM), and the multi-period Queueing Maximal Availability Location Problem (Q-MALP-M2). These models are adapted to incorporate ambulance types, multi-period relocation, and budget constraints related to costs associated with ambulance station openings, ambulance acquisition, transport, and multi-period relocation. The revised models, along with two hybrid models (model 1 and model 2), were evaluated and compared using a discrete-event simulation model based on three key performance indicators: 1) coverage, 2) waiting time, and 3) time to arrive at the hospital. Additionally, the study investigates ambulance sharing as a policy to enhance EMS performance, wherein a single ambulance serves two patients whenever feasible. The study uses data from the Fez-Meknes region in Morocco, collected in 2021. Results indicate that hybrid model 1 outperformed the other models in most scenarios, as it allows for the decentralization of ambulances by investing the allocated budget in constructing new ambulance stations and acquiring new ambulances, contrasting with the other models that allocate almost the entire budget to purchasing new ambulances. Furthermore, the findings reveal that ambulance sharing significantly improves EMS performance, particularly under tightening budgetary restrictions and increasing demand; however, the benefits of ambulance sharing diminish as the allocated budget increases.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"274-297"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Visualisation of Data Envelopment Analysis in primary health services. 初级卫生服务中数据包络分析的可视化。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-05-02 DOI: 10.1007/s10729-025-09702-0

Ane Elixabete Ripoll-Zarraga, José Luis Franco Miguel, Carmen Fullana Belda

{"title":"Visualisation of Data Envelopment Analysis in primary health services.","authors":"Ane Elixabete Ripoll-Zarraga, José Luis Franco Miguel, Carmen Fullana Belda","doi":"10.1007/s10729-025-09702-0","DOIUrl":"10.1007/s10729-025-09702-0","url":null,"abstract":"Benchmark efficiency analysis in public health typically focuses on hospitals rather than primary care providers. Data Envelopment Analysis (DEA) is widely used to assess resource efficiency among decision-making units (DMUs). However, traditional DEA struggles to differentiate between efficient units and is sensitive to the selection of inputs and outputs. Methods like super-efficiency and cross-efficiency address some of these limitations but often exclude outliers and may overlook efficiency related to specialisation. DEA Visualisation integrates DEA with multivariate statistical methods allowing for the identification of inefficiency sources and specialisation patterns without losing discriminatory power or removing extreme cases from the sample. This study analyses 82 public primary health centres in Madrid serving senior citizens in 2018. The findings reveal inefficiencies such as a preference for prescribing specific rather than generic drugs, increasing public health costs. Additionally, two extreme cases (outliers or mavericks) were identified as having high infrastructure costs and disproportionate staffing. Redistributing patients from overcrowded centres could enhance efficiency, while centres focused on preventive care showed greater cost-effectiveness, particularly in reducing prescription costs.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"207-233"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A compartmental modelling methodology to support strategic decision making for managing the elective hospital waiting list; application in England's NHS. 采用分区建模方法，支持管理择期医院候诊名单的战略决策；英国国民健康保险制度的应用。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2025-06-01 Epub Date: 2025-05-13 DOI: 10.1007/s10729-025-09709-7

Richard M Wood, David J Worthington

{"title":"A compartmental modelling methodology to support strategic decision making for managing the elective hospital waiting list; application in England's NHS.","authors":"Richard M Wood, David J Worthington","doi":"10.1007/s10729-025-09709-7","DOIUrl":"10.1007/s10729-025-09709-7","url":null,"abstract":"Waiting list models can support improved strategic management of elective hospital care through estimating possible performance impacts resulting from different demand and capacity related interventions. Single-compartment models have previously been used to model the referral 'inflow' and treatment 'outflow' onto a waiting list, with some also considering the outflow of patients reneging from the waiting list before treatment. The conceptual simplicity of these models promotes scalability through aligning to various waiting list problems and routine data sources. However, these single-compartment models are only able to model waiting list size, and not waiting times. To address this, we extend the single-compartment model with reneging to consider a multi-compartment model, where each compartment represents the number of individuals awaiting treatment for progressively longer periods of time. This problem is formulated in discrete time and solved through a series of difference equations. Open-source code for implementing the model is made freely available. To illustrate the versatility of the methodology, the model is calibrated using routine data for the total England NHS waiting list as of year-end 2023 and used to project various scenarios over the following two years to year-end 2025. Model validation is performed through backtesting (running the model on past unseen data), with 0.4% and 4.7% MAPE attained on six and twelve month windows respectively.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"259-273"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0