MDM Policy and Practice最新文献

{"title":"Sample Size and Model Prediction Accuracy in EQ-5D-5L Valuations Studies: Expected Out-of-Sample Accuracy Based on Resampling with Different Sample Sizes and Alternative Model Specifications","authors":"T. M. Hansen, K. Stavem, K. Rand","doi":"10.1177/23814683221083839","DOIUrl":"https://doi.org/10.1177/23814683221083839","url":null,"abstract":"Background. National valuation studies are costly, with ∼1000 face-to-face interviews recommended, and some countries may deem such studies infeasible. Building on previous studies exploring sample size, we determined the effect of sample size and alternative model specifications on prediction accuracy of modeled coefficients in EQ-5D-5L value set generating regression analyses. Methods. Data sets (n = 50 to ∼1000) were simulated from 3 valuation studies, resampled at the respondent level and randomly drawn 1000 times with replacement. We estimated utilities for each subsample with leave-one-out at the block level using regression models (8 or 20 parameter; with or without a random intercept; time tradeoff [TTO] data only or TTO + discrete choice experiment [DCE] data). Prediction accuracy, root mean square error (RMSE), was calculated by comparing to censored mean predicted values to the left-out block in the full data set. Linear regression was used to estimate the relative effect of changes in sample size and each model specification. Results. Results showed that doubling the sample size decreased RMSE by on average 0.012. Effects of other model specifications were smaller but can when combined compensate for loss in prediction accuracy from a small sample size. For models using TTO data only, 8-parameter models clearly outperformed 20-parameter models. Adding a random intercept, or including DCE responses, also improved mean RMSE, most prominently for variants of the 20-parameter models. Conclusions. The prediction accuracy impact of further increases in sample size after 300 to 500 were smaller than the impact of combining alternative modeling choices. Hybrid modeling, use of constrained models, and inclusion of random intercepts all substantially improve the expected prediction accuracy. Beyond a minimum of 300 to 500 respondents, the sample size may be better informed by other considerations, such as legitimacy and representativeness, than by the technical prediction accuracy achievable. Highlights Increases in sample size beyond a minimum in the range of 300 to 500 respondents provide smaller gains in expected prediction accuracy than alternative modeling approaches. Constrained, nonlinear models; time tradeoff + discrete choice experiment hybrid modeling; and including a random intercept all improved the prediction accuracy of models estimating values for the EQ-5D-5L based on data from 3 different valuation studies. The tested modeling choices can compensate for smaller sample sizes.","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43030709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Approaches to Cost-Effectiveness Analysis in Saudi Arabia: What Can We Learn? A Systematic Review","authors":"F. Maraiki, S. Bazarbashi, P. Scuffham, H. Tuffaha","doi":"10.1177/23814683221086869","DOIUrl":"https://doi.org/10.1177/23814683221086869","url":null,"abstract":"Objective The recent establishment of the health technology assessment (HTA) entity in the Kingdom of Saudi Arabia (KSA) has resulted in increased interest in economic evaluation. The aim of this study is to evaluate the technical approaches used in published economic evaluations and the limitations reported by the authors of the respective studies that could affect the ability to perform economic evaluations in the KSA. Methods We conducted a systematic literature review of published economic evaluations performed for the KSA over the past 10 years. An electronic literature search of the PubMed, EMBASE, and Cochrane databases was performed. A CHEERS checklist was used to assess the quality of reporting. Reported limitations were classified into domains including the definition of perspectives, identification of comparators, estimation of costs and resources, and use of the incremental cost-effectiveness ratio threshold. Results Twelve evaluations were identified; most involved cost-effectiveness analysis (92%). Missing and unclear data were found within the CHEERS criteria. Regardless of the perspective used, most described the perspective as an “institutional” perspective (70%) and almost half were reclassified by the current reviewer (42%). Most did not clearly state the comparator (83%), and published model comparators were commonly used (50%). Resource estimation was mostly performed by the authors of the respective studies (67%), and costs were mostly obtained from hospital institutional data (75%). The lack of an established threshold for the country-specific willingness to pay was observed in 50% of the analyses. Conclusions Economic evaluations from the KSA are limited. Capacity building and country-specific HTA guidelines could improve the quality of evaluations to better inform decision making. Highlights Economic analysis of health technology should follow standard guidelines. Unfortunately, these guides are often underutilized, and our findings identify considerable missing, not clearly stated, or incomplete data within the analyses, which can weaken the impact of the recommendations. The limitations reported by the authors of the respective studies emphasize the suboptimal quality of the reporting. A lack of data was frequently identified and resulted in using “institutional” practice as a major source of data input for the analyses. In light of the call for the establishment of an HTA entity in the KSA, framing a standard analytic approach when conducting economic evaluations will support HTA in informing resource allocation decisions. We hope that our findings highlight the need for country-specific guidance to improve practice and enhance future research.","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41757515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Stage Lung Cancer Patients’ Perceptions of Presurgical Discussions","authors":"R. Schwartz, R. Yip, N. You, C. Gillezeau, Kimberly J. Song, D. Yankelevitz, E. Taioli, C. Henschke, Raja Flores","doi":"10.1177/23814683221085570","DOIUrl":"https://doi.org/10.1177/23814683221085570","url":null,"abstract":"Background Patients with early-stage non–small-cell lung cancer (NSCLC) have high survival rates, but patients often say they did not anticipate the effect of the surgery on their postsurgical quality of life (QoL). This study adds to the literature regarding patient and surgeon interactions and highlights the areas where the current approach is not providing good communication. Design Since its start in 2016, the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study, has enrolled 543 patients who underwent surgery for stage I NSCLC within the Mount Sinai Health System. Presurgical patient and surgeon surveys were available for 314 patients, postsurgical surveys for 420, and both pre- and postsurgical surveys for 285. Results Of patients with presurgical surveys, 31.2% said that their surgeon recommended multiple types of treatment. Of patients with postsurgical surveys, 85.0% felt very well prepared and 11.4% moderately well prepared for their postsurgical recovery. The median Functional Assessment of Cancer Therapy–Lung Cancer score and social support score of the patients who felt very well prepared was significantly higher than those moderately or not well prepared (24.0 v. 22.0, P < 0.001) and (5.0 [interquartile range: 4.7–5.0] v. 5.0 [IQR: 4.2–5.0], p = 0.015). Conclusions This study provides insight into the areas where surgeons are communicating well with their patients as well as the areas where patients still feel uninformed. Most surgeons feel that they prepare their patients well or very well for surgical recovery, whereas some patients still feel that their surgeons did not prepare them well for postsurgical recovery. Surgeons may want to spend additional time emphasizing postsurgical recovery and QoL with their patients or provide their patients with additional avenues to get their questions and concerns addressed. Highlights Pretreatment discussions could help surgeons understand patient priorities and patients understand the anticipated outcomes for their surgeries. There is an association between feeling prepared for surgery and higher quality of life and social support scores after adjustment for confounders. Despite these pretreatment discussions, patients still feel that they are not well prepared about what to expect during their postsurgical recovery.","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47737134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey.","authors":"Marc S Piper, Brian J Zikmund-Fisher, Jennifer K Maratt, Jacob Kurlander, Valbona Metko, Akbar K Waljee, Sameer D Saini","doi":"10.1177/23814683211045648","DOIUrl":"10.1177/23814683211045648","url":null,"abstract":"<p><p><b>Background.</b> In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. <b>Methods.</b> We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. <b>Results.</b> Despite a physician recommendation to stop screening, 29% of respondents reported being \"not at all likely\" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. <b>Conclusion.</b> Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"6 2","pages":"23814683211045648"},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/1e/10.1177_23814683211045648.PMC8488065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Roadmaps for Chronic Illness: Introducing a New Approach for Fostering Patient-Centered Care.","authors":"Laura D Scherer,&nbsp;Daniel D Matlock,&nbsp;Larry A Allen,&nbsp;Chris E Knoepke,&nbsp;Colleen K McIlvennan,&nbsp;Monica D Fitzgerald,&nbsp;Vinay Kini,&nbsp;Channing E Tate,&nbsp;Grace Lin,&nbsp;Hillary D Lum","doi":"10.1177/23814683211019947","DOIUrl":"https://doi.org/10.1177/23814683211019947","url":null,"abstract":"<p><p><b>Background.</b> Too frequently, patients with chronic illnesses are surprised by disease-related changes and are unprepared to make decisions based on their values. Many patients are not activated and do not see a role for themselves in decision making, which is a key barrier to shared decision making and patient-centered care. Patient decision aids can educate and activate patients at the time of key decisions, and yet, for patients diagnosed with chronic illness, it would be advantageous to activate patients in advance of critical decisions. In this article, we describe and formalize the concept of the Patient Roadmap, a novel approach for promoting patient-centered care that aims to activate patients earlier in the care trajectory and provide them with anticipatory guidance. <b>Methods.</b> We first identify the gap that the Patient Roadmap fills, and describe theory underlying its approach. Then we describe what information a Patient Roadmap might include. Examples are provided, as well as a review comparing the Patient Roadmap concept to existing tools that aim to promote patient-centered care (e.g., patient decision aids). <b>Results and Conclusions.</b> New approaches for promoting patient-centered care are needed. This article provides an introduction and overview of the Patient Roadmap concept for promoting patient-centered care in the context of chronic illness.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"6 1","pages":"23814683211019947"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/23814683211019947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10421341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal Cancer Screening within Colonoscopy Capacity Constraints: Can FIT-Based Programs Save More Lives by Trading off More Sensitive Test Cutoffs against Longer Screening Intervals?","authors":"E. McFerran, J. O’Mahony, Steffie K. Naber, L. Sharp, A. Zauber, I. Lansdorp-Vogelaar, F. Kee","doi":"10.1177/23814683221097064","DOIUrl":"https://doi.org/10.1177/23814683221097064","url":null,"abstract":"Introduction. Colorectal cancer (CRC) prevention programs using fecal immunochemical testing (FIT) in screening rely on colonoscopy for secondary and surveillance testing. Colonoscopy capacity is an important constraint. Some European programs lack sufficient capacity to provide optimal screening intensity regarding age ranges, intervals, and FIT cutoffs. It is currently unclear how to optimize programs within colonoscopy capacity constraints. Design. Microsimulation modeling, using the MISCAN-Colon model, was used to determine if more effective CRC screening programs can be identified within constrained colonoscopy capacity. A total of 525 strategies were modeled and compared, varying 3 key screening parameters: screening intervals, age ranges, and FIT cutoffs, including previously unevaluated 4- and 5-year screening intervals (using a lifetime horizon and 100% adherence). Results were compared with the policy decisions taken in Ireland to provide CRC screening within available colonoscopy capacity. Outcomes estimated net costs, quality-adjusted life-years (QALYs), and required colonoscopies. The optimal strategies within finite colonoscopy capacity constraints were identified. Results. Combining a reduced FIT cutoff of 10 µg Hb/g, an extended screening interval of 4 y and an age range of 60–72 y requires 6% fewer colonoscopies, reduces net costs by 23% while preventing 15% more CRC deaths and saving 16% more QALYs relative to a strategy (FIT 40 µg Hb/g, 2-yearly, 60–70 year) approximating current policy. Conclusion. Previously overlooked longer screening intervals may optimize cancer prevention with finite colonoscopy capacity constraints. Changes could save lives, reduce costs, and relieve colonoscopy capacity pressures. These findings are relevant to CRC screening programs across Europe that employ FIT-based testing, which face colonoscopy capacity constraints.","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43309306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision Making in the Era of Telehealth: Implications for Practice and Research.","authors":"Elissa M Ozanne,&nbsp;Peter A Noseworthy,&nbsp;Kenzie A Cameron,&nbsp;Monika Schmidt,&nbsp;Kerri Cavanaugh,&nbsp;Mandy L Pershing,&nbsp;Adriana Guzman,&nbsp;Angela Sivly,&nbsp;Angela Fagerlin","doi":"10.1177/2381468320976364","DOIUrl":"https://doi.org/10.1177/2381468320976364","url":null,"abstract":"Since its emergence in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID19), has infected over 14 million individuals worldwide. This unprecedented pandemic has forced clinicians to rethink how health care can be delivered to minimize the risk of disease transmission and promote patient safety while still meeting the general health needs of patients. As a result, telehealth visits (either by telephone or telehealth audio and video platforms) have become the preferred mode for many encounters. It seems increasingly likely that such telehealth visits will persist long after the pandemic has abated, resulting in the need to assess the impact of this change on clinical care and patientcentered research. Shared decision making (SDM) refers to the process by which clinicians and patients work through clinical problems together to arrive at decisions that make emotional, practical, and intellectual sense for the patient. This process is highly dependent on clear and unhurried communication. Effective SDM is essential to patientcentered care and is recommended by many professional societies when confronted with particular medical decisions. However, how to best implement SDM remains unknown. Strategies that rely on decision aids or patienteducation materials have been developed, but uptake of these tools remains low in clinical practice. What does the current shift toward telehealth in care delivery mean for SDM? Can technology be leveraged to facilitate effective SDM? Will this shift minimize or exacerbate health care disparities? What does this change mean for how researchers study SDM? In this commentary, we explore these questions from the perspectives of clinicians and researchers.","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"5 2","pages":"2381468320976364"},"PeriodicalIF":0.0,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468320976364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38394925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Kansas City Cardiomyopathy Questionnaire (KCCQ) Onto EQ-5D-3L in Heart Failure Patients: Results for the Japanese and UK Value Sets.","authors":"Matthias Hunger,&nbsp;Jennifer Eriksson,&nbsp;Stephane A Regnier,&nbsp;Katsuya Mori,&nbsp;John A Spertus,&nbsp;Joaquim Cristino","doi":"10.1177/2381468320971606","DOIUrl":"https://doi.org/10.1177/2381468320971606","url":null,"abstract":"<p><p><b>Background.</b> Health technology assessment bodies in several countries, including Japan and the United Kingdom, recommend mapping techniques to obtain utility scores in clinical trials that do not have a preference-based measure of health. This study sought to develop mapping algorithms to predict EQ-5D-3L scores from the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failure (HF). <b>Methods.</b> Data from the randomized, double-blind PARADIGM-HF trial were analyzed, and EQ-5D-3L scores were calculated using the Japanese and UK value sets. Several different model specifications were explored to best fit EQ-5D data collected at baseline with KCCQ scores, including ordinary least square regression, two-part, Tobit, and three-part models. Generalized estimating equations models were also fitted to analyze longitudinal EQ-5D data. To validate model predictions, the data set was split into a derivation (<i>n</i> = 4,465) from which the models were developed and a separate sample (<i>n</i> = 1,892) for validation. <b>Results.</b> There were only small differences between the different model classes tested. Model performance and predictive power was better for the item-level models than for the models including KCCQ domain scores. <i>R</i> ² statistics for the item-level models ranged from 0.45 to 0.52. Mean absolute error in the validation sample was 0.10 for the models using the Japanese value set and 0.114 for the UK models. All models showed some underprediction of utility above 0.75 and overprediction of utility below 0.5, but performed well for population-level estimates. <b>Conclusions.</b> Using data from a large clinical trial in HF, we found that EQ-5D-3L scores can be estimated from responses to the KCCQ and can facilitate cost-utility analysis from existing HF trials where only the KCCQ was administered. Future validation in other HF populations is warranted.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"5 2","pages":"2381468320971606"},"PeriodicalIF":0.0,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468320971606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38394924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Determine When SARS-CoV-2 Antibody Testing Is or Is Not Useful for Population Screening: A Tutorial.","authors":"Niklas Keller, Mirjam A Jenny","doi":"10.1177/2381468320963068","DOIUrl":"10.1177/2381468320963068","url":null,"abstract":"<p><p>Extensive testing lies at the heart of any strategy to effectively combat the SARS-COV-2 pandemic. In recent months, the use of enzyme-linked immunosorbent assay-based antibody tests has gained a lot of attention. These tests can potentially be used to assess SARS-COV-2 immunity status in individuals (e.g., essential health care personnel). They can also be used as a screening tool to identify people that had COVID-19 asymptomatically, thus getting a better estimate of the true spread of the disease, gain important insights on disease severity, and to better evaluate the effectiveness of policy measures implemented to combat the pandemic. But the usefulness of these tests depends not only on the quality of the test but also, critically, on how far disease has already spread in the population. For example, when only very few people in a population are infected, a positive test result has a high chance of being a false positive. As a consequence, the spread of the disease in a population as well as individuals' immunity status may be systematically misinterpreted. SARS-COV-2 infection rates vary greatly across both time and space. In many places, the infection rates are very low but can quickly skyrocket when the virus spreads unchecked. Here, we present two tools, natural frequency trees and positive and negative predictive value graphs, that allow one to assess the usefulness of antibody testing for a specific context at a glance. These tools should be used to support individual doctor-patient consultation for assessing individual immunity status as well as to inform policy discussions on testing initiatives.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"5 2","pages":"2381468320963068"},"PeriodicalIF":0.0,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468320963068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38633425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Method for Balancing Provider Schedules in Outpatient Specialty Clinics.","authors":"Bjorn P Berg, S Ayca Erdogan, Jennifer Mason Lobo, Kathryn Pendleton","doi":"10.1177/2381468320963063","DOIUrl":"10.1177/2381468320963063","url":null,"abstract":"<p><p><b>Background.</b> Variability in outpatient specialty clinic schedules contributes to numerous adverse effects including chaotic clinic settings, provider burnout, increased patient waiting times, and inefficient use of resources. This research measures the benefit of balancing provider schedules in an outpatient specialty clinic. <b>Design.</b> We developed a constrained optimization model to minimize the variability in provider schedules in an outpatient specialty clinic. Schedule variability was defined as the variance in the number of providers scheduled for clinic during each hour the clinic is open. We compared the variance in the number of providers scheduled per hour resulting from the constrained optimization schedule with the actual schedule for three reference scenarios used in practice at M Health Fairview's Clinics and Surgery Center as a case study. <b>Results.</b> Compared to the actual schedules, use of constrained optimization modeling reduced the variance in the number of providers scheduled per hour by 92% (1.70-0.14), 88% (1.98-0.24), and 94% (1.98-0.12). When compared with the reference scenarios, the total, and per provider, assigned clinic hours remained the same. Use of constrained optimization modeling also reduced the maximum number of providers scheduled during each of the actual schedules for each of the reference scenarios. The constrained optimization schedules utilized 100% of the available clinic time compared to the reference scenario schedules where providers were scheduled during 87%, 92%, and 82% of the open clinic time, respectively. <b>Limitations.</b> The scheduling model's use requires a centralized provider scheduling process in the clinic. <b>Conclusions.</b> Constrained optimization can help balance provider schedules in outpatient specialty clinics, thereby reducing the risk of negative effects associated with highly variable clinic settings.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"5 2","pages":"2381468320963063"},"PeriodicalIF":0.0,"publicationDate":"2020-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f2/ab/10.1177_2381468320963063.PMC7592316.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38600548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}