IIE transactions on healthcare systems engineering最新文献_第3页

Operations research applications in hospital operations: Part I 运筹学在医院手术中的应用:第一部分

IIE transactions on healthcare systems engineering Pub Date : 2016-01-02 DOI: 10.1080/19488300.2015.1134727

T. Abe, B. Beamon, R. Storch, Justin Agus

{"title":"Operations research applications in hospital operations: Part I","authors":"T. Abe, B. Beamon, R. Storch, Justin Agus","doi":"10.1080/19488300.2015.1134727","DOIUrl":"https://doi.org/10.1080/19488300.2015.1134727","url":null,"abstract":"Abstract Hospital managers are tasked with developing innovative strategies to provide patients with quality healthcare in an effective and efficient manner. Variability within the healthcare delivery system can result in bottlenecks causing department overcrowding, increased staff workload, reduced quality of care, and patient and staff dissatisfaction (Helm et al., 2011). Operations research (OR) methods have been applied to hospital operations to improve effectiveness and efficiency. In this three-part article, we review OR applications in hospital environments. In particular, we develop a timeline of events in US healthcare from the late 1940s to 2015 and separate the timeline into four eras: Expansion, Cost Control, Reform, and Accountability. Part I of the article describes the Eras of Expansion and Cost Control, part II describes the Era of Reform, and part III describes the Era of Accountability. Research performed during each era is contextualized and stratified by OR method and hospital operations application area. The OR methods commonly applied to the hospital operations setting were deterministic; stochastic; discrete event simulation; and Monte Carlo simulation modeling methods. The article indicates the hospital operation areas for which these OR methods are applied and discusses how methods were used as the US healthcare system changed over time.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"6 1","pages":"42 - 54"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1134727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60569384","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}

引用次数: 10

When is an ounce of prevention worth a pound of cure? Identifying high-risk candidates for case management 什么时候一盎司的预防胜过十分的治疗?确定病例管理的高风险候选人

IIE transactions on healthcare systems engineering Pub Date : 2016-01-02 DOI: 10.1080/19488300.2015.1126874

David Anderson, M. Bjarnadóttir

{"title":"When is an ounce of prevention worth a pound of cure? Identifying high-risk candidates for case management","authors":"David Anderson, M. Bjarnadóttir","doi":"10.1080/19488300.2015.1126874","DOIUrl":"https://doi.org/10.1080/19488300.2015.1126874","url":null,"abstract":"ABSTRACT Case management is a $6 billion industry that employs over 34,000 people in the United States alone. Traditionally, case management has been utilized to help patients navigate the health care system and to coordinate care in the hope of lowering costs and achieving better health outcomes. However, since enrollment into these programs is typically either universal or limited to very sick patients, studies on the cost-effectiveness of case management programs find that their performance is mixed, at best. In this article we posit an opportunity to improve outcomes and lower costs by targeting certain patients for case management and early intervention. Utilizing modern data mining methods, we develop a methodology to identify these patients, who we describe as “jumpers” because their costs are currently low but will increase significantly in the near future. Given the performance of the prediction models, we also show that unless case management can prevent over 7.5% of health care cost increases, it may benefit enrolled members but will not reduce overall costs. The article then introduces a performance bounding methodology that characterizes the best obtainable prediction accuracy on a given data set. The derived upper bound demonstrates that searching for jumpers presents a far more challenging prediction problem than identifying future high-cost members, which is the traditional approach to selecting case management candidates.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"6 1","pages":"22 - 32"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1126874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60569609","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}

引用次数: 6

Measuring the effect of pay-for-performance financial incentives on hospital efficiency in the military health system 衡量军队卫生系统中按绩效付费财政激励对医院效率的影响

IIE transactions on healthcare systems engineering Pub Date : 2016-01-02 DOI: 10.1080/19488300.2015.1132488

Nathaniel D. Bastian, Hyojung Kang, P. Griffin, L. Fulton

引用次数: 11

Identification of readmission risk factors by analyzing the hospital-related state transitions of congestive heart failure (CHF) patients 通过分析充血性心力衰竭(CHF)患者的医院相关状态转变来确定再入院的危险因素

IIE transactions on healthcare systems engineering Pub Date : 2015-10-02 DOI: 10.1080/19488300.2015.1095823

Lior Turgeman, J. May, A. Ketterer, R. Sciulli, Dominic L. Vargas

{"title":"Identification of readmission risk factors by analyzing the hospital-related state transitions of congestive heart failure (CHF) patients","authors":"Lior Turgeman, J. May, A. Ketterer, R. Sciulli, Dominic L. Vargas","doi":"10.1080/19488300.2015.1095823","DOIUrl":"https://doi.org/10.1080/19488300.2015.1095823","url":null,"abstract":"The hospital length-of-stay (LOS), and the time between a discharge and the next admission, are important measures of healthcare utilization, and are generally positively skewed. We model the state transitions of CHF patients, using data from the Veterans Health Administration (VHA), by fitting a Coxian phase-type distribution to their LOS data, and extract the associated states in the latent Markov process. Selecting an appropriate number of phases helps to account for some heterogeneity among different LOS groups within the hospital, and provides a way to interpret each added covariate. By analyzing the strength of the connections among patient social, clinical, and historical characteristics within each group, the associated readmission risk may be estimated. For example, we found that groups with a greater LOS tended to have a greater proportion of patients from nursing home care. Nursing home care patients, who belong to the greater LOS group, tended to have a decreased readmission risk. Thus, by increasing the LOS of CHF patients whose characteristics lead to their inclusion into a nursing home group, or who enter the hospital from a nursing home, we might be able to reduce their risk of readmission.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"292 1","pages":"255 - 267"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1095823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60569174","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}

引用次数: 8

Configuring surgical instrument trays to reduce costs 配置手术器械托盘，降低成本

IIE transactions on healthcare systems engineering Pub Date : 2015-08-31 DOI: 10.1080/19488300.2015.1094759

G. Dobson, A. Seidmann, Vera Tilson, Anthony Froix

{"title":"Configuring surgical instrument trays to reduce costs","authors":"G. Dobson, A. Seidmann, Vera Tilson, Anthony Froix","doi":"10.1080/19488300.2015.1094759","DOIUrl":"https://doi.org/10.1080/19488300.2015.1094759","url":null,"abstract":"Most hospitals in the United States provide and manage significant inventories of durable surgical instruments used in operating rooms. The sheer volume and variety of instruments introduces considerable complexity in ensuring that the right instruments are available at the right time. Surgical instruments are usually stored and delivered to an operating room (OR) as procedure-specific sets of trays with multiple instruments included in a single tray. Because procedure trays are used by multiple surgeons trained at different institutions, procedure trays often include surgeon-specific instruments. Hospital materials managers and surgeons appear to weigh differently the various attributes of different tray configurations. Materials managers want to limit the cost of inventory and the variety of trays. Surgeons, on the other hand, prefer trays with the minimum number of unneeded instruments. Clearly, the kitting of surgical instruments into trays has many benefits, yet the actual tray design is a complex combinatorial problem. We propose a mathematical programming formulation to decide on the composition of trays to minimize the costs of owning, maintaining, and using both the trays and the instruments. We show that the optimal configuration depends not only on physician instrument preferences but also on the actual operating rooms’ schedules. This dependency implies that changing surgery schedules can have a significant impact on how trays should be configured. Our numerical experiments suggest that currently, hospital materials managers overestimate the cost of tray variety and underestimate the cost of re-processing the extra instruments in a tray. Using real-world hospital data, we demonstrate that optimizing trays can result in substantial cost savings for the hospital while increasing surgeons’ satisfaction. We introduce a fast heuristic algorithm for finding a near-optimal low-cost tray configuration given surgeons’ preferences and surgical schedules.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"5 1","pages":"225 - 237"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1094759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60567873","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}

引用次数: 29

Designing appointment system templates with operational performance targets 设计具有运营绩效目标的预约系统模板

IIE transactions on healthcare systems engineering Pub Date : 2015-07-03 DOI: 10.1080/19488300.2015.1060550

William P. Millhiser, Emre A. Veral

{"title":"Designing appointment system templates with operational performance targets","authors":"William P. Millhiser, Emre A. Veral","doi":"10.1080/19488300.2015.1060550","DOIUrl":"https://doi.org/10.1080/19488300.2015.1060550","url":null,"abstract":"We investigate characteristics of outpatient appointment templates that provide fair and controlled patient waiting experiences. Using an inverse-simulation application, we establish successive patients’ designated arrival times based on the previous patient’s finish time distribution and a universal targeted wait time set by the provider. This approach results in a template where each patient’s probability of waiting longer than a threshold duration is uniform across all patients. Through investigation of various no-show probabilities and service time distributions, we show that the template designs that achieve wait time uniformity across different patient and service environments have generalizable characteristics. Based on these characteristics, we proceed to design practitioner-oriented heuristics that create rounded interval times for implementation which yield robust performance outcomes. Results suggest that such schedules consist of appointment intervals that differ from average service times, moderated by patient show-rates and service time characteristics. In addition to introducing methods that allow patient “service level agreements,” our conclusions bring into question the advisability of double-booking, multiple-block scheduling, and yield management practices in appointment scheduling, and provide support for interval adjustment approaches that respond to patient service and no-show characteristics.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"5 1","pages":"125 - 146"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1060550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60567295","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}

引用次数: 20

A decision support system on surgical treatments for rotator cuff tears 肩袖撕裂手术治疗的决策支持系统

IIE transactions on healthcare systems engineering Pub Date : 2015-07-03 DOI: 10.1080/19488300.2015.1065935

Weihong Guo, Jionghua Jin, K. Paynabar, B. Miller, J. Carpenter

{"title":"A decision support system on surgical treatments for rotator cuff tears","authors":"Weihong Guo, Jionghua Jin, K. Paynabar, B. Miller, J. Carpenter","doi":"10.1080/19488300.2015.1065935","DOIUrl":"https://doi.org/10.1080/19488300.2015.1065935","url":null,"abstract":"Treatment of patients with rotator cuff tears usually starts with physical therapy, but some patients will still eventually need surgery. Ineffective physical therapy increases the time and cost of treatment and pain for patients. The quality of treatment can be improved if patients who will not respond to physical therapy are identified at an early stage. However, there is little research available to systematically help physicians make a timely decision on whether a surgical treatment is eventually needed or not. In this research, we developed a decision support system that can predict the probability of eventually needing a surgical treatment by effectively analyzing the available patients’ information at an early stage. Missing value imputation, variable selection, and classification methods are integrated in developing such a decision support system. The probability given by our model will either confirm physician's expert decision, or remind physician if there is any information ignored. This research has the potential to improve patient safety, reduce cost of unnecessary treatment, and help physicians prevent treatment errors.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"5 1","pages":"197 - 210"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1065935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60567724","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}

引用次数: 4

Modeling the effect of instrument drift in clinical laboratories: A serum bilirubin assay case study 模拟仪器漂移对临床实验室的影响:血清胆红素测定的案例研究

IIE transactions on healthcare systems engineering Pub Date : 2015-07-03 DOI: 10.1080/19488300.2015.1060551

V. Ramamohan, Jim Abbott, G. Klee, Yuehwern Yih

{"title":"Modeling the effect of instrument drift in clinical laboratories: A serum bilirubin assay case study","authors":"V. Ramamohan, Jim Abbott, G. Klee, Yuehwern Yih","doi":"10.1080/19488300.2015.1060551","DOIUrl":"https://doi.org/10.1080/19488300.2015.1060551","url":null,"abstract":"Clinical laboratory tests play a vital role in the medical decision making process, including diagnosis, prognostic assessment and drug dosage prescription. Drift or degradation in the performance of the analytic instrument over time can have a significant effect on the uncertainty of the clinical laboratory measurement test result. In this paper, we model the drift in the analytic instrumentation used to perform the laboratory tests, and estimate its effect on the uncertainty of the measurement result. This is accomplished developing a physics-based mathematical model of the total bilirubin laboratory test that describes the measurement result as a function of various sources of uncertainty operating within the total bilirubin measurement process. The Monte Carlo method is used to estimate the uncertainty associated with this model. Drift in the instrument is modeled as affecting both the mean (inaccuracy) and the standard deviation (imprecision) of each source of uncertainty. Further, recalibrating the instrument is postulated as a method to nullify the effect of instrument drift on inaccuracy of the measurement result, and the model is used to estimate the average time interval between successive calibrations such that the drift does not exceed clinically significant total error limits and prevents misdiagnosis.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"5 1","pages":"147 - 164"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1060551","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60567496","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}

引用次数: 1

Multi-level preventive care for Type 2 diabetes 2型糖尿病的多层次预防保健

IIE transactions on healthcare systems engineering Pub Date : 2015-07-03 DOI: 10.1080/19488300.2015.1060552

K. Aral, S. Chick, Alfons Grabosch

{"title":"Multi-level preventive care for Type 2 diabetes","authors":"K. Aral, S. Chick, Alfons Grabosch","doi":"10.1080/19488300.2015.1060552","DOIUrl":"https://doi.org/10.1080/19488300.2015.1060552","url":null,"abstract":"Type 2 Diabetes Mellitus (T2DM) accounts for 4.6 million deaths globally and for 11% of the global health expenditure (IDF, 2012). Several different primary, secondary, and tertiary preventive interventions promise better health outcomes and cost savings. Such interventions are typically studied in isolation. This paper proposes a compartmental mathematical model for T2DM that comprehends the interactions of multiple preventive interventions for various stages of T2DM, population dynamics, and the ensuing levels of clinical indicators, costs and utilities of disease states. We use the model to optimize portfolios of interventions for a multi-level preventive care program (using data from a population with high T2DM prevalence such as the UAE) and give insights about different ways in which interventions can be beneficial (such as for screening or for averting new cases). We demonstrate that the cost effectiveness with a classical discounted net present value perspective does not imply cost effectiveness for long-run planning, and that joint optimization of a portfolio of interventions can have benefits relative to the sequential optimization of interventions individually. Thus, accounting for long-run demographics and the interaction of interventions may be a useful extension to traditional cost-utility analyses when designing preventive care policies.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"5 1","pages":"165 - 182"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1060552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60567545","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}

引用次数: 1

Alarm fatigue and its influence on staff performance 报警疲劳及其对员工绩效的影响

IIE transactions on healthcare systems engineering Pub Date : 2015-07-03 DOI: 10.1080/19488300.2015.1062065

S. Deb, David Claudio

{"title":"Alarm fatigue and its influence on staff performance","authors":"S. Deb, David Claudio","doi":"10.1080/19488300.2015.1062065","DOIUrl":"https://doi.org/10.1080/19488300.2015.1062065","url":null,"abstract":"An alarm is a warning of an approaching situation which requires a response. The Emergency Care Research Institute considered alarm hazard as the number one health technology hazard for the years 2012 through 2014. In response, The Joint Commission set a standard for all hospitals in the United States to assess alarm fatigue in their monitoring process and to develop a systematic, coordinated approach to clinical alarm system management. In order to comply with this requirement, a working definition of alarm fatigue is necessary. This observational study undertook the objective of defining alarm fatigue, measuring it and exploring its role in performance deterioration. A conceptual model was developed considering the significance of working conditions and staff individuality on alarm fatigue and, consequently, alarm fatigue on staff performance. The results show that in general, performance deterioration is actually influenced by a combination of alarm fatigue, working conditions and staff individuality. In fact, in the case of nurses and response time, alarm fatigue plays no role, only working conditions and staff individuality. These findings suggest that the role of alarm fatigue as a health hazard in the clinical environment should be reevaluated.","PeriodicalId":89563,"journal":{"name":"IIE transactions on healthcare systems engineering","volume":"675 1","pages":"183 - 196"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/19488300.2015.1062065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60568029","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}

引用次数: 48