Health SystemsPub Date : 2021-05-24eCollection Date: 2022-01-01DOI: 10.1080/20476965.2021.1924085
M Dashtban, Weizi Li
{"title":"Predicting non-attendance in hospital outpatient appointments using deep learning approach.","authors":"M Dashtban, Weizi Li","doi":"10.1080/20476965.2021.1924085","DOIUrl":"https://doi.org/10.1080/20476965.2021.1924085","url":null,"abstract":"<p><p>The hospital outpatient non-attendance imposes a substantial financial burden on hospitals and roots in multiple diverse reasons. This research aims to build an advanced predictive model for predicting non-attendance regarding the whole spectrum of probable contributing factors to non-attendance that could be collated from heterogeneous sources including electronic patients records and external non-hospital data. We proposed a new non-attendance prediction model based on deep neural networks and machine learning models. The proposed approach works upon sparse stacked denoising autoencoders (SDAEs) to learn the underlying manifold of data and thereby compacting information and providing a better representation that can be utilised afterwards by other learning models as well. The proposed approach is evaluated over real hospital data and compared with several well-known and scalable machine learning models. The evaluation results reveal the proposed approach with softmax layer and logistic regression outperforms other methods in practice.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2021.1924085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33477127","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}
Health SystemsPub Date : 2021-05-02DOI: 10.1080/20476965.2021.1906764
Geraint I. Palmer, P. Harper, Vincent A. Knight, Cathy Brooks
{"title":"Modelling changes in healthcare demand through geographic data extrapolation","authors":"Geraint I. Palmer, P. Harper, Vincent A. Knight, Cathy Brooks","doi":"10.1080/20476965.2021.1906764","DOIUrl":"https://doi.org/10.1080/20476965.2021.1906764","url":null,"abstract":"ABSTRACT Stay Well Plans are a new programme of care offered to frail and elderly people in Newport. In 2016 a roll out the programme to be offered in all five counties serviced by Aneurin Bevan University Health Board was planned. This paper presents the data analysis and modelling used to determine the programme's effects on the demand of the wider system, and the effects of a Gwent-wide roll out. We extrapolate information from data from a geographical subset of the model domain to a larger geographical area, adjusting for population sizes, deprivation, and distances to healthcare facilities. These parametrise a Markov model and Monte Carlo simulation to predict changes in demand due to different levels of roll out. We conclude that a programme roll out may result in a large reduction on demand at residential care, however at the expense of an increase in demand at community care services.","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2021.1906764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42965403","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}
Health SystemsPub Date : 2021-04-23eCollection Date: 2022-01-01DOI: 10.1080/20476965.2021.1908851
Safa Chabouh, Sondes Hammami, Eric Marcon, Hanen Bouchriha
{"title":"A pull-strategy for the appointment scheduling of surgical patients in a hospital-integrated facility.","authors":"Safa Chabouh, Sondes Hammami, Eric Marcon, Hanen Bouchriha","doi":"10.1080/20476965.2021.1908851","DOIUrl":"https://doi.org/10.1080/20476965.2021.1908851","url":null,"abstract":"<p><p>This paper addresses the daily appointment scheduling (AS) of patients in a hospital-integrated facility where outpatients and inpatients are treated simultaneously and share critical resources. We propose a lean approach based on the pull-strategy \"Constant Work in Process\" (ConWIP) to develop robust and easy-to-implement AS rules. Our objective is to reduce patients' waiting time and maximise the use rate of resources while considering the global surgical process and stochastic service times. The AS rules based on ConWIP are evaluated using a Discrete-Event-Simulation model. Numerical experiments based on a real-life case study are carried out to assess the proposed appointment rules' performance and compare them to AS rules developed in the literature. The results highlight the robustness of our approach and demonstrate its usefulness in practice.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2021.1908851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33477124","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}
Health SystemsPub Date : 2021-04-18eCollection Date: 2022-01-01DOI: 10.1080/20476965.2021.1908176
Enoch Kung, Sarah E Seaton, Padmanabhan Ramnarayan, Christina Pagel
{"title":"Using a genetic algorithm to solve a non-linear location allocation problem for specialised children's ambulances in England and Wales.","authors":"Enoch Kung, Sarah E Seaton, Padmanabhan Ramnarayan, Christina Pagel","doi":"10.1080/20476965.2021.1908176","DOIUrl":"https://doi.org/10.1080/20476965.2021.1908176","url":null,"abstract":"<p><p>Since 1997, special paediatric intensive care retrieval teams (PICRTs) based in 11 locations across England and Wales have been used to transport sick children from district general hospitals to one of 24 paediatric intensive care units. We develop a location allocation optimisation framework to help inform decisions on the optimal number of locations for each PICRT, where those locations should be, which local hospital each location serves and how many teams should station each location. Our framework allows for stochastic journey times, differential weights for each journey leg and incorporates queuing theory by considering the time spent waiting for a PICRT to become available. We examine the average waiting time and the average time to bedside under different number of operational PICRT stations, different number of teams per station and different levels of demand. We show that consolidating the teams into fewer stations for higher availability leads to better performance.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2021.1908176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33477125","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}
Health SystemsPub Date : 2021-04-04eCollection Date: 2022-01-01DOI: 10.1080/20476965.2021.1906762
Benny Wai, Krisztina Vasarhelyi, Alexander R Rutherford, Chris Buchner, Reka Gustafson, Miranda Compton, Mark Hull, Jf Williams, Rolando Barrios
{"title":"A qualitative model of the HIV care continuum in Vancouver, Canada.","authors":"Benny Wai, Krisztina Vasarhelyi, Alexander R Rutherford, Chris Buchner, Reka Gustafson, Miranda Compton, Mark Hull, Jf Williams, Rolando Barrios","doi":"10.1080/20476965.2021.1906762","DOIUrl":"10.1080/20476965.2021.1906762","url":null,"abstract":"<p><p>A team of health care stakeholders and researchers collaboratively developed a qualitative model and graphic representation of the continuum of HIV care in Vancouver to inform delivery of antiretroviral therapy and other HIV health services. The model describes the patient journey through the HIV care continuum, including states of infection, health services, and care decisions. We used a Unified Modelling Language (UML) <i>activity diagram</i> to capture patient and provider activities and to guide the construction of a UML <i>state machine diagram</i>. The state machine diagram captures model agent states in a formalism that facilitates the development of system dynamics or agent-based models. These quantitative models can be applied to optimizing the allocation of resources, and to evaluate potential strategies for improved patient care and system performance. The novel approach of combining UML diagrams we present provides a general method for modelling capacity ---management strategies within complex health systems.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2021-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9154767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45634369","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}
Health SystemsPub Date : 2021-02-14DOI: 10.1080/20476965.2021.1876533
James F. Cox
{"title":"Using the theory of constraints to create a paradigm shift in organisation performance at a large primary care provider practice","authors":"James F. Cox","doi":"10.1080/20476965.2021.1876533","DOIUrl":"https://doi.org/10.1080/20476965.2021.1876533","url":null,"abstract":"ABSTRACT Healthcare is in crisis with increasing patients’ needs, rising medical technology investment, increasing expenses, and patients’ inability to pay. To address this crisis, a new, simple, effective, and holistic management methodology is needed to rapidly and economically improve each link’s performance in the healthcare supply chain (HCSC). The HCSC involves several links starting with the sick patient, then the primary care provider practice (PCPP) then the specialists … to the well-patient. Most HC research does not address this ill-structured, messy-problem environment: the causalities within a link and across the HCSC; the multiple criteria imposed by different HCSC stakeholders. Better management of the PCPP, the gatekeeper to other links is the leverage point to providing more, cheaper, better and timely healthcare. Action research at a PCPP using Theory of Constraint resulted in increases in revenue and net ordinary income; decreases in patient no-show rates and waiting times; and better provider utilization.","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2021.1876533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47368180","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}
Health SystemsPub Date : 2020-12-15eCollection Date: 2022-01-01DOI: 10.1080/20476965.2020.1848356
Ramna Thakur, Shivendra Sangar
{"title":"Socioeconomic differentials in the burden of paying for healthcare in India: a disaggregated analysis.","authors":"Ramna Thakur, Shivendra Sangar","doi":"10.1080/20476965.2020.1848356","DOIUrl":"https://doi.org/10.1080/20476965.2020.1848356","url":null,"abstract":"<p><p>By using nationally representative consumption expenditure surveys (CES) conducted by the National Sample Survey Organisation (NSSO) in 1999-2000, 2004-05 and 2011-12, this paper has analysed the socioeconomic differentials in the burden of paying for healthcare in India. The study found that in all waves of data, the concentration of population reporting OOP health expenditure has shown a shift towards poor population, while the concentration of overshoot expenditure is still constant among the rich which is more pronounced in the rural areas of the country. Furthermore, Muslims and Sikhs among different religions, Scheduled Casts among social categories, self-employed and casual/agricultural labour among household types and rural areas among sectors are more likely to incur OOP health expenditure as compared to their counterparts. This study argues for the universal health insurance coverage to protect households from the significant burden of expenditure on critical healthcare.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2020.1848356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756481","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}
Health SystemsPub Date : 2020-12-15eCollection Date: 2022-01-01DOI: 10.1080/20476965.2020.1857663
Guillaume Lamé, Sonya Crowe, Matthew Barclay
{"title":"\"What's the evidence?\"-Towards more empirical evaluations of the impact of OR interventions in healthcare.","authors":"Guillaume Lamé, Sonya Crowe, Matthew Barclay","doi":"10.1080/20476965.2020.1857663","DOIUrl":"10.1080/20476965.2020.1857663","url":null,"abstract":"<p><p>Despite an increasing number of papers reporting applications of operational research (OR) to problems in healthcare, there remains little empirical evidence of OR improving healthcare delivery in practice. Without such evidence it is harder both to justify the usefulness of OR to a healthcare audience and to learn and continuously improve our approaches. To progress, we need to build the evidence-base on whether and how OR improves healthcare delivery through careful empirical evaluation. This position paper reviews evaluation standards in healthcare improvement research and dispels some common myths about evaluation. It highlights the current lack of robust evaluation of healthcare OR and makes the case for addressing this. It then proposes possible ways for building better empirical evaluations of OR interventions in healthcare.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756482","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}
Health SystemsPub Date : 2020-11-28eCollection Date: 2022-01-01DOI: 10.1080/20476965.2020.1848355
Mohd Shoaib, Utkarsh Prabhakar, Sumit Mahlawat, Varun Ramamohan
{"title":"A discrete-event simulation model of the kidney transplantation system in Rajasthan, India.","authors":"Mohd Shoaib, Utkarsh Prabhakar, Sumit Mahlawat, Varun Ramamohan","doi":"10.1080/20476965.2020.1848355","DOIUrl":"https://doi.org/10.1080/20476965.2020.1848355","url":null,"abstract":"<p><p>We present a discrete-event simulation model of the kidney transplantation system in an Indian state, Rajasthan. Organs are generated across the state based on the organ donation rate among the general population, and are allocated to patients on the kidney transplantation waitlist. The organ allocation algorithm is developed using official guidelines published for kidney transplantation, and model parameters were estimated using publicly available data to the extent possible. Transplantation outcomes generated by the model include: (a) the probabilities of a patient receiving an organ within one to 5 years of registration and (b) the average number of deaths per year due to lack of donated organs. Simulation experiments involving observing the effect of increasing the organ arrival rate and establishing additional transplantation centres on transplantation outcomes are also conducted. We also demonstrate the use of such a model to optimally locate additional transplantation centres using simulation optimisation methods.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2020.1848355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756480","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}
Health SystemsPub Date : 2020-11-26eCollection Date: 2022-01-01DOI: 10.1080/20476965.2020.1848357
Maartje Zonderland, Jos Bekkers, Jasper van Bommel, Maarten Ter Horst, Wouter van Leeuwen, Femke van den Wall Bake, Willem Wiegersma, Ad Bogers
{"title":"Increasing cardio-thoracic productivity at Erasmus MC.","authors":"Maartje Zonderland, Jos Bekkers, Jasper van Bommel, Maarten Ter Horst, Wouter van Leeuwen, Femke van den Wall Bake, Willem Wiegersma, Ad Bogers","doi":"10.1080/20476965.2020.1848357","DOIUrl":"https://doi.org/10.1080/20476965.2020.1848357","url":null,"abstract":"<p><p>The Thoraxcenter of Erasmus MC started an improvement project in 2015 in order to increase the number of open-heart surgeries by 150 for three consecutive years (450 in total, +46%), and to decrease the access time from 12-14 to 2-3 weeks by the end of 2016. This was required to attain economy of scale in a highly competitive market. In this paper we describe the first year of the project, focusing on its structure and interventions taken, resulting in 165 additional open-heart surgeries carried out in 2016 and a significantly shorter access time of 2-3 weeks.</p>","PeriodicalId":44699,"journal":{"name":"Health Systems","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20476965.2020.1848357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756483","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}