Health Care Management Science最新文献

{"title":"Performance measurement of nonhomogeneous Hong Kong hospitals using directional distance functions.","authors":"Shuguang Lin,&nbsp;Paul Rouse,&nbsp;Ying-Ming Wang,&nbsp;Lin Lin,&nbsp;Zhen-Quan Zheng","doi":"10.1007/s10729-022-09625-0","DOIUrl":"https://doi.org/10.1007/s10729-022-09625-0","url":null,"abstract":"<p><p>Cook et al. (Oper Res 61(3):666-676, 2013) propose a DEA-based model for the performance evaluation of non-homogeneous decision making units (DMUs) based on constant returns to scale (CRS), extended by Li et al. (Health Care Manag Sci 22(2):215-228, 2019) to variable returns to scale (VRS). This paper locates these models into more general DDF models to deal with nonhomogeneous DMUs and applies these to Hong Kong hospitals. The production process of each hospital is divided into subunits which have the same inputs and outputs and hospital performance is measured using the subunits. The paper provides CRS and VRS versions of DDF models and compares them with Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019). A kernel-based method is used to estimate the distributions as well as a DEA-based efficiency analysis adapted by Simar and Zelenyuk to test the distributions. Both DDF CRS and VRS versions produce results similar to Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019) respectively. However, the statistical tests find differences for the different technologies assumed as would be expected. For hospital managers, the more generalised DDF models expand their range of options in terms of directional improvements and priorities as well as dealing with non-homogeneity.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 2","pages":"330-343"},"PeriodicalIF":3.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9902815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9607629","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}

{"title":"Who should see the patient? on deviations from preferred patient-provider assignments in hospitals.","authors":"Mariam K Atkinson,&nbsp;Soroush Saghafian","doi":"10.1007/s10729-022-09628-x","DOIUrl":"https://doi.org/10.1007/s10729-022-09628-x","url":null,"abstract":"<p><p>In various organizations including hospitals, individuals are not forced to follow specific assignments, and thus, deviations from preferred task assignments are common. This is due to the conventional wisdom that professionals should be given the flexibility to deviate from preferred assignments as needed. It is unclear, however, whether and when this conventional wisdom is true. We use evidence on the assignments of generalist and specialists to patients in our partner hospital (a children's hospital), and generate insights into whether and when hospital administrators should disallow such flexibility. We do so by identifying 73 top medical diagnoses and using detailed patient-level electronic medical record (EMR) data of more than 4,700 hospitalizations. In parallel, we conduct a survey of medical experts and utilized it to identify the preferred provider type that should have been assigned to each patient. Using these two sources of data, we examine the consequence of deviations from preferred provider assignments on three sets of performance measures: operational efficiency (measured by length of stay), quality of care (measured by 30-day readmissions and adverse events), and cost (measured by total charges). We find that deviating from preferred assignments is beneficial for task types (patients' diagnosis in our setting) that are either (a) well-defined (improving operational efficiency and costs), or (b) require high contact (improving costs and adverse events, though at the expense of lower operational efficiency). For other task types (e.g., highly complex or resource-intensive tasks), we observe that deviations are either detrimental or yield no tangible benefits, and thus, hospitals should try to eliminate them (e.g., by developing and enforcing assignment guidelines). To understand the causal mechanism behind our results, we make use of mediation analysis and find that utilizing advanced imaging (e.g., MRIs, CT scans, or nuclear radiology) plays an important role in how deviations impact performance outcomes. Our findings also provide evidence for a \"no free lunch\" theorem: while for some task types, deviations are beneficial for certain performance outcomes, they can simultaneously degrade performance in terms of other dimensions. To provide clear recommendations for hospital administrators, we also consider counterfactual scenarios corresponding to imposing the preferred assignments fully or partially, and perform cost-effectiveness analyses. Our results indicate that enforcing the preferred assignments either for all tasks or only for resource-intensive tasks is cost-effective, with the latter being the superior policy. Finally, by comparing deviations during weekdays and weekends, early shifts and late shifts, and high congestion and low congestion periods, our results shed light on some environmental conditions under which deviations occur more in practice.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 2","pages":"165-199"},"PeriodicalIF":3.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9606303","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}

{"title":"A mixed-integer slacks-based measure data envelopment analysis for efficiency measuring of German university hospitals.","authors":"Mansour Zarrin","doi":"10.1007/s10729-022-09620-5","DOIUrl":"https://doi.org/10.1007/s10729-022-09620-5","url":null,"abstract":"<p><p>Standard Data Envelopment Analysis (DEA) models consider continuous-valued and known input and output statuses for measures. This paper proposes an extended Slacks-Based Measure (SBM) DEA model to accommodate flexible (a measure that can play the role of input and output) and integer measures simultaneously. A flexible measure's most appropriate role (designation) is determined by maximizing the technical efficiency of each unit. The main advantage of the proposed model is that all inputs, outputs, and flexible measures can be expressed in integer values without inflation of efficiency scores since they are directly calculated by modifying input and output inefficiencies. Furthermore, we illustrate and examine the application of the proposed models with 28 university hospitals in Germany. We investigate the differences and common properties of the proposed models with the literature to shed light on both teaching and general inefficiencies. Results of inefficiency decomposition indicate that \"Third-party funding income\" that university hospitals receive from the research-granting agencies dominates the other inefficiencies sources. The study of the efficiency scores is then followed up with a second-stage regression analysis based on efficiency scores and environmental factors. The result of the regression analysis confirms the conclusion derived from the inefficiency decomposition analysis.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"138-160"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9244074","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}

{"title":"Monitoring policy in the context of preventive treatment of cardiovascular disease.","authors":"Daniel F Otero-Leon,&nbsp;Mariel S Lavieri,&nbsp;Brian T Denton,&nbsp;Jeremy Sussman,&nbsp;Rodney A Hayward","doi":"10.1007/s10729-022-09621-4","DOIUrl":"https://doi.org/10.1007/s10729-022-09621-4","url":null,"abstract":"<p><p>Preventing chronic diseases is an essential aspect of medical care. To prevent chronic diseases, physicians focus on monitoring their risk factors and prescribing the necessary medication. The optimal monitoring policy depends on the patient's risk factors and demographics. Monitoring too frequently may be unnecessary and costly; on the other hand, monitoring the patient infrequently means the patient may forgo needed treatment and experience adverse events related to the disease. We propose a finite horizon and finite-state Markov decision process to define monitoring policies. To build our Markov decision process, we estimate stochastic models based on longitudinal observational data from electronic health records for a large cohort of patients seen in the national U.S. Veterans Affairs health system. We use our model to study policies for whether or when to assess the need for cholesterol-lowering medications. We further use our model to investigate the role of gender and race on optimal monitoring policies.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"93-116"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9106989","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}

{"title":"Tracking Covid-19 cases and deaths in the United States: metrics of pandemic progression derived from a queueing framework.","authors":"Randolph Hall,&nbsp;Andrew Moore,&nbsp;Mingdong Lyu","doi":"10.1007/s10729-022-09619-y","DOIUrl":"https://doi.org/10.1007/s10729-022-09619-y","url":null,"abstract":"<p><p>We analyze the progression of COVID-19 in the United States over a nearly one-year period beginning March 1, 2020 with a novel metric motivated by queueing models, tracking partial-average day-of-event and cumulative probability distributions for events, where events are points in time when new cases and new deaths are reported. The partial average represents the average day of all events preceding a point of time, and is an indicator as to whether the pandemic is accelerating or decelerating in the context of the entire history of the pandemic. The measure supplements traditional metrics, and also enables direct comparisons of case and death histories on a common scale. We also compare methods for estimating actual infections and deaths to assess the timing and dynamics of the pandemic by location. Three example states are graphically compared as functions of date, as well as Hong Kong as an example that experienced a pronounced recent wave of the pandemic. In addition, statistics are compared for all 50 states. Over the period studied, average case day and average death day varied by two to five months among the 50 states, depending on data source, with the earliest averages in New York and surrounding states, as well as Louisiana.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"79-92"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9106990","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}

{"title":"Nurse rostering with fatigue modelling : Incorporating a validated sleep model with biological variations in nurse rostering.","authors":"Kjartan Kastet Klyve,&nbsp;Ilankaikone Senthooran,&nbsp;Mark Wallace","doi":"10.1007/s10729-022-09613-4","DOIUrl":"https://doi.org/10.1007/s10729-022-09613-4","url":null,"abstract":"<p><p>We use a real Nurse Rostering Problem and a validated model of human sleep to formulate the Nurse Rostering Problem with Fatigue. The fatigue modelling includes individual biologies, thus enabling personalised schedules for every nurse. We create an approximation of the sleep model in the form of a look-up table, enabling its incorporation into nurse rostering. The problem is solved using an algorithm that combines Mixed-Integer Programming and Constraint Programming with a Large Neighbourhood Search. A post-processing algorithm deals with errors, to produce feasible rosters minimising global fatigue. The results demonstrate the realism of protecting nurses from highly fatiguing schedules and ensuring the alertness of staff. We further demonstrate how minimally increased staffing levels enable lower fatigue, and find evidence to suggest biological complementarity among staff can be used to reduce fatigue. We also demonstrate how tailoring shifts to nurses' biology reduces the overall fatigue of the team, which means managers must grapple with the issue of fairness in rostering.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"21-45"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117710","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}

{"title":"On integrating patient appointment grids and technologist schedules in a radiology center.","authors":"Dina Bentayeb,&nbsp;Nadia Lahrichi,&nbsp;Louis-Martin Rousseau","doi":"10.1007/s10729-022-09618-z","DOIUrl":"https://doi.org/10.1007/s10729-022-09618-z","url":null,"abstract":"<p><p>Optimal patient appointment grid scheduling improves medical center performance and reduces pressure from excess demand. Appointment scheduling efficiency depends on resource management, and staff are a key resource. Personnel scheduling takes into account union rules, skills, contract types, training, leave, illness, etc. When combined with appointment scheduling constraints, the complexity of the problem increases. In this paper, we study the combination of the patient appointment grid and technologist scheduling. We present a well-detailed framework outlining our approach. We develop two versions of a mixed-integer programming model: integrated and sequential. In the first version, we elaborate the appointment grid and the technologist schedules simultaneously, while in the second version we generate them sequentially. We evaluate the proposed approach using real data from the MRI department of the Centre hospitalier de l'Université de Montréal (CHUM) radiology center. We study different scenarios by testing several technologist rules and planning construction methods. Obtained solutions are compared to the current CHUM scheduling approach.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"62-78"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9461717","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}

{"title":"Editorial - Acknowledgement of reviewers and editorial board members.","authors":"","doi":"10.1007/s10729-023-09633-8","DOIUrl":"https://doi.org/10.1007/s10729-023-09633-8","url":null,"abstract":"","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"161-164"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9105538","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}

{"title":"Online scheduling using a fixed template: the case of outpatient chemotherapy drug administration.","authors":"Alireza F Hesaraki,&nbsp;Nico P Dellaert,&nbsp;Ton de Kok","doi":"10.1007/s10729-022-09616-1","DOIUrl":"https://doi.org/10.1007/s10729-022-09616-1","url":null,"abstract":"<p><p>In this paper, we use a fixed template of slots for the online scheduling of appointments. The template is a link between planning the service capacity at a tactical level and online scheduling at an operational level. We develop a detailed heuristic for the case of drug administration appointments in outpatient chemotherapy. However, the approach can be applied to online scheduling in other application areas as well. The desired scheduling principles are incorporated into the cost coefficients of the objective function of a binary integer program for booking appointments in the template, as requests arrive. The day and time of appointments are decided simultaneously, rather than sequentially, where optimal solutions may be eliminated from the search. The service that we consider in this paper is an example to show the versatility of a fixed template online scheduling model. It requires two types of resource, one of which is exclusively assigned for the whole appointment duration, and the other is shared among multiple appointments after setting up the service. There is high heterogeneity among appointments on a day of this service. The appointments may range from fifteen minutes to more than eight hours. A fixed template gives a pattern for the scheduling of possibly required steps before the service. Instead of maximizing the fill-rate of the template, the objective of our heuristic is to have high performance in multiple indicators pertaining to various stakeholders (patients, nurses, and the clinic). By simulation, we illustrate the performance of the fixed template model for the key indicators.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"117-137"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9116716","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}

{"title":"Effectiveness of feedback control and the trade-off between death by COVID-19 and costs of countermeasures.","authors":"Akira Watanabe,&nbsp;Hiroyuki Matsuda","doi":"10.1007/s10729-022-09617-0","DOIUrl":"https://doi.org/10.1007/s10729-022-09617-0","url":null,"abstract":"<p><p>We provided a framework of a mathematical epidemic modeling and a countermeasure against the novel coronavirus disease (COVID-19) under no vaccines and specific medicines. The fact that even asymptomatic cases are infectious plays an important role for disease transmission and control. Some patients recover without developing the disease; therefore, the actual number of infected persons is expected to be greater than the number of confirmed cases of infection. Our study distinguished between cases of confirmed infection and infected persons in public places to investigate the effect of isolation. An epidemic model was established by utilizing a modified extended Susceptible-Exposed-Infectious-Recovered model incorporating three types of infectious and isolated compartments, abbreviated as SEIIIHHHR. Assuming that the intensity of behavioral restrictions can be controlled and be divided into multiple levels, we proposed the feedback controller approach to implement behavioral restrictions based on the active number of hospitalized persons. Numerical simulations were conducted using different detection rates and symptomatic ratios of infected persons. We investigated the appropriate timing for changing the degree of behavioral restrictions and confirmed that early initiating behavioral restrictions is a reasonable measure to reduce the burden on the health care system. We also examined the trade-off between reducing the cumulative number of deaths by the COVID-19 and saving the cost to prevent the spread of the virus. We concluded that a bang-bang control of the behavioral restriction can reduce the socio-economic cost, while a control of the restrictions with multiple levels can reduce the cumulative number of deaths by infection.</p>","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 1","pages":"46-61"},"PeriodicalIF":3.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9108205","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}