Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1547348_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Muhammet Gul Author-X-Name-First: Muhammet Author-X-Name-Last: Gul Author-Name: Erkan Celik Author-X-Name-First: Erkan Author-X-Name-Last: Celik Title: An exhaustive review and analysis on applications of statistical forecasting in hospital emergency departments Abstract: Emergency departments (EDs) provide medical treatment for a broad spectrum of illnesses and injuries to patients who arrive at all hours of the day. The quality and efficient delivery of health care in EDs are associated with a number of factors, such as patient overall length of stay (LOS) and admission, prompt ambulance diversion, quick and accurate triage, nurse and physician assessment, diagnostic and laboratory services, consultations and treatment. One of the most important ways to plan the healthcare delivery efficiently is to make forecasts of ED processes. The aim this study is thus to provide an exhaustive review for ED stakeholders interested in applying forecasting methods to their ED processes. A categorisation, analysis and interpretation of 102 papers is performed for review. This exhaustive review provides an insight for researchers and practitioners about forecasting in EDs in terms of showing current state and potential areas for future attempts. Journal: Health Systems Pages: 263-284 Issue: 4 Volume: 9 Year: 2020 Month: 10 X-DOI: 10.1080/20476965.2018.1547348 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1547348 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:4:p:263-284 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1589390_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James Alvin Low Author-X-Name-First: James Alvin Author-X-Name-Last: Low Author-Name: Toh Hui Jin Author-X-Name-First: Toh Author-X-Name-Last: Hui Jin Author-Name: Laurence Tan Lean Chin Author-X-Name-First: Laurence Author-X-Name-Last: Tan Lean Chin Author-Name: Neha Agarwal Author-X-Name-First: Neha Author-X-Name-Last: Agarwal Author-Name: Goh Kim Huat Author-X-Name-First: Goh Author-X-Name-Last: Kim Huat Author-Name: Adrian Yeow Author-X-Name-First: Adrian Author-X-Name-Last: Yeow Author-Name: Christina Soh Author-X-Name-First: Christina Author-X-Name-Last: Soh Title: Cost analysis of implementing a telegeriatrics ecosystem with nursing homes: panel data analysis Abstract: Our study analyzed the economicimpact of a telegeriatrics programme on care of nursing homeresidents, from the healthcare system provider’s perspective. Thisis a retrospective, archival data analysis of multiple data sourcesin 4 nursing homes of Singapore from 2010 to 2015. Individualsadmitted to nursing homes and have undergone telemedicineconsultations (N=859) from 2010 to 2015 were recruited. Weconducted a cost analysis of the programme by reviewing pasthospital admissions’ and specialist outpatient clinic (SOC) visits’billing records, nurse training records, and key performanceindicators’ reports. A significant relationship was observed betweenteleconsultations and SOC visit cost (β1 = -83.366, p-value<0.01) and between teleconsultations and inpatient cost (β1 =-470.971, p-value <0.05). Remote video consultations could reduceunnecessary SOC visits and hospital admissions, and thereforelead to cost savings. Training of nursing home nurses couldtranslate to cost savings as a result of decreased ED transfers. Journal: Health Systems Pages: 285-292 Issue: 4 Volume: 9 Year: 2020 Month: 10 X-DOI: 10.1080/20476965.2019.1589390 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1589390 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:4:p:285-292 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1569481_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Douglas J. Morrice Author-X-Name-First: Douglas Author-X-Name-Last: J. Morrice Author-Name: Jonathan F. Bard Author-X-Name-First: Jonathan Author-X-Name-Last: F. Bard Author-Name: Karl M. Koenig Author-X-Name-First: Karl Author-X-Name-Last: M. Koenig Title: Designing and scheduling a multi-disciplinary integrated practice unit for patient-centred care Abstract: This paper presents the design and analysis of a newly proposed form of care delivery called an integrated practice unit (IPU) in which a multi-disciplinary team of providers and staff work together to cover the full care cycle for a given condition. In an IPU, the different providers circulate among the patients, according to the need for their expertise, while patients remain in a single location once they check-in. From the patient’s perspective, the benefits of such an arrangement should be self-evident. For payers and providers there will also be benefits as the fee-for-service market gives way to structured payments for each episode of care. Before setting up an IPU, it is necessary to gain an understanding of how available resources will limit patient flow and system performance. Treating resources such as providers, imaging equipment, and rooms parametrically, the primary goal of our work is to determine the number of patients that can be seen per day in an IPU while trying to constrain overtime, length of stay, and waiting time to best practice targets. Discrete-event simulation serves as our analytic tool.While we are involved in the design of a comprehensive suite of musculoskeletal IPUs, we illustrate our approach with an extensive computational study of one: a Lower Extremity Joint Pain IPU. Using the simulation methodology, we are not only able to determine the number of patients that can be scheduled for an in-clinic visit each day, but also the daily number of follow-up patients that can be served virtually through telemedicine with no additional resources and minimal impact on IPU performance. These results assisted the Department of Surgery at the Dell Medical School at The University of Texas in the optimal design of its first IPU, which opened in the fall of 2017. Journal: Health Systems Pages: 293-316 Issue: 4 Volume: 9 Year: 2020 Month: 10 X-DOI: 10.1080/20476965.2019.1569481 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1569481 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:4:p:293-316 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1581433_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Renata Konrad Author-X-Name-First: Renata Author-X-Name-Last: Konrad Author-Name: Wenchang Zhang Author-X-Name-First: Wenchang Author-X-Name-Last: Zhang Author-Name: Margrét Bjarndóttir Author-X-Name-First: Margrét Author-X-Name-Last: Bjarndóttir Author-Name: Ruben Proaño Author-X-Name-First: Ruben Author-X-Name-Last: Proaño Title: Key considerations when using health insurance claims data in advanced data analyses: an experience report Abstract: Health claims have become a popular source of data for healthcare analytics, with numerous applications ranging from disease burden estimation and policy evaluation to drug event detection and advanced predictive analytics. Independent of the application, a researcher utilising claims information will likely encounter challenges in using the data, which include dealing with several coding systems and coding irregularities. We highlight some of these challenges and approaches for successful analysis that may reduce implementation time and help in avoiding common pitfalls. We describe the experiences of a group of academic researchers in using an extensive seven-year repository of US medical and pharmaceutical claims data in a research study, and provide an overview of the challenges encountered with handling claims records for data analysis while sharing suggestions on how to address these challenges. To illustrate our experiences, we use the example of defining episodes of care for a bundled payment reimbursement system in the US context. Journal: Health Systems Pages: 317-325 Issue: 4 Volume: 9 Year: 2020 Month: 10 X-DOI: 10.1080/20476965.2019.1581433 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1581433 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:4:p:317-325 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1596338_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Reza Salehnejad Author-X-Name-First: Reza Author-X-Name-Last: Salehnejad Author-Name: Manhal Ali Author-X-Name-First: Manhal Author-X-Name-Last: Ali Author-Name: Nathan Proudlove Author-X-Name-First: Nathan Author-X-Name-Last: Proudlove Title: Combining regression trees and panel regression for exploring and testing the impact of complementary management practices on short-notice elective operation cancellation rates Abstract: Variation in the performance of providers across healthcare systems is pervasive. It is recognised as both a major concern and an opportunity for learning and improvement. Variation between providers is broadly considered to be due to management practices and contextual factors such as catchment-area demographics. However, there is little understanding of the ways in which these impact on performance and how they can be measured. We use recent developments in both regression trees and panel regression techniques to explore and then statistically test complementary alignments of management practices whilst taking into account contextual factors. We apply this to 5 years of NHS hospital trust data, examining performance on short-notice cancellation rates. We find that different alignments of management practices give rise to quite different short-notice cancellation rates between trusts, with some being substantially lower. Our research offers a data-driven approach for identifying optimal clusters of management practices. Journal: Health Systems Pages: 326-344 Issue: 4 Volume: 9 Year: 2020 Month: 10 X-DOI: 10.1080/20476965.2019.1596338 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1596338 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:4:p:326-344 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933304_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Maartje van de Vrugt Author-X-Name-First: Maartje Author-X-Name-Last: van de Vrugt Author-Name: Richard J. Boucherie Author-X-Name-First: Richard J. Author-X-Name-Last: Boucherie Author-Name: Tineke J. Smilde Author-X-Name-First: Tineke J. Author-X-Name-Last: Smilde Author-Name: Mathijn de Jong Author-X-Name-First: Mathijn Author-X-Name-Last: de Jong Author-Name: Maud Bessems Author-X-Name-First: Maud Author-X-Name-Last: Bessems Title: Rapid diagnoses at the breast center of Jeroen Bosch Hospital: a case study invoking queueing theory and discrete event simulation Abstract: When suspected tissue is discovered in a patient’s breast, swiftly available diagnostic test results are essential for medical and psychological reasons. The breast center of the Jeroen Bosch Hospital aims to comply with new Dutch standards to provide 90% of the patients an appointment within three working days, and to communicate the test results to 90% of the patients within a week. This case study reports on interventions based on a discrete time queueing model and discrete event simulation. The implemented interventions concern a new patient appointment schedule and an additional multi-disciplinary meeting, which significantly improve in both the appointment and diagnostics delay. Additionally, we propose a promising new patient schedule to further reduce patient waiting times and staff overtime and provide guidelines for how to achieve implementation of Operations Research methods in practice. Journal: Health Systems Pages: 77-89 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-016-0013-4 File-URL: http://hdl.handle.net/10.1057/s41306-016-0013-4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:77-89 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933305_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Linda Brafford Squiers Author-X-Name-First: Linda Brafford Author-X-Name-Last: Squiers Author-Name: Erik Augustson Author-X-Name-First: Erik Author-X-Name-Last: Augustson Author-Name: Derick Brown Author-X-Name-First: Derick Author-X-Name-Last: Brown Author-Name: Bridget Kelly Author-X-Name-First: Bridget Author-X-Name-Last: Kelly Author-Name: Brian Southwell Author-X-Name-First: Brian Author-X-Name-Last: Southwell Author-Name: Jill Dever Author-X-Name-First: Jill Author-X-Name-Last: Dever Author-Name: Suzanne Dolina Author-X-Name-First: Suzanne Author-X-Name-Last: Dolina Author-Name: Janice Tzeng Author-X-Name-First: Janice Author-X-Name-Last: Tzeng Author-Name: Sarah Parvanta Author-X-Name-First: Sarah Author-X-Name-Last: Parvanta Author-Name: Sidney Holt Author-X-Name-First: Sidney Author-X-Name-Last: Holt Author-Name: Amy Sanders Author-X-Name-First: Amy Author-X-Name-Last: Sanders Author-Name: Brittany Zulkiewicz Author-X-Name-First: Brittany Author-X-Name-Last: Zulkiewicz Author-Name: Yvonne Hunt Author-X-Name-First: Yvonne Author-X-Name-Last: Hunt Title: An experimental comparison of mobile texting programs to help young adults quit smoking Abstract: Text messaging interventions may offer promise for health systems, but we need more evidence. We investigated efficacy of three text messaging programs in helping smokers quit. Arm 1 had cessation assessment and quit date reminder messages. Arm 2 had Arm 1 messages plus quit date preparation messages. Arm 3 had Arm 1 and Arm 2 messages plus 6 weeks of post-quit date messaging. Smokers aged 18–29 interested in quitting were randomly assigned to a study arm. We surveyed participants at baseline, and at 3, 8, 20, and 32 weeks (n = 4,027). At 8 weeks, scores on psychological measures were higher in Arm 3 than in Arm 2 or Arm 1. Seven-day smoking abstinence was higher in Arms 3 and 2 than in Arm 1 after controlling for background and psychological measures. Arm 3 affected quitting the most, suggesting motivational text messages before, on, and after an individual’s quit date may increase quitting. Journal: Health Systems Pages: 1-14 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-016-0014-3 File-URL: http://hdl.handle.net/10.1057/s41306-016-0014-3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:1-14 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933306_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Richard S. Gearhart Author-X-Name-First: Richard S. Author-X-Name-Last: Gearhart Title: Non-parametric frontier estimation of health care efficiency among US states, 2002–2008 Abstract: This paper examines cross-state health care efficiency rankings using modern non-parametric estimators. Cross-state efficiency rankings are robust to minor modifications in the input–output combinations used for estimation. This paper finds that there is no clear relationship between health care efficiency rankings and per capita health care expenditures in that state in the models used for this paper, even though this is a key variable that policymakers target. It also finds that Massachusetts, in one dataset, has shown significant productivity improvement from 2005 to 2008, the time period during which its health care reform was launched. In a second dataset, from 2002 to 2007, productivity regressed in Massachusetts. This may hint that efficiency gains from structural health care reform can outweigh population behavioral inefficiencies from using the ER as a source of primary care with insurance coverage expansion. I also find that states that chose to expand Medicaid were less efficient, on average, than states that did not choose to expand Medicaid. Simple variable comparisons suggest that this is an artifact of the data and political decision making, rather than people migrating for Medicaid or productive inefficiency. Journal: Health Systems Pages: 15-32 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-016-0015-2 File-URL: http://hdl.handle.net/10.1057/s41306-016-0015-2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:15-32 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933307_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Eduardo Pérez Author-X-Name-First: Eduardo Author-X-Name-Last: Pérez Author-Name: Berkcan Uyan Author-X-Name-First: Berkcan Author-X-Name-Last: Uyan Author-Name: David P. Dzubay Author-X-Name-First: David P. Author-X-Name-Last: Dzubay Author-Name: Susan H. Fenton Author-X-Name-First: Susan H. Author-X-Name-Last: Fenton Title: Catheter-associated urinary tract infections: challenges and opportunities for the application of systems engineering Abstract: In the United States about 100,000 people die annually from healthcare-associated infections (HAIs). Catheter-associated urinary tract infections (CAUTI) are the second most common type of HAI in the US, accounting for about 15% of HAIs. CAUTIs pose a significant treat to patients, which consequences could be as minor as an extra day in the hospital or as serious as death. Although studies show that implementing best practices and educating healthcare workers can help prevent HAIs, CAUTI prevention continues to pose a challenge to healthcare quality. Therefore, decreasing CAUTI rates has been targeted as one of the focus areas for several healthcare national initiatives. This survey paper considers research published from 2004 to 2015 on risk factors associated with CAUTIs and current preventive interventions. The goal of the survey is to provide a comprehensive taxonomy that aggregates and compare studies on CAUTIs and to identify future research opportunities for the development of system interventions that can be used to manage CAUTIs. Journal: Health Systems Pages: 68-76 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-016-0017-0 File-URL: http://hdl.handle.net/10.1057/s41306-016-0017-0 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:68-76 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933308_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Alexander Budgett Author-X-Name-First: Alexander Author-X-Name-Last: Budgett Author-Name: Mohan Gopalakrishnan Author-X-Name-First: Mohan Author-X-Name-Last: Gopalakrishnan Author-Name: Eugene Schneller Author-X-Name-First: Eugene Author-X-Name-Last: Schneller Title: Procurement in public & private hospitals in Australia and Costa Rica – a comparative case study Abstract: This article summarizes exploratory research conducted on supply chain management practices in public hospital systems in the Australian State of Victoria and in Costa Rica. Victoria is the site of a clearly articulated (centralized) supply chain strategy as opposed to Costa Rica, where there is a strong presence of government procurement rules but no such articulated strategy. Importantly, both systems have mixed governance structures (public vs private) and had a willingness to share information pertaining to their purchasing practices. Relatively open-ended interviews, analyzed utilizing MAXQDA 11, allowed us to scrutinize the influence of public policy, supply chain integration, supply chain/clinician collaboration, value analysis teams and group purchasing. We found that centralization of procurement was prevalent in public hospitals in both countries, with more regional centralization in Victoria, Australia due to its size. Also, Private hospital systems are encouraged to take advantage of the centralized procurement policy of the government in both the countries. While standardization was achieved in both countries by better integrating procurement and information technology functions, collaboration between clinicians led to more standardization. Journal: Health Systems Pages: 56-67 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-016-0018-z File-URL: http://hdl.handle.net/10.1057/s41306-016-0018-z File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:56-67 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933309_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Srimathy Mohan Author-X-Name-First: Srimathy Author-X-Name-Last: Mohan Author-Name: Qing Li Author-X-Name-First: Qing Author-X-Name-Last: Li Author-Name: Mohan Gopalakrishnan Author-X-Name-First: Mohan Author-X-Name-Last: Gopalakrishnan Author-Name: John Fowler Author-X-Name-First: John Author-X-Name-Last: Fowler Author-Name: Antonios Printezis Author-X-Name-First: Antonios Author-X-Name-Last: Printezis Title: Improving the process efficiency of catheterization laboratories using simulation Abstract: As the size of the population suffering from cardiac problems increases, the number of catheterization procedures performed is growing rapidly. The high costs associated with catheterization laboratories (cath labs) make managing these resources a critical task that impacts the efficiency and operating costs of hospitals as well as the quality of care. This study describes a discrete event simulation model developed to analyze the various factors that affect utilization of cath labs at a 337-bed full-service hospital in Scottsdale Arizona and provide decision support for improving the efficiency of the cath lab operations. The simulation model helped evaluate the performance of the existing approach at the hospital and compare alternative policies to improve operational efficiency. We consider both operational and patient satisfaction metrics and illustrate the tradeoffs between the two. Our analysis recommends reducing the initial time allotted to each case from 120 to 90 min, including a 30-min lunch buffer and end of the day buffer to absorb any delays, and potentially rescheduling inpatients when emergent cases have to be scheduled or other cases are taking longer than anticipated. We also perform detailed parametric analysis to develop more generic recommendations. The facility under study implemented our recommendations and realized a 19% increase in utilization as well as a 71% decrease in overtime. Journal: Health Systems Pages: 41-55 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/s41306-017-0025-8 File-URL: http://hdl.handle.net/10.1057/s41306-017-0025-8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:41-55 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933310_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Eren Demir Author-X-Name-First: Eren Author-X-Name-Last: Demir Author-Name: Murat M Gunal Author-X-Name-First: Murat M Author-X-Name-Last: Gunal Author-Name: David Southern Author-X-Name-First: David Author-X-Name-Last: Southern Title: Demand and capacity modelling for acute services using discrete event simulation Abstract: Increasing demand for services in England with limited healthcare budget has put hospitals under immense pressure. Given that almost all National Health Service (NHS) hospitals have severe capacity constraints (beds and staff shortages), a decision support tool (DST) is developed for the management of a major NHS Trust in England. Acute activities are forecasted over a 5-year period broken down by age groups for 10 specialty areas. Our statistical models have produced forecast accuracies in the region of 90%. We then developed a discrete event simulation model capturing individual patient pathways until discharge (in accident and emergency, inpatient and outpatients), where arrivals are based on the forecasted activity outputting key performance metrics over a period of time, for example, future activity, bed occupancy rates, required bed capacity, theatre utilisations for electives and non-electives, clinic utilisations and diagnostic/treatment procedures. The DST allows Trusts to compare key performance metrics for thousands of different scenarios against their existing service (baseline). The power of DST is that hospital decision makers can make better decisions using the simulation model with plausible assumptions that are supported by statistically validated data. Journal: Health Systems Pages: 33-40 Issue: 1 Volume: 6 Year: 2017 Month: 3 X-DOI: 10.1057/hs.2016.1 File-URL: http://hdl.handle.net/10.1057/hs.2016.1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:1:p:33-40 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933248_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Aaron Baird Author-X-Name-First: Aaron Author-X-Name-Last: Baird Author-Name: T S Raghu Author-X-Name-First: T S Author-X-Name-Last: Raghu Author-Name: Frederick North Author-X-Name-First: Frederick Author-X-Name-Last: North Author-Name: Frederick Edwards Author-X-Name-First: Frederick Author-X-Name-Last: Edwards Title: When traditionally inseparable services are separated by technology: the case of patient portal features offered by primary care providers Abstract: Health-care services have traditionally been provided and consumed simultaneously, as exemplified by in-person patient visits to primary care providers (PCPs), where clinical assessment and treatment are provided and consumed face-to-face. Technological intermediation is changing this traditional assumption, however, as patient-centric technologies, such as patient portals, are creating service separation opportunities. While service separation facilitated by patient portals may bring welcome changes to access, efficiency, and clinical outcomes, usage of patient portals by health-care consumers remains low. Suboptimal demand-side usage of patient portals, especially at the primary care level, could have significant negative implications for patient-centered policy initiatives predicated on patient empowerment and engagement. This paper contributes to this important policy context by reporting findings from a study designed to assess patient perceptions associated with hypothetical patient portal features offered by PCPs and potential subsequent impacts to PCP loyalty and switching propensity. We find that patient portal features focused on back-office (clinical) self-service capabilities (such viewing health records or summaries from prior visits) are perceived positively by consumers, but, interestingly, clinical digital communication and collaboration features (such as online video consultations with physicians) do not have significant perception impacts. These findings suggest that patient portals may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively. Journal: Health Systems Pages: 143-158 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2013.13 File-URL: http://hdl.handle.net/10.1057/hs.2013.13 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:143-158 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933249_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Alan Boyd Author-X-Name-First: Alan Author-X-Name-Last: Boyd Author-Name: Naomi Chambers Author-X-Name-First: Naomi Author-X-Name-Last: Chambers Author-Name: Simon French Author-X-Name-First: Simon Author-X-Name-Last: French Author-Name: Duncan Shaw Author-X-Name-First: Duncan Author-X-Name-Last: Shaw Author-Name: Russell King Author-X-Name-First: Russell Author-X-Name-Last: King Author-Name: Alison Whitehead Author-X-Name-First: Alison Author-X-Name-Last: Whitehead Title: Emergency planning and management in health care: priority research topics Abstract: Many major incidents have significant impacts on people’s health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making. Journal: Health Systems Pages: 83-92 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2013.15 File-URL: http://hdl.handle.net/10.1057/hs.2013.15 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:83-92 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933250_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Christian M Sørup Author-X-Name-First: Christian M Author-X-Name-Last: Sørup Author-Name: Peter Jacobsen Author-X-Name-First: Peter Author-X-Name-Last: Jacobsen Title: Patient safety and satisfaction drivers in emergency departments re-visited – an empirical analysis using structural equation modeling Abstract: How can emergency department (ED) decision makers contribute to increase patient satisfaction rates? This question has been thoroughly investigated in many hospital departments but not so much in the ED, which has led to a number of untested hypotheses. Maximising value-added activities seen from a patient’s perspective has become an essential outcome in health care, meaning that the untested hypotheses are in need of quantitative testing. This study proposes an integrated framework in which four latent constructs reflecting principal aspects of patient care are tested. The four constructs are entitled safety and satisfaction, waiting time, information delivery, and infrastructure accordingly. As an empirical foundation, a recently published comprehensive survey in 11 Danish EDs is analysed in depth using structural equation modeling (SEM). Consulting the proposed framework, ED decision makers are provided with information of where to launch high-impact initiatives to enhance current satisfaction levels. Journal: Health Systems Pages: 105-116 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2013.16 File-URL: http://hdl.handle.net/10.1057/hs.2013.16 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:105-116 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933251_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Karen J Minyard Author-X-Name-First: Karen J Author-X-Name-Last: Minyard Author-Name: Rachel Ferencik Author-X-Name-First: Rachel Author-X-Name-Last: Ferencik Author-Name: Mary Ann Phillips Author-X-Name-First: Mary Author-X-Name-Last: Ann Phillips Author-Name: Chris Soderquist Author-X-Name-First: Chris Author-X-Name-Last: Soderquist Title: Using systems thinking in state health policymaking: an educational initiative Abstract: In response to limited examples of opportunities for state policymakers to learn about and productively discuss the difficult, adaptive challenges of our health system, the Georgia Health Policy Center developed an educational initiative that applies systems thinking to health policymaking. We created the Legislative Health Policy Certificate Program – an in-depth, multi-session series for lawmakers and their staff – concentrating on building systems thinking competencies and health content knowledge by applying a range of systems thinking tools: behavior over time graphs, stock and flow maps, and a system dynamics-based learning lab (a simulatable model of childhood obesity). Legislators were taught to approach policy issues from the big picture, consider changing dynamics, and explore higher-leverage interventions to address Georgia’s most intractable health challenges. Our aim was to determine how we could improve the policymaking process by providing a systems thinking-focused educational program for legislators. Over 3 years, the training program resulted in policymakers’ who are able to think more broadly about difficult health issues. The program has yielded valuable insights into the design and delivery of policymaker education that could be applied to various disciplines outside the legislative process. Journal: Health Systems Pages: 117-123 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2013.17 File-URL: http://hdl.handle.net/10.1057/hs.2013.17 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:117-123 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933252_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Carleigh B Krubiner Author-X-Name-First: Carleigh B Author-X-Name-Last: Krubiner Author-Name: Adnan A Hyder Author-X-Name-First: Adnan A Author-X-Name-Last: Hyder Title: A bioethical framework for health systems activity: a conceptual exploration applying ‘systems thinking’ Abstract: Recognizing that the health system is a complex and dynamic network of actors and activities, this paper seeks to push the field of bioethics to develop a more holistic approach from the health systems perspective. Expanding upon the work of existing public health frameworks and drawing upon concepts from related areas such as governance, human rights, and organizational ethics, our provisional list of ethical considerations for health systems fall under the following categories: Holism, Sustainability, Evidence & Effectiveness, Efficiency, Public Engagement & Transparency, Accountability & Feedback, Equity & Empowerment, Justice & Fairness, Responsiveness, Collaboration, and Quality. By outlining these key domains, we hope to stimulate global discussion and further development of an ethics framework that will help guide ongoing work to strengthen health systems. This will be particularly important for low- and middle-income countries where resources are highly constrained and health systems efforts have scaled-up dramatically in the past decade. Journal: Health Systems Pages: 124-135 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2014.1 File-URL: http://hdl.handle.net/10.1057/hs.2014.1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:124-135 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933253_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Oh Hong Choon Author-X-Name-First: Oh Hong Author-X-Name-Last: Choon Author-Name: Zhang Dali Author-X-Name-First: Zhang Author-X-Name-Last: Dali Author-Name: Phua Tien Beng Author-X-Name-First: Phua Tien Author-X-Name-Last: Beng Author-Name: Chow Peck Yoke Magdalene Author-X-Name-First: Chow Peck Yoke Author-X-Name-Last: Magdalene Title: Uncovering effective process improvement strategies in an emergency department using discrete event simulation Abstract: This study aimed to develop a discrete event simulation (DES) model that realistically represented the process flow of selected non-fever patients in Singapore General Hospital (SGH) Emergency Department (ED). This model was then to be employed to evaluate the impact of different operational strategies on two performance measures, namely, time to first consult (TFC) and turnaround time (TT) of patients at ED. The DES model is used to represent ED sub-processes, including screening, registration, triage, consultation, observation ward visits, procedure room processes, laboratory and diagnostic radiological testing. Upon validating the model by comparing its performance projection with historical data, it was then employed to evaluate effectiveness of several new operational strategies. In the validation, we use the data of ED patients from May 2011 to July 2011 to characterize the load, arrival and resource-utilization pattern of its patients. Medical records of randomly sampled patients from the same period were also reviewed to evaluate the utilization levels of laboratory, diagnostic radiological, observation ward resources among ED patients. On the basis of DES model projections, redeployment of doctors with their hourly availability matching patient arrival pattern would yield the best improvement among the evaluated operational strategies. The manpower redeployment strategy required no additional man-hour compared to baseline requirement. In addition, via numerical results for a set of potential operational strategies, we show that there exists ample room for improvement in TFC and TTs of selected non-fever patients at SGH ED. Journal: Health Systems Pages: 93-104 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2014.2 File-URL: http://hdl.handle.net/10.1057/hs.2014.2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:93-104 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933254_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Radhakrishnan Nagarajan Author-X-Name-First: Radhakrishnan Author-X-Name-Last: Nagarajan Author-Name: Shengfan Zhang Author-X-Name-First: Shengfan Author-X-Name-Last: Zhang Author-Name: Fay Cobb Payton Author-X-Name-First: Fay Author-X-Name-Last: Cobb Payton Author-Name: Suleiman Massarweh Author-X-Name-First: Suleiman Author-X-Name-Last: Massarweh Title: Inferring breast cancer concomitant diagnosis and comorbidities from the Nationwide Inpatient Sample using social network analysis Abstract: Breast cancer is a complex disease and may be accompanied by other multiple health conditions. The present study investigates associations between diagnosis codes in breast cancer patients using the Nationwide Inpatient Sample data. Concomitant diagnoses codes are identified by statistically significant associations between the diagnoses codes in a given breast cancer patient. These are subsequently represented in the form of a network (Breast Cancer Concomitant Diagnosis Network (BCCDN)). In contrast to more classical approaches, BCCDN provides system-level insights and convenient visualization reflected by the complex wiring patterns between the diagnoses codes. Social network analysis is used to investigate highly connected codes in the BCCDN network, and their variation across three different populations: (i) the deceased breast cancer population (ii) the elderly breast cancer population (age>65 years) and (iii) the adult breast cancer population (age <=65 years). BCCDNs were investigated across years 2005 and 2006 in order to identify associations that are robust to the stratified sampling and population heterogeneity as well as possible errors in documentation characteristic of observational healthcare data. The results presented validate known chronic comorbidities and their persistence across the deceased and elderly breast cancer population. They also provide novel associations and potential comorbidities in breast cancer patients that may warrant a more detailed investigation. Journal: Health Systems Pages: 136-142 Issue: 2 Volume: 3 Year: 2014 Month: 6 X-DOI: 10.1057/hs.2014.4 File-URL: http://hdl.handle.net/10.1057/hs.2014.4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:2:p:136-142 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1390056_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Murray J. Côté Author-X-Name-First: Murray J. Author-X-Name-Last: Côté Author-Name: Marlene A. Smith Author-X-Name-First: Marlene A. Author-X-Name-Last: Smith Title: Forecasting the demand for radiology services Abstract: Since the demand for health services is the key driver for virtually all of a health care organisation’s financial and operational activities, it is imperative that health care managers invest the time and effort to develop appropriate and accessible forecasting models for their facility’s services. In this article, we analyse and forecast the demand for radiology services at a large, tertiary hospital in Florida. We demonstrate that a comprehensive and accurate forecasting model can be constructed using well-known statistical techniques. We then use our model to illustrate how to provide decision support for radiology managers with respect to department staffing. The methodology we present is not limited to radiology services and we advocate for more routine and widespread use of demand forecasting throughout the health care delivery system. Journal: Health Systems Pages: 79-88 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2017.1390056 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1390056 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:79-88 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1404743_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: S. P. J. van Brummelen Author-X-Name-First: S. P. J. Author-X-Name-Last: van Brummelen Author-Name: N. M. van Dijk Author-X-Name-First: N. M. Author-X-Name-Last: van Dijk Author-Name: K. van den Hurk Author-X-Name-First: K. Author-X-Name-Last: van den Hurk Author-Name: W. L. de Kort Author-X-Name-First: W. L. Author-X-Name-Last: de Kort Title: Waiting time-based staff capacity and shift planning at blood collection sites Abstract: Sanquin, the organization responsible for blood collection in the Netherlands, aims to be donor-friendly. An important part of the perception of donor-friendliness is the experience of waiting times. At the same time, Sanquin needs to control the costs for blood collection. A significant step to shorten waiting times is to align walk-in arrivals, and staff capacity and shifts. We suggest a two-step procedure. First, we investigate two methods from queuing theory to compute the minimum number of staff members required for every half hour. Next, these minimum numbers of staff members will be used to determine optimal lengths and starting times of shifts with an Integer Linear Program. Finally, the practical implications of the method are shown with numerical results. These results show that the presented approach can bring significant savings while at the same time guaranteeing a waiting time-based service level for blood donors. Journal: Health Systems Pages: 89-99 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1057/s41306-017-0032-9 File-URL: http://hdl.handle.net/10.1057/s41306-017-0032-9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:89-99 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1404721_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Laquanda Leaven Author-X-Name-First: Laquanda Author-X-Name-Last: Leaven Author-Name: Xiuli Qu Author-X-Name-First: Xiuli Author-X-Name-Last: Qu Title: A two-stage stochastic programming model for phlebotomist scheduling in hospital laboratories Abstract: This paper introduces a two-stage stochastic integer linear programming model to improve phlebotomist scheduling in laboratory facilities of healthcare delivery systems. The model developed enables laboratory management to determine optimal scheduling policies that minimize work overload. The stochastic programming model considers the uncertainty associated with the blood collection demand in laboratory environments when optimizing phlebotomist scheduling. The paper presents an application of the model to a hospital laboratory in urban North Carolina as a case study discussing the implications for hospital laboratory management. Journal: Health Systems Pages: 100-110 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1057/s41306-017-0033-8 File-URL: http://hdl.handle.net/10.1057/s41306-017-0033-8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:100-110 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1390185_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nazanin Zinouri Author-X-Name-First: Nazanin Author-X-Name-Last: Zinouri Author-Name: Kevin M. Taaffe Author-X-Name-First: Kevin M. Author-X-Name-Last: Taaffe Author-Name: David M. Neyens Author-X-Name-First: David M. Author-X-Name-Last: Neyens Title: Modelling and forecasting daily surgical case volume using time series analysis Abstract: Hospitals and outpatient surgery centres are often plagued by a recurring staff management question: “How can we plan our nursing schedule weeks in advance, not knowing how many and when patients will require surgery?” Demand for surgery is driven by patient needs, physician constraints, and weekly or seasonal fluctuations. With all of these factors embedded into historical surgical volume, we use time series analysis methods to forecast daily surgical case volumes, which can be extremely valuable for estimating workload and labour expenses. Seasonal Autoregressive Integrated Moving Average (SARIMA) modelling is used to develop a statistical prediction model that provides short-term forecasts of daily surgical demand. We used data from a Level 1 Trauma Centre to build and evaluate the model. Our results suggest that the proposed SARIMA model can be useful for estimating surgical case volumes 2–4 weeks prior to the day of surgery, which can support robust and reliable staff schedules. Journal: Health Systems Pages: 111-119 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2017.1390185 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1390185 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:111-119 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1390635_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ofir Ben-Assuli Author-X-Name-First: Ofir Author-X-Name-Last: Ben-Assuli Author-Name: Rema Padman Author-X-Name-First: Rema Author-X-Name-Last: Padman Title: Analysing repeated hospital readmissions using data mining techniques Abstract: Few studies have examined how to identify future readmission of patients with a large number of repeat emergency department (ED) visits. We explore 30-day readmission risk prediction using Microsoft’s AZURE machine learning software and compare five classification methods: Logistic Regression, Boosted Decision Trees (BDTs), Support Vector Machine (SVM), Bayes Point Machine (BPM), and Two-Class Neural Network (TCNN). We predict the last readmission visit of frequent ED patients extracted from the electronic health records of their 8455 penultimate visits. The methods show differential improvement, with the BDT indicating marginally better AUC (area under the ROC curve) than logistic regression and BPM, followed by the TCNN and SVM. A comparison of BDT and Logistic Regression results for correct and incorrect classification highlights the similarities and differences in the significant predictors identified by each method. Future research may incorporate time-varying covariates to identify other longitudinal factors that can lead to readmission risk reduction. Journal: Health Systems Pages: 120-134 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2017.1390635 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1390635 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:120-134 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1397237_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Eric R. Swenson Author-X-Name-First: Eric R. Author-X-Name-Last: Swenson Author-Name: Nathaniel D. Bastian Author-X-Name-First: Nathaniel D. Author-X-Name-Last: Bastian Author-Name: Harriet B. Nembhard Author-X-Name-First: Harriet B. Author-X-Name-Last: Nembhard Author-Name: Charles M. Davis III Author-X-Name-First: Charles M. Author-X-Name-Last: Davis III Title: Reducing cost drivers in total joint arthroplasty: understanding patient readmission risk and supply cost Abstract: Introduction: Understanding and planning for the factors that impact supply cost and unplanned readmission risk for total joint arthroplasty (TJA) patients is helpful for hospitals at financial risk under bundled payments. Readmission and operating room supply costs are two of the biggest expenses. Methods: Logistic and linear regressions are used to measure the impacts of TJA patient attributes on readmission risk and supply costs, respectively. Results: Patients’ health market segment and the number/type of comorbidity impacts 30/90-day readmission rates. Surgeon implant preference and type of surgery impact supply costs. Discharge location and two of the five health market segments increase the odds of 30-day readmission. Arrhythmia and lymphoma are the primary comorbidities that impact the odds of readmission at 90 days. Conclusions: Preoperatively identifying TJA patients likely to have large supply costs and higher readmission risk allows hospitals to invest in low-cost interventions to reduce risk and improve healthcare value. Journal: Health Systems Pages: 135-147 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2017.1397237 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1397237 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:135-147 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1403675_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Corine Laan Author-X-Name-First: Corine Author-X-Name-Last: Laan Author-Name: Maartje van de Vrugt Author-X-Name-First: Maartje Author-X-Name-Last: van de Vrugt Author-Name: Jan Olsman Author-X-Name-First: Jan Author-X-Name-Last: Olsman Author-Name: Richard J. Boucherie Author-X-Name-First: Richard J. Author-X-Name-Last: Boucherie Title: Static and dynamic appointment scheduling to improve patient access time Abstract: Appointment schedules for outpatient clinics have great influence on efficiency and timely access to health care services. The number of new patients per week fluctuates, and capacity at the clinic varies because physicians have other obligations. However, most outpatient clinics use static appointment schedules, which reserve capacity for each patient type. In this paper, we aim to optimise appointment scheduling with respect to access time, taking fluctuating patient arrivals and unavailabilities of physicians into account. To this end, we formulate a stochastic mixed integer programming problem, and approximate its solution invoking two different approaches: (1) a mixed integer programming approach that results in a static appointment schedule, and (2) Markov decision theory, which results in a dynamic scheduling strategy. We apply the methodologies to a case study of the surgical outpatient clinic of the Jeroen Bosch Hospital. We evaluate the effectiveness and limitations of both approaches by discrete event simulation; it appears that allocating only 2% of the capacity flexibly already increases the performance of the clinic significantly. Journal: Health Systems Pages: 148-159 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2017.1403675 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1403675 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:148-159 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1510620_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: The Editors Title: Erratum Journal: Health Systems Pages: 160-160 Issue: 2 Volume: 7 Year: 2018 Month: 5 X-DOI: 10.1080/20476965.2018.1510620 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1510620 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:2:p:160-160 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933222_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Steve Gallivan Author-X-Name-First: Steve Author-X-Name-Last: Gallivan Author-Name: Sonya Crowe Author-X-Name-First: Sonya Author-X-Name-Last: Crowe Title: A stochastic model associated with paediatric heart transplantation Abstract: A child judged to need cardiac transplantation must wait until a suitable donor heart becomes available. There are criteria that must be satisfied for suitable donor hearts, which depend on the tissue type and body mass of the recipient and potential donor. Depending on the clinical status of the recipient, so-called ‘bridging’ therapy may be given which involves admitting the child to an intensive care unit in an effort to ensure that they survive long enough for a suitable donor heart to become available. Such bridging is both distressing for the child and parents and is also very resource intensive. It is useful to have an estimate of how long the child must wait before a suitably matched donor heart becomes available and the probability of death while waiting. A stochastic model has been devised to derive such estimates informed by graphical considerations. Journal: Health Systems Pages: 24-31 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.10 File-URL: http://hdl.handle.net/10.1057/hs.2012.10 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:24-31 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933223_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Adam J Hindle Author-X-Name-First: Adam J Author-X-Name-Last: Hindle Author-Name: Giles A Hindle Author-X-Name-First: Giles A Author-X-Name-Last: Hindle Author-Name: Tony Hindle Author-X-Name-First: Tony Author-X-Name-Last: Hindle Title: Geographical modelling of patient episode flows and hospital catchment populations: a case study in Northern Ireland Abstract: This paper describes the development of a decision support framework, which contributed to the strategic management of radical changes in hospital services in Northern Ireland. The approach employed geographical modelling to estimate patient episode flow effects between geographical areas and hospitals under different hospital configurations. Such effects are central to the evaluation of key strategic issues such as catchment population characteristics (and the funding of such), capacity planning and achievement of access/travel time targets. The approach is illustrated with an evaluation of a new-build hospital development in a region within the Province. With respect to the modelling of episode flows, this research has investigated proximity to the nearest ‘appropriate’ hospital as a primary explanatory factor determining hospital choice and has explored ways of defining and quantifying appropriateness. Journal: Health Systems Pages: 53-60 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.13 File-URL: http://hdl.handle.net/10.1057/hs.2012.13 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:53-60 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933224_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Gillian Mould Author-X-Name-First: Gillian Author-X-Name-Last: Mould Author-Name: John Bowers Author-X-Name-First: John Author-X-Name-Last: Bowers Author-Name: Colin Dewar Author-X-Name-First: Colin Author-X-Name-Last: Dewar Author-Name: Elizabeth McGugan Author-X-Name-First: Elizabeth Author-X-Name-Last: McGugan Title: Assessing the impact of systems modeling in the redesign of an Emergency Department Abstract: Systems modeling has been used to redesign care in the National Health Service in the United Kingdom. However, assessing the benefits of such modeling is problematic. This paper examines the impact of two complementary techniques, process mapping and simulation, in the redesign of Emergency Department (ED) systems. Using the example of one significant change prompted by systems modeling, the introduction of a new staff roster, the impact on patient-time in the ED is examined. Any assessment has to recognize the effect of changes in the environment, notably staff experience and volume of activity. Using a performance model that incorporates these variables, the main quantifiable impact of the new roster was identified as a reduction in the mean patient-time of 16 min, for the 87% of ED patients classified as minor. Attributing credit for any improvement requires care but systems modeling can provide valuable insights into the design of ED systems resulting in quantifiable improvements. Journal: Health Systems Pages: 3-10 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.15 File-URL: http://hdl.handle.net/10.1057/hs.2012.15 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:3-10 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933225_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Navonil Mustafee Author-X-Name-First: Navonil Author-X-Name-Last: Mustafee Author-Name: Korina Katsaliaki Author-X-Name-First: Korina Author-X-Name-Last: Katsaliaki Author-Name: Eberhard E Bischoff Author-X-Name-First: Eberhard E Author-X-Name-Last: Bischoff Author-Name: Michael D Williams Author-X-Name-First: Michael D Author-X-Name-Last: Williams Title: Proximity-based modelling of cross-contamination through agent-based simulation: a feasibility study Abstract: Proximity-based modelling methodology enables mathematical representation of a real system that is characterised by the existence of entities that come into physical contact. Healthcare systems can benefit from this methodology since physical proximity between entities (e.g., patients, clinical items like surgical equipment and blood units) can result in the spread of infectious diseases and cross-contamination. The existing analytical techniques, which are mainly based on differential equations, are unsuitable for representing the fine-grained, micro-world view of the entity interactions that we intend to model. We therefore extend Agent-Based Simulation (ABS) by enabling individual agents to be aware of the physical location of the other agents being modelled in a 3-dimensional space – this is a perquisite for our proximity-based modelling methodology. To demonstrate the feasibility of our approach, we experiment with a scenario wherein boxes of degradable clinical items, modelled as agents, are stored in close proximity. We use Cutting and Packing Optimisation (CPO) algorithms from literature to define the arrangement of these agents in the 3-D space and to make the individual agents ‘location-aware’. An ABS model then simulates cross-contamination by modelling the spread of contaminants among the agents confined in the well-defined space. Our approach can be used to model analogous situations wherein physical proximity between entities in the underlying system is a necessary condition for entity interactions. Journal: Health Systems Pages: 61-71 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.16 File-URL: http://hdl.handle.net/10.1057/hs.2012.16 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:61-71 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933226_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Janette McQuillan Author-X-Name-First: Janette Author-X-Name-Last: McQuillan Author-Name: Adele H Marshall Author-X-Name-First: Adele H Author-X-Name-Last: Marshall Author-Name: Karen J Cairns Author-X-Name-First: Karen J Author-X-Name-Last: Cairns Title: Assessing length of stay and associated characteristics of geriatric patients in Northern Ireland Abstract: The effective provision of care for the elderly is becoming increasingly more difficult. This is due to the rising proportion of elderly in the population, increasing demands placed on the health services and the financial strain placed on an already stretched economy. The research presented in this paper uses three different models to represent the length of stay distribution of geriatric patients admitted to one of the six key acute hospitals in Northern Ireland and various patient characteristics associated with their respective length of stay. The accurate modelling of bed usage within wards would enable hospital managers to prepare patient discharge packages and rehabilitation services in advance. The models presented within the paper include a Cox proportional hazards model, a Bayesian network with a discrete variable to represent length of stay and a special conditional phase-type model (C-Ph) with a connecting outcome node. This research demonstrates the new efficient fitting algorithm employed for Coxian phase-type distributions while updating C-Ph models for recent elderly patient data. Journal: Health Systems Pages: 32-42 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.19 File-URL: http://hdl.handle.net/10.1057/hs.2012.19 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:32-42 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933227_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Lene Berge Holm Author-X-Name-First: Lene Berge Author-X-Name-Last: Holm Author-Name: Fredrik A Dahl Author-X-Name-First: Fredrik A Author-X-Name-Last: Dahl Author-Name: Mathias Barra Author-X-Name-First: Mathias Author-X-Name-Last: Barra Title: Towards a multimethodology in health care – synergies between Soft Systems Methodology and Discrete Event Simulation Abstract: Multimethodology is the combination of methodologies, often from different paradigms. While methodologies from hard paradigms are rather positivist and treats the organizational world as objective, methodologies from soft paradigms are interpretivist by nature. Some argue that these paradigms are incommensurable and multimethodology is therefore a challenging research field. However, we believe this is possible within a pragmatic paradigm. In this article, a multimethodology combining Soft Systems Methodology (SSM) and Discrete Event Simulation (DES) is developed and tested at a Norwegian Hospital. The initial phases of the multimethodology anchored the project with the staff by basing the DES-model on their narratives. This phase also revealed real-world mechanisms vital to the DES-modelling. During later SSM-steps, the DES-model was used to detect possible areas of improvement. Our findings were well received by the hospital. Our work shows how soft and hard methodologies yield synergies when they are carefully brought together in a pragmatic fashion. Journal: Health Systems Pages: 11-23 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.21 File-URL: http://hdl.handle.net/10.1057/hs.2012.21 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:11-23 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933228_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Elizabeth L Rowse Author-X-Name-First: Elizabeth L Author-X-Name-Last: Rowse Author-Name: Paul R Harper Author-X-Name-First: Paul R Author-X-Name-Last: Harper Author-Name: Janet E Williams Author-X-Name-First: Janet E Author-X-Name-Last: Williams Author-Name: Mark Smithies Author-X-Name-First: Mark Author-X-Name-Last: Smithies Title: Optimising the use of resources within the district nursing service: a case study Abstract: Recent statements from the U.K. government indicate that future provision of services within the National Health Service will involve the transition of care from hospitals into the community. District nurses play an important role in caring for housebound patients while alleviating some pressure on other primary care services. An increase in the number and complexity of patients’ needs treated within the community, coupled with the predicted decline in the number of district nurses poses a potential supply and demand problem. Working closely with a district nursing service in Wales, the optimal size and skill mix of district nursing teams to meet patient demand is investigated. A two-stage model is developed that uses Monte Carlo simulation to generate patient demand and Linear Programming to find an optimal team composition that meets this patient demand at minimum cost. Results suggest significant cost savings if district nursing teams are restructured using this approach. Journal: Health Systems Pages: 43-52 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.22 File-URL: http://hdl.handle.net/10.1057/hs.2012.22 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:43-52 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933229_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Vincent Knight Author-X-Name-First: Vincent Author-X-Name-Last: Knight Author-Name: Janet Williams Author-X-Name-First: Janet Author-X-Name-Last: Williams Title: Editorial Journal: Health Systems Pages: 1-2 Issue: 1 Volume: 2 Year: 2013 Month: 3 X-DOI: 10.1057/hs.2012.23 File-URL: http://hdl.handle.net/10.1057/hs.2012.23 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:1:p:1-2 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1473944_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Matt Wimble Author-X-Name-First: Matt Author-X-Name-Last: Wimble Author-Name: Gondy Leroy Author-X-Name-First: Gondy Author-X-Name-Last: Leroy Title: Health information technology: promise and progress Abstract: Healthcare costs have risen faster than the rate of inflation for decades. The resulting resource constrains have placed substantial burden on organizations, governments, and societies. While the problem is most prominent in the United States, it is a substantial problem all over the world as populations age. Health information technology holds great promise at helping to alleviate these problems. In this commentary, we use the lens of health economics to outline how health IT holds the potential reduce of some these inefficiencies, highlight the progress that has been made, and provide a framework to connect the lessons learned in health economics with the current efforts in health IT. We discuss ideas at the population, organizational, and individual levels. To this end, we highlight the papers in this special issue which deal with both organizational level healthcare deliver issues and individual-level self-care. Journal: Health Systems Pages: 161-165 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2018.1473944 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1473944 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:161-165 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1510040_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ofir Ben-Assuli Author-X-Name-First: Ofir Author-X-Name-Last: Ben-Assuli Author-Name: Rema Padman Author-X-Name-First: Rema Author-X-Name-Last: Padman Title: Analysing repeated hospital readmissions using data mining techniques Abstract: Few studies have examined how to identify future readmission of patients with a large number of repeat emergency department (ED) visits. We explore 30-day readmission risk prediction using Microsoft’s AZURE machine learning software and compare five classification methods: Logistic Regression, Boosted Decision Trees (BDTs), Support Vector Machine (SVM), Bayes Point Machine (BPM), and Two-Class Neural Network (TCNN). We predict the last readmission visit of frequent ED patients extracted from the electronic health records of their 8455 penultimate visits. The methods show differential improvement, with the BDT indicating marginally better AUC (area under the ROC curve) than logistic regression and BPM, followed by the TCNN and SVM. A comparison of BDT and Logistic Regression results for correct and incorrect classification highlights the similarities and differences in the significant predictors identified by each method. Future research may incorporate time-varying covariates to identify other longitudinal factors that can lead to readmission risk reduction. Journal: Health Systems Pages: 166-180 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2018.1510040 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1510040 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:166-180 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1405875_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sumate Permwonguswa Author-X-Name-First: Sumate Author-X-Name-Last: Permwonguswa Author-Name: Jiban Khuntia Author-X-Name-First: Jiban Author-X-Name-Last: Khuntia Author-Name: Dobin Yim Author-X-Name-First: Dobin Author-X-Name-Last: Yim Author-Name: Dawn Gregg Author-X-Name-First: Dawn Author-X-Name-Last: Gregg Author-Name: Abhishek Kathuria Author-X-Name-First: Abhishek Author-X-Name-Last: Kathuria Title: Knowledge sharing in a health infomediary: role of self-concept, emotional empowerment, and self-esteem Abstract: Health infomediary systems are emerging as important knowledge sharing platforms that help patients manage their own health outside of traditional health care delivery models. Patients participate in health infomediaries to learn from other patients’ experiences and knowledge. Knowledge sharing is an important aspect of the success of a health infomediary. Factors related to self-concept have been widely studied in the domains of psychiatry and psychology, in settings such as mental health and behavioural well-being, but remain unexplored in the digital health context. In particular, it is not known how self-concept influences knowledge sharing behaviours in health infomediaries. This study posits that self-efficacy, social identity, and self-stigma drive knowledge sharing in an infomediary through emotional empowerment and appearance-contingent self-esteem. We use the health belief model as a foundation to propose a two-stage model and testable hypotheses. We used secondary archival data of 222 patients participating in a health infomediary specialising in reconstructive surgery. Analyses using structural equation modelling and econometric methods support the hypotheses. Findings broadly suggest that there are distinct paths through emotional empowerment and appearance-contingent self-esteem that can motivate users to contribute knowledge in health infomediaries. We explain the managerial insights and contributions of our study. Journal: Health Systems Pages: 181-194 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2017.1405875 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1405875 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:181-194 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1405876_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Steven Mertens Author-X-Name-First: Steven Author-X-Name-Last: Mertens Author-Name: Frederik Gailly Author-X-Name-First: Frederik Author-X-Name-Last: Gailly Author-Name: Geert Poels Author-X-Name-First: Geert Author-X-Name-Last: Poels Title: Discovering health-care processes using DeciClareMiner Abstract: Flexible, human-centric and knowledge-intensive processes occur in many service industries and are prominent in the health-care sector. Knowledge workers (e.g., doctors or other health-care personnel) are given the flexibility to address each process instance (i.e., episode of care) in the way that they deem most suitable. As a result, the knowledge of these processes is generally of a tacit nature, with many stakeholders lacking a clear view of a process. In this paper, we propose an algorithm called DeciClareMiner that combines process and decision mining to extract a process model and the corresponding knowledge from past executions of these processes. The algorithm was evaluated by applying it to a realistic health-care case and comparing the results to a complete search benchmark. In a relatively short time (10 min), DeciClareMiner was able to produce a DeciClare model that represents 93% of episodes of care with atomic constraints. Compared to the 50 h required to calculate the 100%-episode model via an exhaustive search approach, our result is considered a major improvement. Journal: Health Systems Pages: 195-211 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2017.1405876 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1405876 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:195-211 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1397238_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Varun Jain Author-X-Name-First: Varun Author-X-Name-Last: Jain Author-Name: Usha Mohan Author-X-Name-First: Usha Author-X-Name-Last: Mohan Title: A simulation-based neighbourhood search algorithm to schedule multi-category patients at a multi-facility health care diagnostic centre Abstract: A key operational decision faced by a multi-facility health care diagnostic centre serving different patient categories (for example: Health Check-up Patient (HCP), Out-Patient (OP), Emergency Patient (EP), or In-Patient) is whom to serve next at a particular facility. In this paper, we model random arrival of these patients belonging to different categories and priorities at multiple diagnostic facilities over a finite planning horizon. We formulate a mathematical model for sequential decision-making under uncertainty using Markov Decision Process (MDP) with the objective of maximising net revenue and use dynamic programming (DP) to solve it. To address dimensionality and scalability issue of MDP, we provide a decentralised MDP (D_MDP) formulation. We develop simulation-based neighbourhood search algorithm to improve DP solution for D_MDP. We compare these solutions with three other rule-based heuristics using simulation. Journal: Health Systems Pages: 212-229 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2017.1397238 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1397238 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:212-229 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1403674_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Victoria Mabin Author-X-Name-First: Victoria Author-X-Name-Last: Mabin Author-Name: Julie Yee Author-X-Name-First: Julie Author-X-Name-Last: Yee Author-Name: Sally Babington Author-X-Name-First: Sally Author-X-Name-Last: Babington Author-Name: Vanessa Caldwell Author-X-Name-First: Vanessa Author-X-Name-Last: Caldwell Author-Name: Robyn Moore Author-X-Name-First: Robyn Author-X-Name-Last: Moore Title: Using the Theory of Constraints to resolve long-standing resource and service issues in a large public hospital Abstract: Public health care providers typically struggle with the need to meet demand for services, within a limited budget. This paper describes an analysis of a large public hospital, using the Theory of Constraints’ (TOC) comprehensive set of mapping tools to logically represent a problematic situation and investigate options for resolution. Based on the symptoms present, root causes and conflicts were identified, along with potential solutions. Further TOC tools were used to check for possible side effects of the solution, and identify obstacles that might impede successful implementation. Based on the TOC analysis, a trial project was implemented with significant benefits for two departments. Outcomes included dramatically reduced patient wait times and staff overtime, increased patient satisfaction, increased efficiencies, smoothed workload, and improved staff morale and retention, while maintaining patient safety and integrity of treatment, and staying within defined cost parameters. Journal: Health Systems Pages: 230-249 Issue: 3 Volume: 7 Year: 2018 Month: 9 X-DOI: 10.1080/20476965.2017.1403674 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1403674 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:3:p:230-249 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933255_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: William V Padula Author-X-Name-First: William V Author-X-Name-Last: Padula Author-Name: Michael P Duffy Author-X-Name-First: Michael P Author-X-Name-Last: Duffy Author-Name: Taygan Yilmaz Author-X-Name-First: Taygan Author-X-Name-Last: Yilmaz Author-Name: Manish K Mishra Author-X-Name-First: Manish K Author-X-Name-Last: Mishra Title: Integrating systems engineering practice with health-care delivery Abstract: Health-care delivery is a complex and fragmented system with work-around culture. Improving health-care delivery requires innovating system interventions that redesign processes for consistent implementation of evidence-based practices (EBPs). Systems engineering is an approach that involves anticipating ineffective processes that jeopardize quality, and designing interventions to overcome such shortcomings. This approach is based on systems teaching about reflexivity, which when addressed can support consistent EBP and assesses how the newly designed system meets this consistency. Integrating a systems engineering approach to implementing EBP may effectively address complex issues such as hospital-acquired pressure ulcer prevention, which has an EBP protocol that is not consistently implemented without system redesign. Engineering approaches and methods including Plan-Do-Study-Act (PDSA), Situation-Background-Assessment-Recommendations (SBAR), stochastic modeling, House of Quality, and statistical process control charts with lean six sigma provide a structured approach to identifying points of successful implementation for EBPs that can subvert work-around culture. This perspective piece reviews successful approaches of systems engineering to solve the problem of clinical work-arounds and puts forward the case for its wider application to health-care delivery systems that could benefit from standardized EBPs. Journal: Health Systems Pages: 159-164 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.3 File-URL: http://hdl.handle.net/10.1057/hs.2014.3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:159-164 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933256_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Lauren M Aquino Shluzas Author-X-Name-First: Lauren M Author-X-Name-Last: Aquino Shluzas Author-Name: Ruth C Cronkite Author-X-Name-First: Ruth C Author-X-Name-Last: Cronkite Author-Name: Dallas Chambers Author-X-Name-First: Dallas Author-X-Name-Last: Chambers Author-Name: Brian B Hoffman Author-X-Name-First: Brian B Author-X-Name-Last: Hoffman Author-Name: James Breeling Author-X-Name-First: James Author-X-Name-Last: Breeling Author-Name: Mark A Musen Author-X-Name-First: Mark A Author-X-Name-Last: Musen Author-Name: Douglas K Owens Author-X-Name-First: Douglas K Author-X-Name-Last: Owens Author-Name: Mary K Goldstein Author-X-Name-First: Mary K Author-X-Name-Last: Goldstein Title: Organizational factors affecting implementation of the ATHENA-Hypertension clinical decision support system during the VA’s nation-wide information technology restructuring: a case study Abstract: This case study documents organizational factors that affected implementation of the ATHENA-Hypertension (ATHENA-HTN) clinical decision support system (CDSS) at five medical centers within the U.S. Department of Veterans Affairs (VA). The ATHENA-HTN implementation occurred during a system-wide reorganization of the VA’s Office of Information & Technology (OI&T) to a centralized information technology (IT) system with heightened security. Guided by a logic-model framework, we used template analysis and grounded methods to identify barriers and enablers to the ATHENA-HTN implementation process. Implementation barriers included limited autonomy within a centralized reporting structure, permissions issues for remote computer access, and uncertainty regarding standardized procedures. Strategies to overcome these barriers included garnering support from clinical and IT leadership, validating data with physicians at local medical centers, and establishing IT communication channels. The findings from this study provide insights for the implementation of CDSS within integrated healthcare networks, particularly during periods of IT restructuring and organizational change. Journal: Health Systems Pages: 214-234 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.5 File-URL: http://hdl.handle.net/10.1057/hs.2014.5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:214-234 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933257_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James E Stahl Author-X-Name-First: James E Author-X-Name-Last: Stahl Author-Name: Mark A Drew Author-X-Name-First: Mark A Author-X-Name-Last: Drew Author-Name: Alexandra B Kimball Author-X-Name-First: Alexandra B Author-X-Name-Last: Kimball Title: Real-time location systems, normative messaging and modifying clinician behavior: a pilot study Abstract: Modifying physician behavior is challenging. Normative feedback may offer an opportunity. In this pilot study, we explore whether normative feedback on workflow behavior can modify clinician behavior. In the two study clinics, clinicians and patients wore real-time location system tags during the workday to measure face time, wait time and flow time. For 6 months, individuals could identify the performance of themselves, their peers and their clinic. Overall variability in face time, wait time and flow time decreased significantly across all groups, except for minority and attending clinicians where face time and flow time increased in duration and variability. Our pilot study suggests that providing normative feedback on workflow is potentially an effective way of modifying clinician practice behavior. Journal: Health Systems Pages: 165-172 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.6 File-URL: http://hdl.handle.net/10.1057/hs.2014.6 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:165-172 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933258_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Luu Trong Tuan Author-X-Name-First: Luu Trong Author-X-Name-Last: Tuan Title: Clinical governance initiative: a case of an obstetrics hospital Abstract: The aim of this empirical inquiry is to decode the levels to which clinical governance initiative elevates emotional intelligence, ethics of care, and knowledge transfer. A longitudinal case research was conducted over 8 months since May 2011. Hospital document collection, field observations, and in-depth interviews contributed to data collection. Through content analysis, research data was coded into patterns of relationships between constructs. The results revealed that a clinical governance initiative, when effectively implemented, can act as a lever for transformations in emotional intelligence, ethics of care, and knowledge transfer. This research paints a landscaping of clinical governance effectiveness and its organizational outcomes such as emotional intelligence, ethics of care, and knowledge transfer in an obstetrics hospital. Journal: Health Systems Pages: 173-184 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.7 File-URL: http://hdl.handle.net/10.1057/hs.2014.7 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:173-184 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933259_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Marco Marabelli Author-X-Name-First: Marco Author-X-Name-Last: Marabelli Author-Name: Sue Newell Author-X-Name-First: Sue Author-X-Name-Last: Newell Author-Name: Chantal Krantz Author-X-Name-First: Chantal Author-X-Name-Last: Krantz Author-Name: Jacky Swan Author-X-Name-First: Jacky Author-X-Name-Last: Swan Title: Knowledge sharing and health-care coordination: the role of creation and use brokers Abstract: This paper arises from research that examined a health-care coordination improvement initiative that was focused on increasing knowledge sharing among a network of health-care workers involved in the care of children with complex medical needs. Part of this initiative involved a summary medical note (the Single Point of Care (SPOC)) that was paper-based and carried by parents between the specialists involved in their child’s care. The SPOC’s effectiveness is discussed through a knowledge-as-practice perspective, which focuses on the role of mediators (both material and human). Our analysis demonstrates that the SPOC’s effectiveness can be understood by looking at the combined roles of boundary objects and human brokers. We identify two distinct broker roles: creation brokers and use brokers. In discussing our case, we extend our analysis to suggest how these broker roles may also be useful in thinking about how to improve the effectiveness of (electronic) health record systems more generally – for researchers as well as for practitioners. Journal: Health Systems Pages: 185-198 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.8 File-URL: http://hdl.handle.net/10.1057/hs.2014.8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:185-198 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933260_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Kon Shing Kenneth Chung Author-X-Name-First: Kon Shing Author-X-Name-Last: Kenneth Chung Author-Name: Jane Young Author-X-Name-First: Jane Author-X-Name-Last: Young Author-Name: Kate White Author-X-Name-First: Kate Author-X-Name-Last: White Title: Using social network-based complexity profiles to understand attitudes to medical care Abstract: Aggregate complexity deals with how individual elements (within a system – e.g., social system) work harmoniously and holistically to create systems with complex behaviour. Here, we develop an aggregate complexity framework (ACF) based on social network measures of density (the extent of connected ties or relationships within a social network) and inclusiveness (the extent of connected actors (e.g., doctors & specialists) within a social network) to capture ‘degree of interrelatedness’ of the social system. Using this with the number of actors within one’s professional network, it is possible to characterize one’s network with a complexity profile (ranging from ‘simple’, ‘complicated’, ‘relatively complex’ to ‘complex’), which is then associated with attitudes to medical care. Results from a sample data set of 109 rural general practitioners (GP) in New South Wales, Australia show that GPs with a ‘simple’ profile score lower on attitudes to medical care compared with those with ‘non-simple’ profiles. Journal: Health Systems Pages: 199-213 Issue: 3 Volume: 3 Year: 2014 Month: 11 X-DOI: 10.1057/hs.2014.9 File-URL: http://hdl.handle.net/10.1057/hs.2014.9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:3:p:199-213 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2085190_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: John Mourmouris Author-X-Name-First: John Author-X-Name-Last: Mourmouris Author-Name: Thomas Poufinas Author-X-Name-First: Thomas Author-X-Name-Last: Poufinas Title: Multi-criteria decision-making methods applied in health-insurance underwriting Abstract: This study attempts to structure methodologically the health insurance underwriting process by applying Multi-criteria Decision-making (MCDM) analysis in health insurance underwriting. This is done by assigning a score to each health insurance applicant which can be used to determine whether he or she is accepted, rejected or accepted with special terms and conditions (such as exclusions, additional waiting periods and/ or surcharge). The introduction of MCDM approaches in health insurance underwriting enables the quantification of the selection criteria, the increased standardization and automation of the process and its alignment through quantitative indicators with the risk tolerance/ risk appetite of the insurer, and there lie the novelties of this research. The proposed methodology can be readily implemented by insurers with added value in the underwriting, risk management and distribution (sales & marketing) functions, as well as in the profitability of the company or the level of premium paid by the insured. Journal: Health Systems Pages: 52-84 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2022.2085190 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2085190 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:52-84 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2162445_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Elisabetta Ronchieri Author-X-Name-First: Elisabetta Author-X-Name-Last: Ronchieri Author-Name: Marco Canaparo Author-X-Name-First: Marco Author-X-Name-Last: Canaparo Title: Assessing the impact of software quality models in healthcare software systems Abstract: Health and medical care are safety-critical environments. The development of a safe and reliable healthcare software system is one of the most important processes which may affect the accuracy of clinical decision making and have an impact on determining diagnoses of and treatment for diseases. The aim of this study is to assess if software quality models, such as McCall, can have an impact on healthcare software quality for the purpose of reducing software failures. We have identified the main criticalities of healthcare software systems based on existing literature, software quality models and programming language standards; we have related these criticalities to software characteristics; we have analysed the relationship between the main criticalities of healthcare software systems and their software characteristics. The following criticalities - the risk of changing hard-coded software and the importance of developing maintainable software – must be addressed at the start of the software development process. Journal: Health Systems Pages: 85-97 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2022.2162445 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2162445 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:85-97 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2062460_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Julie Babyar Author-X-Name-First: Julie Author-X-Name-Last: Babyar Title: Trade, intellectual property, and the public health bearing Abstract: The objective of this article is to describe the current fracture between global trade and public health priorities, as well as examine opportunities for harmonisation. A literature review of public health, global trade, and intellectual property articles describes several issues with recommendations. Currently, there is mixed quality of research and a lack of health impact assessments to accompany the global trade agenda. Human rights concepts continue in debate as flexibilities to trade laws remain without organised surveillance or evaluation. There are specific, relevant recommendations to implement a trade agenda inclusive of public health leadership. Recent trade and intellctual property advances in public health collaborations should be supported and continued. Trade groups should produce impact assessments before decisions on policies are made, with quality to the research. Lastly, a global research and development treaty should be an open, accessed path. Journal: Health Systems Pages: 123-132 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2022.2062460 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2062460 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:123-132 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2113343_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Arun Rai Author-X-Name-First: Arun Author-X-Name-Last: Rai Author-Name: Mark Keil Author-X-Name-First: Mark Author-X-Name-Last: Keil Author-Name: Hyoungyong Choi Author-X-Name-First: Hyoungyong Author-X-Name-Last: Choi Author-Name: Vitali Mindel Author-X-Name-First: Vitali Author-X-Name-Last: Mindel Title: Understanding how physician perceptions of job demand and process benefits evolve during CPOE implementation Abstract: We examine how physicians’ perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians’ response to CPOE implementation. Journal: Health Systems Pages: 98-122 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2022.2113343 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2113343 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:98-122 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1983476_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sally Brailsford Author-X-Name-First: Sally Author-X-Name-Last: Brailsford Author-Name: Steffen Bayer Author-X-Name-First: Steffen Author-X-Name-Last: Bayer Author-Name: Con Connell Author-X-Name-First: Con Author-X-Name-Last: Connell Author-Name: Abraham George Author-X-Name-First: Abraham Author-X-Name-Last: George Author-Name: Jonathan Klein Author-X-Name-First: Jonathan Author-X-Name-Last: Klein Author-Name: Peter Lacey Author-X-Name-First: Peter Author-X-Name-Last: Lacey Title: Embedding OR modelling as decision support in health capacity planning: insights from an evaluation Abstract: Literature reviews over five decades have reported the paucity of examples of OR methods being routinely used to support decision-making in health and social care. This paper presents insights from an independent evaluation of a project intended to overcome some of the barriers to implementation by establishing a “community of practice” in Kent (England). The project itself was undertaken by practitioners, and had two main aims: providing training in system dynamics modelling to analysts, and making senior managers aware of the benefits of modelling. The findings largely confirmed previous studies, but also raised issues about style of training delivery and selection of problems to be modelled. Project leaders fully understood the barriers to embedding OR modelling skills, and made considerable efforts to avoid them, but nevertheless the main barrier, pressures on people’s time, remained an obstacle. The paper concludes with general reflections and advice. Journal: Health Systems Pages: 22-35 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2021.1983476 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1983476 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:22-35 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2018362_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Maria Van Zyl-Cillié Author-X-Name-First: Maria Author-X-Name-Last: Van Zyl-Cillié Author-Name: Derya Demirtas Author-X-Name-First: Derya Author-X-Name-Last: Demirtas Author-Name: Erwin Hans Author-X-Name-First: Erwin Author-X-Name-Last: Hans Title: Wait!What does that mean?: Eliminating ambiguity of delays in healthcare from an OR/MS perspective Abstract: Waiting time in healthcare is a significant problem that occurs across the world and often has catastrophic effects. There are various terms used for waiting time (“sojourn”, “throughput” etc.) and there is no consensus on how these terms are defined. Ambiguous definitions of waiting time make it difficult to compare and measure the problems related to waiting times and delays in healthcare. We present a systematic search and review of the Operations Research and Management Science (ORMS) literature on delays in healthcare services. We search for articles from 2004 to 2019 and base our search strategy on a well-known healthcare planning and control decision taxonomy. An important step towards reducing the ambiguity in the definitions is to distinguish between access time and waiting time. We provide clear definitions and examples of access time and waiting time, and we classify our search results according to three categories: article type, healthcare service investigated and ORMS technique used to solve the delay problem. We find that half of the ORMS research on the waiting and access time problem is done on Ambulatory Care services. We provide tables for each healthcare service that highlight key definitions, the techniques that are used most often and the healthcare environment where the research is done. This research highlights the significant ORMS research that is done on access and waiting time in healthcare as well as the remaining research opportunities. Moreover, it provides a common language for the ORMS community to solve critical waiting time issues in healthcare. Journal: Health Systems Pages: 3-21 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2021.2018362 File-URL: http://hdl.handle.net/10.1080/20476965.2021.2018362 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:3-21 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1992300_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Catherine Decouttere Author-X-Name-First: Catherine Author-X-Name-Last: Decouttere Author-Name: Nico Vandaele Author-X-Name-First: Nico Author-X-Name-Last: Vandaele Author-Name: Kim De Boeck Author-X-Name-First: Kim Author-X-Name-Last: De Boeck Author-Name: Stany Banzimana Author-X-Name-First: Stany Author-X-Name-Last: Banzimana Title: A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms Abstract: Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system’s (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design. Journal: Health Systems Pages: 36-51 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2021.1992300 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1992300 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:36-51 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2180173_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Samir Chatterjee Author-X-Name-First: Samir Author-X-Name-Last: Chatterjee Author-Name: Kathy Kotiadis Author-X-Name-First: Kathy Author-X-Name-Last: Kotiadis Author-Name: Daniel Gartner Author-X-Name-First: Daniel Author-X-Name-Last: Gartner Title: A new vision and direction for Health Systems Journal: Health Systems Pages: 1-2 Issue: 1 Volume: 12 Year: 2023 Month: 01 X-DOI: 10.1080/20476965.2023.2180173 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2180173 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:1:p:1-2 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1966323_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Dinesh R. Pai Author-X-Name-First: Dinesh R. Author-X-Name-Last: Pai Author-Name: Hengameh M. Hosseini Author-X-Name-First: Hengameh M. Author-X-Name-Last: Hosseini Author-Name: Stephen R. Rosito Author-X-Name-First: Stephen R. Author-X-Name-Last: Rosito Title: Determining the relative risk of hospitalisation and surgery of fall injury patients Abstract: Falls are one of the most common cause of nonfatal and fatal injuries in the U.S. costing over an estimated $54 billion annually. A significant percentage of patients presenting to hospital emergency departments (ED) for falls are hospitalised. This paper analyzes a regional hospital data pertaining to adults presenting to the ED because of falls. We use patient demographics and medical conditions to help identify patients at risk for immediate undesirable outcomes after a fall. Furthermore, we determine the relative risk of patient hospitalisation and surgery and their characteristics. Our results indicate that older patient’s, patients arriving by ambulance, patients with higher severity levels and patients with pre-existing comorbidities were at a higher relative risk of hospitalisation and surgery. Furthermore, patients with medical conditions pertaining to femur and tibia fractures, pelvis, renal failure, ambulatory dysfunction, and cellulitis, among others, and non-Hispanic whites were at a much higher relative risk of hospitalisation and surgery. Journal: Health Systems Pages: 288-302 Issue: 4 Volume: 11 Year: 2022 Month: 10 X-DOI: 10.1080/20476965.2021.1966323 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1966323 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:4:p:288-302 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1936658_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jia Guo Author-X-Name-First: Jia Author-X-Name-Last: Guo Author-Name: Jonathan F. Bard Author-X-Name-First: Jonathan Author-X-Name-Last: F. Bard Author-Name: Douglas J. Morrice Author-X-Name-First: Douglas Author-X-Name-Last: J. Morrice Author-Name: Carlos R. Jaén Author-X-Name-First: Carlos R. Author-X-Name-Last: Jaén Author-Name: Ramin Poursani Author-X-Name-First: Ramin Author-X-Name-Last: Poursani Title: Offering transportation services to economically disadvantaged patients at a family health center: a case study Abstract: It has been established that high no-show rates of publicly supported health systems in economically depressed areas are largely due to a lack of inexpensive, reliable transportation. The purpose of this paper is to determine the financial feasibility of offering transportation and investigate the net cost savings by reducing no-show rates. The approach starts with a data analysis on 636 patients at the Family Health Center (FHC) in San Antonio, Texas, followed by logistic regression to determine the impact of various transportation factors on cancellations/no-shows and late arrivals. We then investigate the costs savings that could be realised by reducing the no-show rate from 24.3% by up to 60%. Finally, we analyse the expenses that would be incurred should the FHC provide transportation. The full analysis indicates a cost reduction of more than $15,000 per month can be achieved when the no-show rate is reduced by 25% down to 18.2%. Journal: Health Systems Pages: 251-275 Issue: 4 Volume: 11 Year: 2022 Month: 10 X-DOI: 10.1080/20476965.2021.1936658 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1936658 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:4:p:251-275 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1966324_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Tawseef Ayoub Shaikh Author-X-Name-First: Tawseef Ayoub Author-X-Name-Last: Shaikh Author-Name: Rashid Ali Author-X-Name-First: Rashid Author-X-Name-Last: Ali Title: An automated machine learning tool for breast cancer diagnosis for healthcare professionals Abstract: The paper proposes a hybrid metaheuristic algorithm known as harmony search and simulated annealing (HS-SA) for accurate and precise breast malignancy disclosure by integrating harmony search (HS) and simulated annealing (SA) optimisation methods. An enhanced wavelet-based contourlet transform (WBCT) procedure for mining the highlights of the region of interest (ROI) is explored, that allows execution upgradation over other standard procedures. The anticipated HS-SA algorithm aims to reduce the feature dimensions and assemble at the unparalleled optimal feature subset. The SVM classifier fed with the picke.d feature subsets and assisted by varied kernel functions upheld its classification capacities in contrast with the conformist machine learning classification and optimisation methods. The portrayed computer-aided diagnosis (CAD) model is confronted by evaluating its learning capability on two different breast mammographic datasets i) benchmark BCDR-F03 dataset and ii) local mammographic dataset. Preliminary propagations, experimental outcomes, and quantifiable assessments likewise demonstrate that the proposed model is pragmatic and favourable for the automated breast malignancy findings with optimal performance and fewer overheads. The discoveries show that the proposed CAD system (HS-SA+Kernel SVM) is superior to various characterisation accuracy techniques with an accuracy of 99.89% for the local mammographic dataset and 99.76% for benchmark BCDR-F03 dataset, AUC of 99.41% for the local mammographic dataset and 99.21% for reference BCDR-F03 dataset while keeping the element space restricted to only seven feature subsets and computational prerequisites as low as is judicious. Journal: Health Systems Pages: 303-333 Issue: 4 Volume: 11 Year: 2022 Month: 10 X-DOI: 10.1080/20476965.2021.1966324 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1966324 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:4:p:303-333 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1943010_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jacob Wing Author-X-Name-First: Jacob Author-X-Name-Last: Wing Author-Name: Peter Vanberkel Author-X-Name-First: Peter Author-X-Name-Last: Vanberkel Title: Simulation optimisation for mixing scheduled and walk-in patients Abstract: Mixed registration type clinics accept both walk-in and scheduled patients. Such clinics provide patients with an additional option for how they access care while patient bookings help providers ensure a full workday. The model described in this paper determines how many patients to schedule (and when) in mixed registration type clinics. The methodology, simulation optimisation allows stochastic features found in such clinic to be modelled and provides optimisation techniques to identify solutions. A general simulation optimisation formulation for mixed registration type clinics is presented. Furthermore, the methodology is applied to a case study of a collaborative emergency centre in Nova Scotia, Canada. We demonstrate how the model can be used in clinics with multiple providers and multiple objectives. We compare the simulation optimisation generated schedule with existing schedules and show the advantages the collaborative emergency centre can expect when using schedules developed with the presented methods. Journal: Health Systems Pages: 276-287 Issue: 4 Volume: 11 Year: 2022 Month: 10 X-DOI: 10.1080/20476965.2021.1943010 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1943010 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:4:p:276-287 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933319_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nikky Kortbeek Author-X-Name-First: Nikky Author-X-Name-Last: Kortbeek Author-Name: M. F. van der Velde Author-X-Name-First: M. F. Author-X-Name-Last: van der Velde Author-Name: N. Litvak Author-X-Name-First: N. Author-X-Name-Last: Litvak Title: Organizing multidisciplinary care for children with neuromuscular diseases at the Academic Medical Center, Amsterdam Abstract: The Academic Medical Center (AMC) in Amsterdam, The Netherlands, recently opened the ‘Children’s Muscle Center Amsterdam’ (CMCA). The CMCA diagnoses and treats children with neuromuscular diseases. The patients with such diseases require care from a variety of clinicians. Through the establishment of the CMCA, children and their parents will generally visit the hospital only once a year, while previously they used to visit on average six times a year. This is a major improvement, because the hospital visits are both physically and psychologically demanding for the patients. This paper describes how quantitative modelling supports the design and operations of the CMCA. First, an integer linear program is presented that selects which patients are to be invited for a treatment day and schedules the required combination of consultations, examinations and treatments on one day. Second, the integer linear program is used as input to a simulation study to estimate the capacity of the CMCA, expressed in terms of the distribution of the number patients that can be seen on one diagnosis day. Finally, a queueing model is formulated to predict the access time distributions based upon the simulation outcomes under various demand scenarios. Its contribution on the case under study is twofold. First, we design highly constrained appointment schedules for multiple patients that require service from multiple disciplines’ resources. Second, we study the effect of the trade-offs between scheduling constraints and access times. As such, the contribution of this case study paper is that it illustrates the value of applying Operations Research techniques in complex healthcare settings, by designing context-specific combinations of mathematical models, thereby improving delivery of the highly-constrained multidisciplinary care. Journal: Health Systems Pages: 209-225 Issue: 3 Volume: 6 Year: 2017 Month: 11 X-DOI: 10.1057/s41306-016-0020-5 File-URL: http://hdl.handle.net/10.1057/s41306-016-0020-5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:3:p:209-225 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933320_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Shikha Gupta Author-X-Name-First: Shikha Author-X-Name-Last: Gupta Title: Awareness and utilization of Rashtriya Swasthaya Bima Yojana and its implications for access to health care by the poor in slum areas of Delhi Abstract: Rashtriya Swasthya Bima Yojana (RSBY), a national flagship health insurance scheme of India, was launched in 2008 with an aim to improve access to cashless inpatient care for the families below poverty line. Delhi being the national capital of India was one of the first states where this scheme was implemented. The objectives of this study were to find out the awareness of the scheme among the enrolled families, utilization of its services, and the extent to which RSBY provided cost-free access to inpatient care to its enrolled beneficiaries. A mixed method study was conducted in ten slum areas of East and North East Delhi. Data were collected through the household survey with 120 families having RSBY cards (service recipients) and qualitative interviews with 30 professionals responsible for managing various aspects of the RSBY program. Quantitative data were analysed using statistical package of social sciences (SPSS) whereas thematic analysis was done for qualitative data. The findings suggest that RSBY benefitted only 20% of the families among the total sample. It appeared that families who were relatively more aware about the range of benefits and operational mechanisms of the scheme were able to utilize its benefits as compared to others who were not. However, the families who utilized or tried to utilize the RSBY benefits were not satisfied with the scheme and faced many problems while accessing hospital care through RSBY. They faced refusals for the treatment by RSBY empaneled hospitals, demands for extra money, and poor quality treatment provided to them. These situations forced few families to approach another public or private hospitals in case of illness and incur significant out-of-pocket expenditure on emergency health care despite having RSBY insurance coverage. The data obtained through the interviews illuminated the challenges associated with the implementation of RSBY from service provider’s perspective. The study recommends that if RSBY scheme aspires to cover the entire Indian poor population under its umbrella of risk protection, the government should adopt rigorous administrative mechanisms with robust monitoring and evaluation systems at different levels to ensure quality and timely healthcare is provided to the beneficiaries. Journal: Health Systems Pages: 242-259 Issue: 3 Volume: 6 Year: 2017 Month: 11 X-DOI: 10.1057/s41306-017-0022-y File-URL: http://hdl.handle.net/10.1057/s41306-017-0022-y File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:3:p:242-259 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933321_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Melanie Reuter-Oppermann Author-X-Name-First: Melanie Author-X-Name-Last: Reuter-Oppermann Author-Name: Pieter L. van den Berg Author-X-Name-First: Pieter L. Author-X-Name-Last: van den Berg Author-Name: Julie L. Vile Author-X-Name-First: Julie L. Author-X-Name-Last: Vile Title: Logistics for Emergency Medical Service systems Abstract: Emergency Medical Service (EMS) systems worldwide are complex systems, characterized by significant variation in service providers, care pathways, patient case-mix and quality care indicators. Analysing and improving them is therefore challenging. Since EMS systems differ between countries, it is difficult to provide generic rules and approaches for EMS planning. Nevertheless, the common goal for all service providers is to offer medical assistance to patients with serious injuries or illnesses as quickly as possible. This paper presents an overview of logistical problems arising for EMS providers, demonstrating how some of these problems are related and intertwined. For each individual planning problem, a description as well as a concise literature overview of solution approaches considered is given. A summary table classifies the literature according to the problems addressed and connects it to the proposed taxonomy. Journal: Health Systems Pages: 187-208 Issue: 3 Volume: 6 Year: 2017 Month: 11 X-DOI: 10.1057/s41306-017-0023-x File-URL: http://hdl.handle.net/10.1057/s41306-017-0023-x File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:3:p:187-208 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933322_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sajid Haider Author-X-Name-First: Sajid Author-X-Name-Last: Haider Author-Name: Antonio Fernandez-Ortiz Author-X-Name-First: Antonio Author-X-Name-Last: Fernandez-Ortiz Author-Name: Carmen de Pablos Heredero Author-X-Name-First: Carmen Author-X-Name-Last: de Pablos Heredero Title: Organizational citizenship behavior and implementation of evidence-based practice: Moderating role of senior management’s support Abstract: This study sought to empirically examine the link between OCB and EBP implementation, and tested senior management’s support as a moderator of this relationship. A cross-sectional survey design was used. Data were based on the survey of participants’ perceptions of the study variables. The participants were professionals involved in the treatment of acute myocardial infarction at five hospitals in Madrid Community of Spain. Hypothetico-deductive method was applied, and partial least squares structural equation modeling (PLS-SEM) was used for data analysis. The relationship between OCB and EBP implementation was supported. A significant moderating effect was also found, which indicates that with an increase in senior management’s support OCBs become more important for explaining their effect on EBP implementation. The findings of this research are promising to organizations and agencies that take into account the importance of implementing EBP. This research provides conditions valuable to successful use of EBP. Especially, where senior management interacts positively with other variables such as OCB, the likelihood of EBP implementation and its effectiveness may increase. An improvement in these factors and their interaction is liable to guide an improved continuity in healthcare resulting from positive organizational ethos. Journal: Health Systems Pages: 226-241 Issue: 3 Volume: 6 Year: 2017 Month: 11 X-DOI: 10.1057/s41306-017-0026-7 File-URL: http://hdl.handle.net/10.1057/s41306-017-0026-7 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:3:p:226-241 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933323_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Michael Emes Author-X-Name-First: Michael Author-X-Name-Last: Emes Author-Name: Stella Smith Author-X-Name-First: Stella Author-X-Name-Last: Smith Author-Name: Suzanne Ward Author-X-Name-First: Suzanne Author-X-Name-Last: Ward Author-Name: Alan Smith Author-X-Name-First: Alan Author-X-Name-Last: Smith Author-Name: Timothy Ming Author-X-Name-First: Timothy Author-X-Name-Last: Ming Title: Care and Flow: Using Soft Systems Methodology to understand tensions in the patient discharge process Abstract: Many hospitals face a daily struggle to manage capacity, especially where wards contain patients with a combination of health and social care needs. In this study, Soft Systems Methodology was used to understand the process of discharging patients from an acute hospital and to answer the question ‘Why do patients with complex needs often spend longer on the wards than is necessary?’. Through a series of twenty structured interviews, several problems with the discharge planning process were identified. Problems included ineffective communication, slow processing of paperwork, limited forward planning, no clear ownership of the process and delays in finding care in the community. The persistence of these problems despite longstanding guidance on discharge planning can be understood by recognising the tension between two different philosophies in hospitals – a traditional ‘Care’ mindset focusing on the immediate needs of patients on the wards, and a planning-focused ‘Flow’ mentality, where the hospital’s responsibility to the wider community dominates. Soft Systems Methodology was found to be an effective approach for discussing discharge planning and highlighting this tension. Based on the insights gained from the interviews, three practical initiatives have now been implemented to reconcile the tension and thereby reduce delays in the hospital. Journal: Health Systems Pages: 260-278 Issue: 3 Volume: 6 Year: 2017 Month: 11 X-DOI: 10.1057/s41306-017-0027-6 File-URL: http://hdl.handle.net/10.1057/s41306-017-0027-6 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:3:p:260-278 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933235_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mark Mellott Author-X-Name-First: Mark Author-X-Name-Last: Mellott Author-Name: Jason Bennett Thatcher Author-X-Name-First: Jason Bennett Author-X-Name-Last: Thatcher Author-Name: Nicholas Roberts Author-X-Name-First: Nicholas Author-X-Name-Last: Roberts Title: Electronic medical record compliance and continuity in delivery of care: an empirical investigation in a combat environment Abstract: Electronic medical records (EMRs) are central to continuity in delivery of care in a combat environment. Yet, despite their benefits, technological advances, and legislation mandating their use, EMRs are not widely diffused in the U.S. military. Several contextual factors, such as armed conflict, multiple layers of bureaucracy, inconsistent rotation schedules, and competing goals, contribute to the complexity and difficulty of EMR implementation in a combat environment. This study applies a principal–agent perspective to understand barriers to EMR policy compliance in the U.S. military. Using a unique data set collected over a 105-week period, we investigate the implementation and effect of monitoring and sanctions on EMR compliance in combat support hospitals. Our results show that monitoring and sanctions positively impact the rate of EMR completion, yet they have no effect on the rate of EMRs started. Our results have implications for research and policy on EMR compliance and implementation in vertically integrated healthcare systems. Journal: Health Systems Pages: 147-161 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.2 File-URL: http://hdl.handle.net/10.1057/hs.2013.2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:147-161 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933236_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Holly O Witteman Author-X-Name-First: Holly O Author-X-Name-Last: Witteman Author-Name: James E Stahl Author-X-Name-First: James E Author-X-Name-Last: Stahl Author-Name: Author-X-Name-First: Author-X-Name-Last: Title: Facilitating interdisciplinary collaboration to tackle complex problems in health care: report from an exploratory workshop Abstract: Complex problems in health care are complex issues that resist solution via traditional perspectives and are better tackled through interdisciplinary, systems-level approaches. Interdisciplinary approaches can be difficult to implement in assembled groups of health-care practitioners and researchers from diverse disciplines. We developed a set of four methods intended to explicitly facilitate interdisciplinary collaboration toward the end goal of solving complex problems in health care. This article describes the results of a workshop designed to explore these four methods: (1) deep dives, (2) an explicitly interdisciplinary framework of problem solving and problematizing, (3) exercises from improv theater, and (4) rapid sketching and visualization. Meeting attendees indicated that the workshop provided them with insights and new ways to facilitate interdisciplinary collaboration. These methods show promise for bridging disciplinary differences, opening possibilities for new perspectives, and encouraging more creative and disciplinary-spanning approaches to complex problems in health care. Journal: Health Systems Pages: 162-170 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.3 File-URL: http://hdl.handle.net/10.1057/hs.2013.3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:162-170 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933237_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Leili Lind Author-X-Name-First: Leili Author-X-Name-Last: Lind Author-Name: Daniel Karlsson Author-X-Name-First: Daniel Author-X-Name-Last: Karlsson Title: Electronic patient-reported symptom assessment in palliative end-of-life home care Abstract: Good symptom control in palliative end-of-life home care requires adequate access to patients’ symptom assessments. The aim of the study was to investigate the feasibility of an electronic symptom assessment reporting system to support symptom control. A randomised controlled study was performed during April 2008–December 2009. The intervention consisted of a networked digital-pen-based information system. The primary outcome measure chosen was the time span from the patient's reporting of a symptom to the care providers’ noticing this assessment. Patients with at least moderately severe symptoms were invited to participate in the study. Eighteen (11 intervention, seven control) patients from four home care centres participated, submitting a total of 330 symptom assessments. There was a significantly shorter median time span from reporting to noticing for assessments in the intervention group. The system used allowed both frequent and regular symptom reporting from patients that can contribute to more correct and prompt medical decisions in palliative end-of-life home care. Trial registration number: ISRCTN09750271. Journal: Health Systems Pages: 171-180 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.4 File-URL: http://hdl.handle.net/10.1057/hs.2013.4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:171-180 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933238_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Glenis J Crane Author-X-Name-First: Glenis J Author-X-Name-Last: Crane Author-Name: Steven M Kymes Author-X-Name-First: Steven M Author-X-Name-Last: Kymes Author-Name: Janet E Hiller Author-X-Name-First: Janet E Author-X-Name-Last: Hiller Author-Name: Robert Casson Author-X-Name-First: Robert Author-X-Name-Last: Casson Author-Name: Jonathan D Karnon Author-X-Name-First: Jonathan D Author-X-Name-Last: Karnon Title: Development and calibration of a constrained resource health outcomes simulation model of hospital-based glaucoma services Abstract: Health service delivery and organization often develops in an ad hoc manner, in response to unplanned changes in referral patterns, technologies and system-level factors. We developed a discrete event simulation model for the analysis of health services in a routine clinical setting, with the objective of predicting the process impact of variations to current forms of service delivery and organization. As a case study, we use glaucoma services provided at the Royal Adelaide Hospital, South Australia. Both clinical and administrative hospital data were used to populate and calibrate the model. A random search strategy of a constrained parameter space identified convergent input parameter sets, representing the current operation of glaucoma services at the hospital. Analyses of alternative service configurations showed that extending the patient booking cycle, and review times for stable patients lowered patient numbers per clinic and decreased delays. Applied health services can be successfully simulated and calibrated, providing a basis for analyses of patient throughput, and potentially the economic evaluation of alternative approaches to organizing such services. Journal: Health Systems Pages: 181-197 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.5 File-URL: http://hdl.handle.net/10.1057/hs.2013.5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:181-197 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933239_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Aviv Shachak Author-X-Name-First: Aviv Author-X-Name-Last: Shachak Author-Name: Catherine Montgomery Author-X-Name-First: Catherine Author-X-Name-Last: Montgomery Author-Name: Rustam Dow Author-X-Name-First: Rustam Author-X-Name-Last: Dow Author-Name: Jan Barnsley Author-X-Name-First: Jan Author-X-Name-Last: Barnsley Author-Name: Karen Tu Author-X-Name-First: Karen Author-X-Name-Last: Tu Author-Name: Alejandro R Jadad Author-X-Name-First: Alejandro R Author-X-Name-Last: Jadad Author-Name: Louise Lemieux-Charles Author-X-Name-First: Louise Author-X-Name-Last: Lemieux-Charles Title: End-user support for primary care electronic medical records: a qualitative case study of users’ needs, expectations, and realities Abstract: Support is considered an important factor for realizing the benefits of health information technology, but there is a dearth of research on the topic of support, especially in primary care. We conducted a qualitative multiple case study of four family health teams and one family health organization in Ontario, Canada in an attempt to gain insight into users’ expectations and needs, and the realities of end-user support for primary care electronic medical records. Data were collected by semi-structured interviews, document review, and observation of training sessions. The analysis highlights the important role of on-site information technology staff and super-users in liaising with various stakeholders to solve technical problems and providing hardware and functional (how to) support; the local development of data support practices to ensure consistent documentation; and the gaps that exist in users’ and support personnel’s understanding of each other’s work processes. Journal: Health Systems Pages: 198-212 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.6 File-URL: http://hdl.handle.net/10.1057/hs.2013.6 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:198-212 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933240_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Roslyn Donnellan-Fernandez Author-X-Name-First: Roslyn Author-X-Name-Last: Donnellan-Fernandez Author-Name: Lareen Newman Author-X-Name-First: Lareen Author-X-Name-Last: Newman Author-Name: Kerreen Reiger Author-X-Name-First: Kerreen Author-X-Name-Last: Reiger Author-Name: Sally K Tracy Author-X-Name-First: Sally K Author-X-Name-Last: Tracy Title: Identifying better systems design in Australian maternity care: a Boundary Critique analysis Abstract: This paper examines the background and limitations of maternity care policy and provision in Australia using the Boundary Critique (BC) method from critical systems thinking. We argue that the historical legacy of funding maternity care within medically dominated fee-for-service structures and acute hospital budgets is seriously flawed. Furthermore, it cannot deliver the policy goals of healthy and socially equitable birth practices. Despite the 2009 national Maternity Services Review (MSR) and progress of a National Maternity Services Plan (2011), most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based ‘best practice’. The present system drives unnecessary clinical interventions, increased expenditure, short-term adverse health outcomes and the potential for a larger, unacknowledged legacy of future chronic disease. By contrast, BC analysis suggests that redesigning for good maternity service provision can act as a population-level preventative health strategy, offering better value, better health and improved equity in maternity care. Journal: Health Systems Pages: 213-225 Issue: 3 Volume: 2 Year: 2013 Month: 11 X-DOI: 10.1057/hs.2013.7 File-URL: http://hdl.handle.net/10.1057/hs.2013.7 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:3:p:213-225 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1952905_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Victoria Lyon Author-X-Name-First: Victoria Author-X-Name-Last: Lyon Author-Name: Cynthia LeRouge Author-X-Name-First: Cynthia Author-X-Name-Last: LeRouge Author-Name: Ann Fruhling Author-X-Name-First: Ann Author-X-Name-Last: Fruhling Author-Name: Matthew Thompson Author-X-Name-First: Matthew Author-X-Name-Last: Thompson Title: Home testing for COVID-19 and other virus outbreaks: The complex system of translating to communities Abstract: Home testing is an emerging innovation that can enable nations and health care systems to safely and efficiently test large numbers of patients to manage COVID-19 and other viral outbreaks.  In this position paper, we explore the process of moving home testing across the translational continuum from labs to households, and ultimately into practice and communities for optimal public health impact. We focus on the four translational science drivers to accelerate the implementation of systems-wide home testing programmes 1) collaboration and team science, 2) technology, 3) multilevel interventions, and 4) knowledge integration. We use the Socio Ecological Model (SEM) as a framework to illustrate our vision for the ideal future state of a comprehensive system of stakeholders utilising tech-enabled home testing for COVID-19 and other virus outbreaks, and we suggest SEM as a tool to address key translational readiness and response questions. Journal: Health Systems Pages: 298-317 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2021.1952905 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1952905 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:298-317 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1768807_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Renee Fekieta Author-X-Name-First: Renee Author-X-Name-Last: Fekieta Author-Name: Alana Rosenberg Author-X-Name-First: Alana Author-X-Name-Last: Rosenberg Author-Name: Beth Hodshon Author-X-Name-First: Beth Author-X-Name-Last: Hodshon Author-Name: Shelli Feder Author-X-Name-First: Shelli Author-X-Name-Last: Feder Author-Name: Sarwat I. Chaudhry Author-X-Name-First: Sarwat I. Author-X-Name-Last: Chaudhry Author-Name: Beth L. Emerson Author-X-Name-First: Beth L. Author-X-Name-Last: Emerson Title: Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement Abstract: During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care. Journal: Health Systems Pages: 239-248 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2020.1768807 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1768807 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:239-248 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1796530_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ahmed Kheiri Author-X-Name-First: Ahmed Author-X-Name-Last: Kheiri Author-Name: Rhyd Lewis Author-X-Name-First: Rhyd Author-X-Name-Last: Lewis Author-Name: Jonathan Thompson Author-X-Name-First: Jonathan Author-X-Name-Last: Thompson Author-Name: Paul Harper Author-X-Name-First: Paul Author-X-Name-Last: Harper Title: Constructing operating theatre schedules using partitioned graph colouring techniques Abstract: In hospitals, scheduled operations can often be cancelled in large numbers due to the unavailability of beds for post-operation recovery. Operating theatre scheduling is known to be an $${\mathcal N}{\mathcal P}$$NP-hard optimisation problem. Previous studies have shown that the correct scheduling of surgical procedures can have a positive impact on the availability of beds in hospital wards, thereby allowing a reduction in number of elective operation cancellations. This study proposes an exact technique based on the partitioned graph colouring problem for constructing optimal master surgery schedules, with the goal of minimising the number of cancellations. The resultant schedules are then simulated in order to measure how well they cope with the stochastic nature of patient arrivals. Our results show that the utilisation of post-operative beds can be increased, whilst the number of cancellations can be decreased, which may ultimately lead to greater patient throughput and reduced waiting times. A scenario-based model has also been employed to integrate the stochastic-nature associated with the bed requirements into the optimisation process. The results indicate that the proposed model can lead to more robust solutions. Journal: Health Systems Pages: 286-297 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2020.1796530 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1796530 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:286-297 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1803148_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ralf Müller-Polyzou Author-X-Name-First: Ralf Author-X-Name-Last: Müller-Polyzou Author-Name: Melanie Reuter-Oppermann Author-X-Name-First: Melanie Author-X-Name-Last: Reuter-Oppermann Author-Name: Anke Engbert Author-X-Name-First: Anke Author-X-Name-Last: Engbert Author-Name: Raphael Schmidt Author-X-Name-First: Raphael Author-X-Name-Last: Schmidt Title: Identifying user assistance systems for radiotherapy to increase efficiency and help saving lives Abstract: Increasing efficiency and reducing risk in radiotherapy cancer treatment is of high importance. User assistance systems within a digitally connected radiotherapy environment can support all involved professionals to perform their individual tasks faster and better. This paper presents a qualitative analysis of radiotherapy workflows and a corresponding process modelling in order to identify hypothetical user assistance systems for specific process activities. In addition, the results of an empirical study on the identified systems are presented together with derived requirements and design principles for these systems. A structured online survey with 50 medical physicists in Germany has been conducted. Among others the acceptance, the increase of perceived efficiency and the risk reduction while using the assistance systems are analysed and discussed. The results support the creation of value adding user assistance systems for radiotherapy that improve efficiency, reduce treatment risks and reach high user acceptance levels. Journal: Health Systems Pages: 318-336 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2020.1803148 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1803148 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:318-336 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1771619_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Toni Tagimacruz Author-X-Name-First: Toni Author-X-Name-Last: Tagimacruz Author-Name: Diane P. Bischak Author-X-Name-First: Diane P. Author-X-Name-Last: Bischak Author-Name: Deborah A. Marshall Author-X-Name-First: Deborah A. Author-X-Name-Last: Marshall Title: Alternative care providers in rheumatoid arthritis patient care: a queueing and simulation analysis Abstract: Patients diagnosed with rheumatoid arthritis require lifelong monitoring by a rheumatologist. Initiation of the disease-modifying anti-rheumatic drug therapy within twelve weeks of the onset of symptoms is crucial to prevent joint damage and functional disability. We examine the impact of the engagement of alternate care providers (ACP) in alleviating delay due to limited rheumatologist capacity. Using queueing theory and discrete-event simulation, we model rheumatologist-only and rheumatologist-with-ACP system configurations as closed, multi-class queueing networks with class switching.Using summary data from an actual rheumatology clinic for illustration, we analyze various parameter conditions to aid clinic managers and policymakers in decisions concerning capacity allocations and feasible patient panel size that impact timeliness of care and resource utilization.Results not only confirm that a substantial increase in RA patient panel size with an ACP involved in the care of follow-up patients but also demonstrates the boundaries for feasible panel sizes and workload allocation Journal: Health Systems Pages: 249-267 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2020.1771619 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1771619 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:249-267 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1973348_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: R. M. Wood Author-X-Name-First: R. M. Author-X-Name-Last: Wood Author-Name: A. C. Pratt Author-X-Name-First: A. C. Author-X-Name-Last: Pratt Author-Name: B. J. Murch Author-X-Name-First: B. J. Author-X-Name-Last: Murch Author-Name: A. L. Powell Author-X-Name-First: A. L. Author-X-Name-Last: Powell Author-Name: R. D. Booton Author-X-Name-First: R. D. Author-X-Name-Last: Booton Author-Name: D. G. Thomas Author-X-Name-First: D. G. Author-X-Name-Last: Thomas Author-Name: J. Twigger Author-X-Name-First: J. Author-X-Name-Last: Twigger Author-Name: E. Diakou Author-X-Name-First: E. Author-X-Name-Last: Diakou Author-Name: S. Coleborn Author-X-Name-First: S. Author-X-Name-Last: Coleborn Author-Name: T. Manning Author-X-Name-First: T. Author-X-Name-Last: Manning Author-Name: C. Davies Author-X-Name-First: C. Author-X-Name-Last: Davies Author-Name: K. M. Turner Author-X-Name-First: K. M. Author-X-Name-Last: Turner Title: Establishing an SEIR-based framework for local modelling of COVID-19 infections, hospitalisations and deaths Abstract: Without timely assessments of the number of COVID-19 cases requiring hospitalisation, healthcare providers will struggle to ensure an appropriate number of beds are made available. Too few could cause excess deaths while too many could result in additional waits for elective treatment. As well as supporting capacity considerations, reliably projecting future “waves” is important to inform the nature, timing and magnitude of any localised restrictions to reduce transmission. In making the case for locally owned and locally configurable models, this paper details the approach taken by one major healthcare system in founding a multi-disciplinary “Scenario Review Working Group”, comprising commissioners, public health officials and academic epidemiologists. The role of this group, which met weekly during the pandemic, was to define and maintain an evolving library of plausible scenarios to underpin projections obtained through an SEIR-based compartmental model. Outputs have informed decision-making at the system’s major incident Bronze, Silver and Gold Commands. This paper presents illustrated examples of use and offers practical considerations for other healthcare systems that may benefit from such a framework. Journal: Health Systems Pages: 337-347 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2021.1973348 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1973348 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:337-347 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1783190_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mohamed A K Al-Azzani Author-X-Name-First: Mohamed A K Author-X-Name-Last: Al-Azzani Author-Name: Soheil Davari Author-X-Name-First: Soheil Author-X-Name-Last: Davari Author-Name: Tracey Jane England Author-X-Name-First: Tracey Jane Author-X-Name-Last: England Title: An empirical investigation of forecasting methods for ambulance calls - a case study Abstract: A primary goal of emergency services is to minimise the response times to emergencies whilst managing operational costs. This paper is motivated by real data from the Welsh Ambulance Service which in recent years has been criticised for not meeting its eight-minute response target. In this study, four forecasting approaches (ARIMA, Holt Winters, Multiple Regression and Singular Spectrum Analysis (SSA)) are considered to investigate whether they can provide more accurate predictions to the call volume demand (total and by category) than the current approach on a selection of planning horizons (weekly, monthly and 3-monthly). Each method is applied to a training and test set and root mean square error (RMSE) and mean absolute percentage error (MAPE) error statistics are determined. Results showed that ARIMA is the best forecasting method for weekly and monthly prediction of demand and the long-term demand is best predicted using the SSA method. Journal: Health Systems Pages: 268-285 Issue: 4 Volume: 10 Year: 2021 Month: 10 X-DOI: 10.1080/20476965.2020.1783190 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1783190 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:4:p:268-285 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933230_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jon Maguire Author-X-Name-First: Jon Author-X-Name-Last: Maguire Author-Name: Vasant Dhar Author-X-Name-First: Vasant Author-X-Name-Last: Dhar Title: Comparative effectiveness for oral anti-diabetic treatments among newly diagnosed type 2 diabetics: data-driven predictive analytics in healthcare Abstract: A difficult problem in healthcare is predicting who will become very sick in the near future. In our case, we find that the top 10% of newly diagnosed type 2 diabetes patients account for 68% of healthcare utilization. In this paper, we demonstrate how the U.S. healthcare system can provide improved healthcare quality per unit of spend through better predictive data-based analytics applied to the increasingly available troves of healthcare claims data. Specifically, we demonstrate the effectiveness of data mining by applying machine learning methods to large-scale medical and pharmacy claims data for over 65,000 patients newly diagnosed with type 2 diabetes, a common and costly disease globally. This analysis reveals some important heretofore unknown patterns in the cost and quality among of the disease's common treatments and demonstrates the potential for using large-scale data mining for efficiently focusing further inquiry. Journal: Health Systems Pages: 73-92 Issue: 2 Volume: 2 Year: 2013 Month: 7 X-DOI: 10.1057/hs.2012.20 File-URL: http://hdl.handle.net/10.1057/hs.2012.20 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:2:p:73-92 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933231_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sue S Feldman Author-X-Name-First: Sue S Author-X-Name-Last: Feldman Author-Name: Thomas A Horan Author-X-Name-First: Thomas A Author-X-Name-Last: Horan Author-Name: David Drew Author-X-Name-First: David Author-X-Name-Last: Drew Title: Understanding the value proposition of health information exchange: the case of uncompensated care cost recovery Abstract: This case study examined the use of the Nationwide Health Information Network as a mechanism for secure and interoperable transport of existing clinical data from electronic health records. The context for this study was the secondary use of existing data from MedVirginia, a Virginia Health Information Exchange, for Social Security Administration disability determination. The study found that an estimated U.S. $1.9 million in uncompensated care costs were recovered over a 12-month period from August 2009 to July 2010, and serves as an example demonstrating that uncompensated care cost recovery is a promising means by which a health information exchange can provide value to healthcare providers. Journal: Health Systems Pages: 134-146 Issue: 2 Volume: 2 Year: 2013 Month: 7 X-DOI: 10.1057/hs.2012.24 File-URL: http://hdl.handle.net/10.1057/hs.2012.24 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:2:p:134-146 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933232_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Samitha Wijedasa Author-X-Name-First: Samitha Author-X-Name-Last: Wijedasa Author-Name: Charith Gunasekara Author-X-Name-First: Charith Author-X-Name-Last: Gunasekara Author-Name: Marek Laskowsk Author-X-Name-First: Marek Author-X-Name-Last: Laskowsk Author-Name: Marcia R Friesen Author-X-Name-First: Marcia R Author-X-Name-Last: Friesen Author-Name: Robert D McLeod Author-X-Name-First: Robert D Author-X-Name-Last: McLeod Title: Smartphone and vehicular trajectories as data sources for agent-based infection spread modelling Abstract: Agent-based modelling (ABM) is becoming a valuable tool in understanding infection spread. In this work, two real data sets – a travel survey data set and a cellular service records data set – are used as mobility inputs in ABMs of infection spread on urban and regional scales, respectively. The data sets are novel in that they were not generated for public health purposes, but are nonetheless amenable and accessible, largely due to an emerging data culture. Data processing methods have been developed to extract trajectories of agents from the data sets, where the trajectories are then used within an ABM to simulate the spread of a close-proximity contact-based infection, such as influenza-like illnesses. Two separate models of infection spread at the scale of a city and a province were developed. Simulations were run to demonstrate infection spread within the population, as a means of exploring the applicability and contribution of the data sets to infection spread modelling. The novelty of the work is derived from the integration of disparate and non-obvious data sets, and the results – by demonstrating qualitative congruence with the results of compartmentalized mathematical models – demonstrate the robustness of the ABM approach and set a framework for future work. Our intention is to highlight the emerging opportunities within a data culture to the multidisciplinary research associated with infection spread modelling without requiring a formal background in telecommunications or intelligent transportation systems in order to better understand the use of available data, its potential, and limitations. Journal: Health Systems Pages: 120-133 Issue: 2 Volume: 2 Year: 2013 Month: 7 X-DOI: 10.1057/hs.2012.25 File-URL: http://hdl.handle.net/10.1057/hs.2012.25 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:2:p:120-133 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933233_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Cem Saydam Author-X-Name-First: Cem Author-X-Name-Last: Saydam Author-Name: Hari K Rajagopalan Author-X-Name-First: Hari K Author-X-Name-Last: Rajagopalan Author-Name: Elizabeth Sharer Author-X-Name-First: Elizabeth Author-X-Name-Last: Sharer Author-Name: Kay Lawrimore-Belanger Author-X-Name-First: Kay Author-X-Name-Last: Lawrimore-Belanger Title: The dynamic redeployment coverage location model Abstract: Demand for ambulances is known to fluctuate spatially and temporally by day of the week and time of day. Faced with fluctuating demand during the day, emergency medical systems (EMS) managers utilize redeployment strategies to meet demand. Such shifting of personnel, although better able to cover a region with fluctuating demand, can cause fatigue amongst ambulance crew members. Considering these phenomena, we extend the dynamic available coverage location model to be driven by two objectives: (1) Minimize the number of ambulances, and (2) Minimize the number of redeployments for a given fleet during a given shift. We develop a heuristic search algorithm and present the comparative statistics using real data from an urban EMS agency. Our findings suggest that EMS managers can effectively balance a need for additional ambulances with those redeployments required to meet variable demand patterns. Journal: Health Systems Pages: 103-119 Issue: 2 Volume: 2 Year: 2013 Month: 7 X-DOI: 10.1057/hs.2012.27 File-URL: http://hdl.handle.net/10.1057/hs.2012.27 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:2:p:103-119 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933234_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Yu-Li Huang Author-X-Name-First: Yu-Li Author-X-Name-Last: Huang Author-Name: Justin Marcak Author-X-Name-First: Justin Author-X-Name-Last: Marcak Title: Radiology scheduling with consideration of patient characteristics to improve patient access to care and medical resource utilization Abstract: The objective of this paper is to redesign a scheduling scheme in a hospital radiology department that accounts for patient characteristics to improve patient access to care and utilization of medical resources. Patients’ characteristics are used to determine the length of required procedure time. The reclassification of patient groups is demonstrated using a decision tree technique and an algorithm based on the least weighted average coefficient of variation. The results indicate that the proposed scheduling scheme reduces patient wait time as much as 71%, increases the radiographer utilization by at most 83%, reduces overall cost by as far as 54%, and improves patient access by 1.25 times than current schedule capability. The proposed approach provides relatively implementable details and a minimal system accommodation, especially for the participated radiology department. The success of the implementation will bring better service for patients and the use of medical resources more efficiently. Journal: Health Systems Pages: 93-102 Issue: 2 Volume: 2 Year: 2013 Month: 7 X-DOI: 10.1057/hs.2013.1 File-URL: http://hdl.handle.net/10.1057/hs.2013.1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:2:y:2013:i:2:p:93-102 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1404745_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: M. O. Papuga Author-X-Name-First: M. O. Author-X-Name-Last: Papuga Author-Name: C. Dasilva Author-X-Name-First: C. Author-X-Name-Last: Dasilva Author-Name: A. McIntyre Author-X-Name-First: A. Author-X-Name-Last: McIntyre Author-Name: D. Mitten Author-X-Name-First: D. Author-X-Name-Last: Mitten Author-Name: S. Kates Author-X-Name-First: S. Author-X-Name-Last: Kates Author-Name: J. F. Baumhauer Author-X-Name-First: J. F. Author-X-Name-Last: Baumhauer Title: Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record Abstract: The objective of this research was to assess the implementation of collecting patient-reported outcomes data in the outpatient clinics of a large academic hospital and identify potential barriers and solutions to such an implementation. Three PROMIS computer adaptive test instruments, (1) physical function, (2) pain interference, and (3) depression, were administered at 23,813 patient encounters using a novel software platform on tablet computers. The average time to complete was 3.50 ± 3.12 min, with a median time of 2.60 min. Registration times for new patients did not change significantly, 6.87 ± 3.34 to 7.19 ± 2.69 min. Registration times increased for follow-up (p = .007) from 2.94 ± 1.57 (p < .01) min to 3.32 ± 1.78 min. This is an effective implementation strategy to collect patient-reported outcomes and directly import the results into the electronic medical record in real time for use during the clinical visit. Journal: Health Systems Pages: 1-12 Issue: 1 Volume: 7 Year: 2018 Month: 1 X-DOI: 10.1057/s41306-016-0016-1 File-URL: http://hdl.handle.net/10.1057/s41306-016-0016-1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:1:p:1-12 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1390050_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: P.A. Kostagiolas Author-X-Name-First: P.A. Author-X-Name-Last: Kostagiolas Author-Name: P.E. Kourouthanassis Author-X-Name-First: P.E. Author-X-Name-Last: Kourouthanassis Author-Name: K. Martzoukou Author-X-Name-First: K. Author-X-Name-Last: Martzoukou Author-Name: N. Korfiatis Author-X-Name-First: N. Author-X-Name-Last: Korfiatis Author-Name: D. Niakas Author-X-Name-First: D. Author-X-Name-Last: Niakas Title: Information seeking behavioural paths of physicians for diabetes mellitus care: a qualitative comparative analysis of information needs, sources, and barriers Abstract: This study addresses diabetes physicians’ information seeking behavioural paths (digital, conventional, interpersonal) which lead to information needs satisfaction and the barriers encountered in this process. The study was based on empirical evidence from a survey of 159 physicians. Theoretical analysis was informed by Wilson’s model of information seeking behaviour. The data were analysed using fuzzy set qualitative comparative analysis method. The method was successful in identifying five behavioural paths leading to physicians’ information needs satisfaction (professional/health coaching) which demonstrate different relationships between information sources (conventional/interpersonal/digital) and information barriers (personal/digital illiteracy) and five behavioural paths that are not leading to satisfaction. Journal: Health Systems Pages: 13-28 Issue: 1 Volume: 7 Year: 2018 Month: 1 X-DOI: 10.1080/20476965.2017.1390050 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1390050 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:1:p:13-28 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1404747_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ryan Palmer Author-X-Name-First: Ryan Author-X-Name-Last: Palmer Author-Name: Naomi J. Fulop Author-X-Name-First: Naomi J. Author-X-Name-Last: Fulop Author-Name: Martin Utley Author-X-Name-First: Martin Author-X-Name-Last: Utley Title: A systematic literature review of operational research methods for modelling patient flow and outcomes within community healthcare and other settings Abstract: An ambition of healthcare policy has been to move more acute services into community settings. This systematic literature review presents analysis of published operational research methods for modelling patient flow within community healthcare, and for modelling the combination of patient flow and outcomes in all settings. Assessed for inclusion at three levels – with the references from included papers also assessed – 25 “Patient flow within community care”, 23 “Patient flow and outcomes” papers and 5 papers within the intersection are included for review. Comparisons are made between each paper’s setting, definition of states, factors considered to influence flow, output measures and implementation of results. Common complexities and characteristics of community service models are discussed with directions for future work suggested. We found that in developing patient flow models for community services that use outcomes, transplant waiting list may have transferable benefits. Journal: Health Systems Pages: 29-50 Issue: 1 Volume: 7 Year: 2018 Month: 1 X-DOI: 10.1057/s41306-017-0024-9 File-URL: http://hdl.handle.net/10.1057/s41306-017-0024-9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:1:p:29-50 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1404746_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: David Rees Author-X-Name-First: David Author-X-Name-Last: Rees Author-Name: Robert Y. Cavana Author-X-Name-First: Robert Author-X-Name-Last: Y. Cavana Author-Name: Jacqueline Cumming Author-X-Name-First: Jacqueline Author-X-Name-Last: Cumming Title: Using cognitive and causal modelling to develop a theoretical framework for implementing innovative practices in primary healthcare management in New Zealand Abstract: The continuing rise in chronic health conditions requires major changes in how healthcare is managed and delivered. While research has identified a number of factors key to bringing this about, implementing these changes requires an understanding of how the factors interact over time in different contexts. In this research study, seven senior health experts in New Zealand were interviewed, using cognitive mapping, to ascertain their thinking about major implementation challenges to enhance primary healthcare systems. The resulting cognitive maps were then consolidated and developed into a causal loop diagram, which describes a set of interlinked feedback loops representing the processes involved in implementing changes. It is concluded that these systems methods are very effective in better understanding the contextual and behavioural factors necessary for the development of a theoretical framework to support the successful implementation of innovative primary healthcare programmes. Journal: Health Systems Pages: 51-65 Issue: 1 Volume: 7 Year: 2018 Month: 1 X-DOI: 10.1057/s41306-017-0029-4 File-URL: http://hdl.handle.net/10.1057/s41306-017-0029-4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:1:p:51-65 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1390060_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mustafa Ozkaynak Author-X-Name-First: Mustafa Author-X-Name-Last: Ozkaynak Author-Name: Rupa Valdez Author-X-Name-First: Rupa Author-X-Name-Last: Valdez Author-Name: Richard J. Holden Author-X-Name-First: Richard J. Author-X-Name-Last: Holden Author-Name: Jason Weiss Author-X-Name-First: Jason Author-X-Name-Last: Weiss Title: Infinicare framework for integrated understanding of health-related activities in clinical and daily-living contexts Abstract: Clinical and consumer health informatics interventions promise to transform health care, yielding higher quality, more accessible care at a lower cost. However, the potential of these interventions cannot be achieved if they are developed and rolled out in a disconnected way: clinic-based systems typically do not interface with home-based systems that capture patient-generated health-related data. The fragmentation between these interventions severely limits the benefits of all interventions; given that health care is a continuum between clinical and daily-living settings. We introduce the Infinicare framework, which posits that clinical health-related activities “shape” daily-living-based health-related activities and, conversely, that daily-living-based health-related activities “inform” activities in clinics. Non-alignment of activities across these diverse contexts yields systemic gaps. Workflow studies that capture health-related activities and characterise gaps between clinical and daily-living contexts can inform the design and implementation of gap-filling, collaborative health information technologies. To inform these technologies, workflow studies should be patient-oriented, include both clinical and daily-living settings and subsume both process and structure variables. Novel methodologies are needed to effectively and efficiently capture health-related activities across both clinical and daily-living settings and their contexts. Guidelines for applying these recommendations in developing collaborative health information technologies are provided. Journal: Health Systems Pages: 66-78 Issue: 1 Volume: 7 Year: 2018 Month: 1 X-DOI: 10.1080/20476965.2017.1390060 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1390060 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:7:y:2018:i:1:p:66-78 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933241_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Tobias Mettler Author-X-Name-First: Tobias Author-X-Name-Last: Mettler Author-Name: René Fitterer Author-X-Name-First: René Author-X-Name-Last: Fitterer Author-Name: Peter Rohner Author-X-Name-First: Peter Author-X-Name-Last: Rohner Author-Name: Robert Winter Author-X-Name-First: Robert Author-X-Name-Last: Winter Title: Does a hospital’s IT architecture fit with its strategy? An approach to measure the alignment of health information technology Abstract: Hospitals as the main entities of healthcare need to respond to policy initiatives affecting in particular the quality, efficiency and costs of health service delivery as well as cope with continuous technological advancements. Considering the information intensive character of healthcare, a shift in a hospital’s business policy also induces potentials and pitfalls to the management of health information technology. In this sense, this paper strives to find an answer to the problem how to reduce misalignment of the business and IT architecture in hospitals. Following the design science research methodology, this paper emphasises the description of a method named H-BIT, which may support decision-makers in overcoming this alignment problem. Implications for healthcare practice are reported based on the experiences that were gained from the exemplary application of the method at a larger hospital. Journal: Health Systems Pages: 29-42 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.10 File-URL: http://hdl.handle.net/10.1057/hs.2013.10 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:29-42 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933242_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Waleed Abo-Hamad Author-X-Name-First: Waleed Author-X-Name-Last: Abo-Hamad Author-Name: Amr Arisha Author-X-Name-First: Amr Author-X-Name-Last: Arisha Title: Multi-criteria approach using simulation-based balanced scorecard for supporting decisions in health-care facilities: an emergency department case study Abstract: Health research is a priority in every economy, and this research – set in the context of building a more sustainable and efficient health-care system – examines how operations management practices can be translated to clinical applications. Health-care systems in general (and emergency departments (EDs) in particular) around the world are facing enormous challenges in meeting the increasingly conflicting objectives of providing wide accessibility and delivering high-quality services efficiently and promptly. The framework proposed in this study integrates simulation modelling, the Balanced Scorecard, and multi-criteria decision analysis with the aim of providing a decision support system for health-care managers. Using the Analytic Hierarchy Process, simulation results are aggregated to achieve defined strategic as well as tactical and operational objectives. Communicating the significance of investigated strategies can encourage managers to implement the framework’s recommendations in the ED within the partner hospital. Journal: Health Systems Pages: 43-59 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.11 File-URL: http://hdl.handle.net/10.1057/hs.2013.11 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:43-59 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933243_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Andrew Clarke Author-X-Name-First: Andrew Author-X-Name-Last: Clarke Author-Name: Robert Steele Author-X-Name-First: Robert Author-X-Name-Last: Steele Title: A secure query assurance approach for distributed health records Abstract: Health information system architectures inherently include distributed systems and data repositories across multiple organizations, health providers and with potentially some data stored with the health consumer. This is part of the shift to more fully integrated electronic health systems. Due to the varied stakeholders of these systems, it will become more important to provide a high level of query quality assurance for the parties utilizing these distributed and shared data repositories. A core consideration of health records is providing data confidentiality, including to protect against insider security threats. As such, it will often be desirable that electronic health information be stored in an encrypted format. In this paper, we present and describe the implementation and evaluation of a query assurance model that implements the three requirements of query assurance across sources of searchable encrypted health data. Furthermore, we consider the issue of freshness and data persistence in a multiple data owner environment, including a discussion of the characteristics of consumer interfacing health information systems. Journal: Health Systems Pages: 60-73 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.12 File-URL: http://hdl.handle.net/10.1057/hs.2013.12 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:60-73 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933244_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Inez Mikkelsen-Lopez Author-X-Name-First: Inez Author-X-Name-Last: Mikkelsen-Lopez Author-Name: Peter Cowley Author-X-Name-First: Peter Author-X-Name-Last: Cowley Author-Name: Harun Kasale Author-X-Name-First: Harun Author-X-Name-Last: Kasale Author-Name: Conrad Mbuya Author-X-Name-First: Conrad Author-X-Name-Last: Mbuya Author-Name: Graham Reid Author-X-Name-First: Graham Author-X-Name-Last: Reid Author-Name: Don de Savigny Author-X-Name-First: Don Author-X-Name-Last: de Savigny Title: Essential medicines in Tanzania: does the new delivery system improve supply and accountability? Abstract: Objective: Assess whether reform in the Tanzanian medicines delivery system from a central ‘push’ kit system to a decentralized ‘pull’ Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines. Journal: Health Systems Pages: 74-81 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.14 File-URL: http://hdl.handle.net/10.1057/hs.2013.14 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:74-81 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933245_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nelson King Author-X-Name-First: Nelson Author-X-Name-Last: King Title: Expanding the boundaries of clinical informatics for interdisciplinary systems research Abstract: Health-care organizations and the information they exchange are increasingly complex and difficult to understand necessitating fresh methodological approaches on the part of clinical informatics researchers. Looking at the interplay between health-care information technology (HIT), clinical workflow, and the surrounding organization requires some notion of a system and an interdisciplinary orientation toward research. The paper offers practical advice grounded in the systems approach to researchers who wish to view HIT holistically and part of an integrated system. Examples from literature describe the importance of expanding system boundaries, looking for relationships within those boundaries, simplifying complexity, and accounting for social behavior. Journal: Health Systems Pages: 1-11 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.18 File-URL: http://hdl.handle.net/10.1057/hs.2013.18 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:1-11 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933246_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Asmaa S Hussein Author-X-Name-First: Asmaa S Author-X-Name-Last: Hussein Author-Name: Wail M Omar Author-X-Name-First: Wail M Author-X-Name-Last: Omar Author-Name: Xue Li Author-X-Name-First: Xue Author-X-Name-Last: Li Author-Name: Muhammed Amer Hatem Author-X-Name-First: Muhammed Author-X-Name-Last: Amer Hatem Title: Smart collaboration framework for managing chronic disease using recommender system Abstract: E-Healthcare services show promising solutions to reduce patients’ life risk with improving the provided services along with being cost effective. This paper presents Chronic Disease Recommender System that assists patients to monitor and control their cases through suggesting medical advices and diagnosis. For the system to be accurate, which is vital in such application, it needs to work with high-dimensional data. This work proposed Integrated Collaborative Filtering framework that reduces the complexity and improves the response time of high-dimensional data to develop recommender system. The paper concluded with presenting and discussing real case study with real medical data on providing medical advices for diabetes. Journal: Health Systems Pages: 12-17 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.8 File-URL: http://hdl.handle.net/10.1057/hs.2013.8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:12-17 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933247_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Dennis Moeke Author-X-Name-First: Dennis Author-X-Name-Last: Moeke Author-Name: Ger Koole Author-X-Name-First: Ger Author-X-Name-Last: Koole Author-Name: Lineke Verkooijen Author-X-Name-First: Lineke Author-X-Name-Last: Verkooijen Title: Scale and skill-mix efficiencies in nursing home staffing: inside the black box Abstract: Care workers account for a significant proportion of the total health expenditure in nursing homes and are by far the largest controllable resource. Therefore, determining the appropriate number and type of care workers required plays an important role in the search for more efficiency. This study provides insights into how and why ‘scale of scheduling’ and the enlargement of care workers’ jobs (blending tasks of different qualification levels (QLs)) affect the number and type of staff required to meet the preferences (in terms of day and time) of nursing home residents. The scheduling data for plannable care activities of three separate decision-making units within a single Dutch nursing home have been analyzed. The results show that in >85% of the examined cases, substantial scale and skill-mix economies can be achieved. We also found that the correlation between the demand patterns of different types of care tasks is of considerable importance when it comes to possible scale and skill-mix efficiencies. Journal: Health Systems Pages: 18-28 Issue: 1 Volume: 3 Year: 2014 Month: 2 X-DOI: 10.1057/hs.2013.9 File-URL: http://hdl.handle.net/10.1057/hs.2013.9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:3:y:2014:i:1:p:18-28 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933311_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Kenneth C M Yip Author-X-Name-First: Kenneth C M Author-X-Name-Last: Yip Author-Name: Kevin W H Huang Author-X-Name-First: Kevin W H Author-X-Name-Last: Huang Author-Name: Esther W Y Ho Author-X-Name-First: Esther W Y Author-X-Name-Last: Ho Author-Name: W K Chan Author-X-Name-First: W K Author-X-Name-Last: Chan Author-Name: Irene L Y Lee Author-X-Name-First: Irene L Y Author-X-Name-Last: Lee Title: Optimized staff allocation for inpatient phlebotomy and electrocardiography services via mathematical modelling in an acute regional and teaching hospital Abstract: Adhering to pre-defined service routes that cover a fixed set of wards in a shift, the inpatient phlebotomy service provides 24-hour coverage for a 27-storey, 1,400-bed hospital. We present an application of mathematical optimization to improve its service efficiency without injecting additional resources. A mixed integer programming model was implemented to revamp the service route configuration to minimize workload discrepancies among service routes, limit maximum daily workload per route and restrict routes to span a maximum number of floor levels, while taking into consideration the ward-specific demand for each duty (i.e. daytime, evening, and night time) throughout the day. This data-driven and evidence-based approach has facilitated an overhaul of the existing route configuration of the inpatient phlebotomy service, which resulted in a more effective and contented workforce, as well as a more efficient service with an evened-out workload among phlebotomists and increased time spent on direct patient care by phlebotomists. Subsequent scenario analysis revealed that more manpower on a micro-level is not necessarily better and highlighted the importance to strategically design duty hours and allocate manpower across different duties on a system level. Journal: Health Systems Pages: 102-111 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/s41306-016-0001-8 File-URL: http://hdl.handle.net/10.1057/s41306-016-0001-8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:102-111 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933312_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James Greenwood-Lee Author-X-Name-First: James Author-X-Name-Last: Greenwood-Lee Author-Name: Geoff Wild Author-X-Name-First: Geoff Author-X-Name-Last: Wild Author-Name: Deborah Marshall Author-X-Name-First: Deborah Author-X-Name-Last: Marshall Title: Improving accessibility through referral management: setting targets for specialist care Abstract: The use of optimized referral distribution strategies to improve access to specialty care is assessed. A mathematical model of a generalized care pathway is developed and the distribution of referrals is posed as an optimization problem. The objective is to minimize time from referral to a targeted stage in the care pathway (e.g., specialist consult, surgery, etc.). Numerical simulations informed by data on hip and knee surgeries demonstrate wait reductions from 21 to 38 days (16.8–30.4%) from time of referral to time of consult and from 33 to 66 days (12.6–24.7%) to time of surgery. However, the optimized referral distribution strategy minimizes wait times to the targeted stage only; wait times to non-targeted stages in the care pathway are suboptimal and may increase as an unintended consequence. Consequently, to achieve desired improvements in access, the targeted stage for wait time minimization must be carefully identified and prioritized. Journal: Health Systems Pages: 161-170 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2015.20 File-URL: http://hdl.handle.net/10.1057/hs.2015.20 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:161-170 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933313_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Roopa Raman Author-X-Name-First: Roopa Author-X-Name-Last: Raman Author-Name: Kimberly Green Author-X-Name-First: Kimberly Author-X-Name-Last: Green Title: Multi-level factors affecting timely electronic documentation of medication administration: a hierarchical linear modeling approach Abstract: This study applies a systematic hierarchical linear modeling approach to identify factors impacting timely documentation of medication administration on electronic medication administration record (eMAR) systems. Delayed documentation of medications poses significant risks to patient safety. Multi-level quantitative data were collected from a large urban hospital system, spanning the non-physician clinician workforce across 27 patient-care units. Data suggests the overall perception of psychological safety on one’s unit was a significant predictor of individual clinicians’ timely eMAR documentation. The impact of each clinician’s personal psychological safety was nuanced by his/her patient-care unit and type of hospital. Other characteristics of the provider’s patient-care unit were also relevant. Thus, even though timely eMAR documentation is an individual-level activity, it is predicted by characteristics beyond complete control of the individual. We illustrate the value of applying systematic hierarchical linear modeling approach to better illuminate the problem of consistently achieving timely eMAR documentation across all providers. Journal: Health Systems Pages: 171-185 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2016.3 File-URL: http://hdl.handle.net/10.1057/hs.2016.3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:171-185 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933314_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Suzanne J. Wood Author-X-Name-First: Suzanne J. Author-X-Name-Last: Wood Author-Name: Matthew L. Nathan Author-X-Name-First: Matthew L. Author-X-Name-Last: Nathan Title: When the world calls for emergency services, who answers? A surgeon general’s perspective on running a high performance health services organization Abstract: This article records an interview by the author with Vice Admiral (retired) Matthew L. Nathan, 37th surgeon general of the United States (U.S.) Navy and chief of the U.S. Navy’s Bureau of Medicine and Surgery. The interview provides insights into developing a globally dispersed yet highly integrated health system managed and operated by an agile, mission-focused team of devoted professionals whose credo is to deliver “World-Class Care…Anytime, Anywhere.” We examine characteristics of Navy Medicine that align with evidence-based factors of high performance organizations (HPOs) to determine whether the system itself should be classified as an HPO. In conclusion, we summarize key implications for practice. Journal: Health Systems Pages: 91-101 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/s41306-017-0028-5 File-URL: http://hdl.handle.net/10.1057/s41306-017-0028-5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:91-101 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933315_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Stefanie M Keen Author-X-Name-First: Stefanie M Author-X-Name-Last: Keen Author-Name: Nicholas Roberts Author-X-Name-First: Nicholas Author-X-Name-Last: Roberts Title: Preliminary evidence for the use and efficacy of mobile health applications in managing posttraumatic stress disorder symptoms Abstract: Mobile health applications like PTSD Coach are emerging as tools to help individuals manage post traumatic stress disorder (PTSD) symptoms. However, these applications will not be effective if people do not use them. Using PTSD Coach as the focal application, we address two interrelated questions: (1) what are the primary determinants of PTSD Coach use? and (2) is PTSD Coach use related to changes in PTSD symptomatology? Building on the Unified Theory of Acceptance and Use of Technology, we develop and test a research model that addresses these questions. Our results show that performance expectancy and social influence are positively related to PTSD Coach use; however, effort expectancy and facilitating conditions are not related to PTSD Coach use. We also found that PTSD Coach use is positively related to improvements in PTSD symptomatology. Our results provide preliminary evidence for the use and efficacy of mobile health applications in managing PTSD symptoms. Journal: Health Systems Pages: 122-129 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2016.2 File-URL: http://hdl.handle.net/10.1057/hs.2016.2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:122-129 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933316_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Hyojung Kang Author-X-Name-First: Hyojung Author-X-Name-Last: Kang Author-Name: Harriet Black Nembhard Author-X-Name-First: Harriet Black Author-X-Name-Last: Nembhard Author-Name: William Curry Author-X-Name-First: William Author-X-Name-Last: Curry Author-Name: Nasrollah Ghahramani Author-X-Name-First: Nasrollah Author-X-Name-Last: Ghahramani Author-Name: Wenke Hwang Author-X-Name-First: Wenke Author-X-Name-Last: Hwang Title: A systems thinking approach to prospective planning of interventions for chronic kidney disease care Abstract: Chronic kidney disease (CKD) is a growing health problem. Previous approaches to improve CKD care tend to focus on the linear relationships between a specific intervention and its effects on the target CKD population. The objective of this paper is to investigate how a systems thinking approach can support decision making on system-level interventions for chronic disease management. Our research team conducted a case study at an academic health-care organization. To support prospective planning of interventions at the study institution, we adopted a systems thinking approach in three phases: intervention structuring, causal loop modeling, and implementation planning. In the first phase, four potential interventions were proposed to address gaps in the current system. In the second phase, a causal loop diagram was developed to identify feedback loops and evaluate potential impacts of the interventions on patients and care providers. In the last phase, the analysis was linked to decision making on intervention implementation. Overall, this whole process based on systems thinking helped the health-care organization to holistically understand the impact of various components of their CKD care system. Furthermore, the findings from the qualitative modeling and analysis provided the leadership with insights into gaps in care and a way forward for implementing interventions more successfully and effectively. Journal: Health Systems Pages: 130-147 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2015.17 File-URL: http://hdl.handle.net/10.1057/hs.2015.17 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:130-147 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933317_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Renata Konrad Author-X-Name-First: Renata Author-X-Name-Last: Konrad Author-Name: Christine Tang Author-X-Name-First: Christine Author-X-Name-Last: Tang Author-Name: Brian Shiner Author-X-Name-First: Brian Author-X-Name-Last: Shiner Author-Name: Bradley V Watts Author-X-Name-First: Bradley V Author-X-Name-Last: Watts Title: Workforce design in primary care-mental health integration: a case study at one veterans affairs medical center Abstract: Many Veterans screen positive for mental health disorders in primary care, yet it appears that only a fraction of those who could benefit receive treatment. One potential way to ensure that a larger proportion of these Veterans receive appropriate care would be to increase access to mental health services through primary care-mental health integration (PC-MHI) clinics. Yet a systematic method to evaluate the impact of projected increases in patient volumes on PC-MHI clinics is lacking. As a first step, we develop and validate a discrete-event simulation model to understand how the clinic could respond to a projected increase in PC-MHI utilization at one Veterans Affairs Medical Center. Numerical results illustrate the impact of increased patient volume and the availability of providers on patient wait times and patients seen by mental health providers outside of clinic hours. We also note that although discrete-event simulation has a long history in health care, it is rarely used in the assessment of the resource allocation decisions in mental health. Journal: Health Systems Pages: 148-160 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2015.18 File-URL: http://hdl.handle.net/10.1057/hs.2015.18 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:148-160 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933318_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Muge Capan Author-X-Name-First: Muge Author-X-Name-Last: Capan Author-Name: Pan Wu Author-X-Name-First: Pan Author-X-Name-Last: Wu Author-Name: Michele Campbell Author-X-Name-First: Michele Author-X-Name-Last: Campbell Author-Name: Susan Mascioli Author-X-Name-First: Susan Author-X-Name-Last: Mascioli Author-Name: Eric V Jackson Author-X-Name-First: Eric V Author-X-Name-Last: Jackson Title: Using electronic health records and nursing assessment to redesign clinical early recognition systems Abstract: As health-care organizations transition from paper to electronic documentation systems, capturing the nursing assessment electronically can play a fundamental role in transforming health-care delivery. Especially in preventive health, electronic capture of nursing assessment, combined with vital sign-based monitoring, can support early detection of physiological deterioration of patients. While vital sign-based Early Warning Systems have the potential to detect signals of physiological deterioration, their clinical interpretation and integration into the workflow in hospital-based care setting remain a challenge. This study presents a clinical early recognition algorithm using electronic health records (EHRs) coupled with an electronic Nurse Screening Assessment (NSA) that targets various health assessment categories and its integration into the nursing workflow. Data was collected retrospectively from a single institution (N=2,405 visits). χ2 tests showed significant differences between algorithms with and without NSA (P<0.01). This study provides a practical framework for facilitating the meaningful use of EHRs in hospitals. Journal: Health Systems Pages: 112-121 Issue: 2 Volume: 6 Year: 2017 Month: 7 X-DOI: 10.1057/hs.2015.19 File-URL: http://hdl.handle.net/10.1057/hs.2015.19 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:6:y:2017:i:2:p:112-121 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1687264_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sue S. Feldman Author-X-Name-First: Sue S. Author-X-Name-Last: Feldman Author-Name: Ferhat D. Zengul Author-X-Name-First: Ferhat D. Author-X-Name-Last: Zengul Author-Name: Bunyamin Ozaydin Author-X-Name-First: Bunyamin Author-X-Name-Last: Ozaydin Author-Name: Victoria Brazil Author-X-Name-First: Victoria Author-X-Name-Last: Brazil Author-Name: Leslie Hayes Author-X-Name-First: Leslie Author-X-Name-Last: Hayes Author-Name: Benjamin Schooley Author-X-Name-First: Benjamin Author-X-Name-Last: Schooley Title: Introduction to “health informatics, healthcare quality and safety, and healthcare simulation: the new triad to advance healthcare operations” Abstract: This special themed international issue explores the multiple facets of health informatics, healthcare quality and safety, and healthcare simulation from different parts of the world. The papers in this issue fall into two broad themes. The first theme uses the intersection to address better management of care including physical design layout. The second theme examines innovative uses of the triad to prevent critical and non-critical safety events. The collection of papers culminates with a position paper reporting on the interdependence that is emerging as an important triad for research and practice within medical education, system development and testing, and teamwork and communication and concludes with reducing imprecision and factual errors in handoffs. Findings from the special collection of papers can inform managers and leaders on advancing operations in healthcare settings. Journal: Health Systems Pages: 153-154 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1687264 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1687264 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:153-154 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1620638_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Lauren Shivers Author-X-Name-First: Lauren Author-X-Name-Last: Shivers Author-Name: Sue S. Feldman Author-X-Name-First: Sue S. Author-X-Name-Last: Feldman Author-Name: Leslie W. Hayes Author-X-Name-First: Leslie W. Author-X-Name-Last: Hayes Title: Development of a computerized paediatric intensive care unit septic shock pathway: improving user experience Abstract: The purpose of this study was to understand the user experience with a computerized septic shock protocol relative to the workflow of Paediatric Intensive Care Unit clinicians. The need for data-driven, condition-specific, computerized protocols in the intensive care unit helps improve decision-making at the bedside. PICU clinicians were interviewed and given pre-and post-implementation surveys asking their opinions on the current PICU septic shock protocol, as well as the current electronic health record being used at [Paediatric Academic Medical Center]. User preferences guided adjustments toward improved usability of the septic shock protocol. Computerized Physician Order Entry, a critical component of the septic shock protocol, allows for more streamlined processes, more complete records, and more time to care for patients. This study revealed that although clinicians had an unfavorable view of the EHR in general, the computerized septic shock protocol was very well-received with an overall usability score of 82. Journal: Health Systems Pages: 155-161 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1620638 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1620638 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:155-161 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1561160_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Vahab Vahdat Author-X-Name-First: Vahab Author-X-Name-Last: Vahdat Author-Name: Amir Namin Author-X-Name-First: Amir Author-X-Name-Last: Namin Author-Name: Rana Azghandi Author-X-Name-First: Rana Author-X-Name-Last: Azghandi Author-Name: Jacqueline Griffin Author-X-Name-First: Jacqueline Author-X-Name-Last: Griffin Title: Improving patient timeliness of care through efficient outpatient clinic layout design using data-driven simulation and optimisation Abstract: With greater demand for outpatient services, the importance of patient-centric clinic layout design that improves timeliness of patient care has become more elucidated. In this paper, a novel simulation-optimisation (SO) framework is proposed focusing on the physical and process flows of patients in the design of a paediatric orthopaedic outpatient clinic. A discrete-event simulation model is used to estimate the frequency of movements between clinic units. The resulting information is utilised as input to a mixed integer programming (MIP) model, optimising the clinic layout design. In order to solve the MIP model, Particle Swarm Optimisation (PSO), a metaheuristic approach enhanced with several heuristics is utilised. Finally, the optimisation model outputs are evaluated with the simulation model. The results demonstrate that improvements to the quality of the patient experience can be achieved through incorporating SO methods into the clinic layout design process. Journal: Health Systems Pages: 162-183 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2018.1561160 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1561160 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:162-183 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1569482_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Shilpa Register Author-X-Name-First: Shilpa Author-X-Name-Last: Register Author-Name: Michelle Brown Author-X-Name-First: Michelle Author-X-Name-Last: Brown Author-Name: Marjorie Lee White Author-X-Name-First: Marjorie Lee Author-X-Name-Last: White Title: Using healthcare simulation in space planning to improve efficiency and effectiveness within the healthcare system Abstract: Healthcare professionals are continuously being challenged to address the triple aim necessary for effective patient care: improving the quality and satisfaction of patients, improving the health of populations, and reducing per capita cost of healthcare. Today, innovation and cost-effective methods are a requirement to meet the triple aim given the current economic climate and financial limitations. Healthcare simulation is currently underutilised, particularly during the space or facility planning process in healthcare. This position paper will describe the process of implementing space simulations that were conducted between 2016 and 2018 in six different clinical settings that identified patient and provider safety concerns, and patient and provider needs. Simulation design and development along with the methodology for data collection and data analyses will be presented. Qualitative results will be presented to demonstrate the impact of the use of simulation to prevent critical and non-critical safety events.  Journal: Health Systems Pages: 184-189 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1569482 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1569482 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:184-189 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1599701_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Olufemi A. Omitaomu Author-X-Name-First: Olufemi A. Author-X-Name-Last: Omitaomu Author-Name: Ozgur Ozmen Author-X-Name-First: Ozgur Author-X-Name-Last: Ozmen Author-Name: Mohammed M. Olama Author-X-Name-First: Mohammed M. Author-X-Name-Last: Olama Author-Name: Laura L. Pullum Author-X-Name-First: Laura L. Author-X-Name-Last: Pullum Author-Name: Teja Kuruganti Author-X-Name-First: Teja Author-X-Name-Last: Kuruganti Author-Name: James Nutaro Author-X-Name-First: James Author-X-Name-Last: Nutaro Author-Name: Hilda B. Klasky Author-X-Name-First: Hilda B. Author-X-Name-Last: Klasky Author-Name: Helia Zandi Author-X-Name-First: Helia Author-X-Name-Last: Zandi Author-Name: Aneel Advani Author-X-Name-First: Aneel Author-X-Name-Last: Advani Author-Name: Angela L. Laurio Author-X-Name-First: Angela L. Author-X-Name-Last: Laurio Author-Name: Merry Ward Author-X-Name-First: Merry Author-X-Name-Last: Ward Author-Name: Jeanie Scott Author-X-Name-First: Jeanie Author-X-Name-Last: Scott Author-Name: Jonathan R. Nebeker Author-X-Name-First: Jonathan R. Author-X-Name-Last: Nebeker Title: Real-Time Automated Hazard Detection Framework for Health Information Technology Systems Abstract: An increase in the reliability of Health Information Technology (HIT) will facilitate institutional trust and credibility of the systems. In this paper, we present an end-to-end framework for improving the reliability and performance of HIT systems. Specifically, we describe the system model, present some of the methods that drive the model, and discuss an initial implementation of two of the proposed methods using data from the Veterans Affairs HIT and Corporate Data Warehouse systems. The contributions of this paper, thus, include (1) the design of a system model for monitoring and detecting hazards in HIT systems, (2) a data-driven approach for analysing the health care data warehouse, (3) analytical methods for characterising and analysing failures in HIT systems, and (4) a tool architecture for generating and reporting hazards in HIT systems. Our goal is to work towards an automated system that will help identify opportunities for improvements in HIT systems. Journal: Health Systems Pages: 190-202 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1599701 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1599701 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:190-202 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1620637_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Danny T. Y. Wu Author-X-Name-First: Danny T. Y. Author-X-Name-Last: Wu Author-Name: Smruti Deoghare Author-X-Name-First: Smruti Author-X-Name-Last: Deoghare Author-Name: Zhe Shan Author-X-Name-First: Zhe Author-X-Name-Last: Shan Author-Name: Karthikeyan Meganathan Author-X-Name-First: Karthikeyan Author-X-Name-Last: Meganathan Author-Name: Katherine Blondon Author-X-Name-First: Katherine Author-X-Name-Last: Blondon Title: The potential role of dashboard use and navigation in reducing medical errors of an electronic health record system: a mixed-method simulation handoff study Abstract: The dashboards of electronic health record (EHR) systems could potentially support the chart biopsy that occurs before or after physician handoffs. In this study, we conducted a simulation handoff study and recorded the participants’ navigation patterns in an EHR system mock-up. We analyzed the navigation patterns of dashboard use in terms of duration, frequency, and sequence, and we examined the relationship between dashboard use in chart biopsy and the errors identified after handoffs. The results show that the participants frequently used the dashboard as an information hub and as an information resource to help them navigate the EHR system and answer the questions in a nursing call. Moreover, using the dashboard as an information hub can help reduce imprecision and factual errors in handoffs. Our findings suggest the need for a “context-aware” dashboard to accommodate dynamic navigation patterns and to support clinical work as well as to reduce medical errors. Journal: Health Systems Pages: 203-214 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1620637 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1620637 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:203-214 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1687263_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Shikha Modi Author-X-Name-First: Shikha Author-X-Name-Last: Modi Author-Name: Bunyamin Ozaydin Author-X-Name-First: Bunyamin Author-X-Name-Last: Ozaydin Author-Name: Ferhat Zengul Author-X-Name-First: Ferhat Author-X-Name-Last: Zengul Author-Name: Sue S. Feldman Author-X-Name-First: Sue S. Author-X-Name-Last: Feldman Title: The emerging literature for the triad of health informatics, healthcare quality and safety, and healthcare simulation Abstract: The areas of health informatics, healthcare quality and safety, and healthcare simulation are often thought of as separate domains. The purpose of this position paper is to report on the interdependence that is emerging as an important triad across the healthcare/health system continuum. A qualitative review of 24 studies suggests the interdependence of health informatics, healthcare quality and safety, and healthcare simulation reaches much broader than traditional utilisation of simulation. We suggest ways that organisations can take advantage of the interdependence of this triad across a broader variety of healthcare environments, including teamwork, communication, and complex system relationships. In conclusion, the reviewed 24 studies suggest that the research in the triad focuses on simulation education and computerised simulation, and when coupled with health informatics, bears greater strength on quality improvement or patient safety. Journal: Health Systems Pages: 215-227 Issue: 3 Volume: 8 Year: 2019 Month: 9 X-DOI: 10.1080/20476965.2019.1687263 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1687263 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:3:p:215-227 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933277_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sofie Wass Author-X-Name-First: Sofie Author-X-Name-Last: Wass Author-Name: Bertil Carlsson Author-X-Name-First: Bertil Author-X-Name-Last: Carlsson Author-Name: Vivian Vimarlund Author-X-Name-First: Vivian Author-X-Name-Last: Vimarlund Author-Name: Seher Korkmaz Author-X-Name-First: Seher Author-X-Name-Last: Korkmaz Author-Name: Tero Shemeikka Author-X-Name-First: Tero Author-X-Name-Last: Shemeikka Author-Name: Anikó Vég Author-X-Name-First: Anikó Author-X-Name-Last: Vég Title: Exploring the effects of eHealth service innovation Abstract: To analyse the impact of implementation and use of eHealth services is fraught with difficulty, and there is often a gap between expected and identified outcomes. In this paper, we identify innovation effects of an eHealth service by applying a framework that focusses on the expected coherent impacts of implementing an IT innovation and contributes to the body of knowledge on tracking innovation effects of services in eHealth. A case study examines four different care units in a government-funded health-care setting. The results show that the effects in the first two contexts of the framework, the micro level and intra-/interorganisational level, could be clearly identified with regard to the physicians and the organisation. However, effects were lacking in the virtual context when looking beyond the involvement of the stakeholders in the eHealth service. The connections between effects for societal groups and larger societal systems simply could not be made in a satisfactory manner. Journal: Health Systems Pages: 212-223 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2014.15 File-URL: http://hdl.handle.net/10.1057/hs.2014.15 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:212-223 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933278_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Faustina Acheampong Author-X-Name-First: Faustina Author-X-Name-Last: Acheampong Author-Name: Vivian Vimarlund Author-X-Name-First: Vivian Author-X-Name-Last: Vimarlund Title: Business models for telemedicine services: a literature review Abstract: Telemedicine has been acknowledged to improve the quality of healthcare. However, many telemedicine services fail beyond the pilot phase. A literature review on business model components for telemedicine services was conducted. Based on specified inclusion criteria, 22 publications were included in the review. To facilitate the analysis of literature, a business model framework with value as its central focus was proposed. Improvement in quality, efficiency and accessibility of care were identified to be the outcomes of telemedicine, with patients and healthcare personnel being the main users of the services, which are delivered through home, institutional and community-based care. Patients, health providers, vendors, payers and government agencies are actors involved in the delivery of telemedicine services, which require investments in resources like videoconferencing technologies, home monitoring devices and other IT infrastructure. Subscriptions, reimbursements and pay-per-use revenue streams were identified as feasible for commercializing telemedicine services. Journal: Health Systems Pages: 189-203 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2014.20 File-URL: http://hdl.handle.net/10.1057/hs.2014.20 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:189-203 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933279_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Aric Katz Author-X-Name-First: Aric Author-X-Name-Last: Katz Author-Name: Fuad Basis Author-X-Name-First: Fuad Author-X-Name-Last: Basis Author-Name: Avraham Shtub Author-X-Name-First: Avraham Author-X-Name-Last: Shtub Title: Using Wizard of Oz technology for telemedicine Abstract: Traditional computer simulations do not incorporate human intuition and human-like engagement that acknowledges complex and abstract questions. This paper presents WOTS (Wizard of Oz Telemedicine Simulator), a generic cognitive training platform that supports transfer of medical knowledge through remote training and consultations (telemedicine training). Medical training via the WOTS provides remote learners a risk-free environment in which they can practice and make mistakes, while receiving online feedback about their decisions. WOTS leverages the Wizard of Oz (WOZ) concept, where human intuition is applied through corrective feedback to complex and abstract misconceptions of learners’ thinking (flawed mental models). The contribution of WOTS to enhanced learning is demonstrated by a number of pilot runs and a case study. Journal: Health Systems Pages: 224-235 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2014.23 File-URL: http://hdl.handle.net/10.1057/hs.2014.23 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:224-235 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933280_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Christophe Van Huele Author-X-Name-First: Christophe Author-X-Name-Last: Van Huele Author-Name: Mario Vanhoucke Author-X-Name-First: Mario Author-X-Name-Last: Vanhoucke Title: Decomposition-based heuristics for the integrated physician rostering and surgery scheduling problem Abstract: In this paper, a comparison and validation of various priority rules for the Integrated Physician Rostering and Surgery Scheduling Problem (IPSSP) under different objective functions is made. We integrate three constructive heuristic types with two corresponding priority rule classes in order to obtain a solution for the combined physician rostering and surgery scheduling problem. Twelve priority rules for the surgery assignments and six priority rules for the physician rostering are used to schedule the surgeries in the operating theatre on a weekly basis, while generating adequate rosters for the physicians that maximizes their preferences. Our goal is to provide a suitable heuristic for every problem type, problem size and problem structure for the hospital manager to use in every possible condition. The problem type represents the most occurring objectives and goals according to literature. The problem size depicts the size of the hospital and its corresponding utilization. The problem structure defines the different demands of the physician roster and the surgery schedule. It can be shown that for every situation a fitting heuristic can be provided. These high-quality decomposition-based constructive heuristics can also be used in meta-heuristics to generate good solutions. Most importantly, we have established general recommendations with respect to the use of the different proposed heuristics in different hospital settings. Journal: Health Systems Pages: 159-175 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2014.27 File-URL: http://hdl.handle.net/10.1057/hs.2014.27 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:159-175 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933281_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Maria E Mayorga Author-X-Name-First: Maria E Author-X-Name-Last: Mayorga Author-Name: Odette S Reifsnider Author-X-Name-First: Odette S Author-X-Name-Last: Reifsnider Author-Name: Zinan Yi Author-X-Name-First: Zinan Author-X-Name-Last: Yi Author-Name: Kelly J Hunt Author-X-Name-First: Kelly J Author-X-Name-Last: Hunt Title: Trends in BMI and obesity in U.S. women of childbearing age during the period of 1980–2010 Abstract: Statistical analyses and simulation are combined to provide insights about the trends in weight gain in U.S. women of childbearing age. This population is of specific interest because it is central to understanding the trans-generational effects of obesity in future U.S. populations. We estimated BMI trends among women of childbearing age during the period 1980–2010 using the National Health and Nutrition Examination Survey (NHANES) data. Then, we introduce a secondary approach; using the BMI profile of women by age and race as it was before the onset of the obesity epidemic (1970–1980) we project the BMI of women during the period 1980–2010 using U.S. Census demographic information. Hence, we compare the real-world situation to the age-adjusted scenario without the obesity epidemic. We found that there are differences in weight gain in black and white women, the racial disparity has worsened over time and that changes in the racial disparity were not because of changes in the age structure of the population. Journal: Health Systems Pages: 176-186 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2014.29 File-URL: http://hdl.handle.net/10.1057/hs.2014.29 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:176-186 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933282_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Gunilla Myreteg Author-X-Name-First: Gunilla Author-X-Name-Last: Myreteg Title: Cost-benefit evaluation of e-health services: acceptance and value creation are interactive forces Abstract: Resources are limited in health care. There is a scarcity of knowledge on how to economically evaluate e-health. The present study is a review of research in this area. The article proposes a theoretical frame of reference for cost-benefit evaluation of e-health services from the vantage point of electronic health records. The basis of the evaluation needs to acknowledge the context of all relevant heterogeneous stakeholder groups. Acceptance is linked to the unique situation, as one group may perceive costs while another realizes the benefits. The model is expressed as a loop, where expected values and realized values within the processes are intricately connected to one another, evolving over time. Journal: Health Systems Pages: 204-211 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2015.10 File-URL: http://hdl.handle.net/10.1057/hs.2015.10 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:204-211 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933283_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: David Ben-Arieh Author-X-Name-First: David Author-X-Name-Last: Ben-Arieh Author-Name: Vivian Vimarlund Author-X-Name-First: Vivian Author-X-Name-Last: Vimarlund Author-Name: Patrick Boissy Author-X-Name-First: Patrick Author-X-Name-Last: Boissy Title: Special issue on evaluation of telehealth and e-health systems and processes Journal: Health Systems Pages: 187-188 Issue: 3 Volume: 4 Year: 2015 Month: 11 X-DOI: 10.1057/hs.2015.14 File-URL: http://hdl.handle.net/10.1057/hs.2015.14 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:3:p:187-188 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1848357_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Maartje Zonderland Author-X-Name-First: Maartje Author-X-Name-Last: Zonderland Author-Name: Jos Bekkers Author-X-Name-First: Jos Author-X-Name-Last: Bekkers Author-Name: Jasper van Bommel Author-X-Name-First: Jasper Author-X-Name-Last: van Bommel Author-Name: Maarten Ter Horst Author-X-Name-First: Maarten Author-X-Name-Last: Ter Horst Author-Name: Wouter van Leeuwen Author-X-Name-First: Wouter Author-X-Name-Last: van Leeuwen Author-Name: Femke van den Wall Bake Author-X-Name-First: Femke Author-X-Name-Last: van den Wall Bake Author-Name: Willem Wiegersma Author-X-Name-First: Willem Author-X-Name-Last: Wiegersma Author-Name: Ad Bogers Author-X-Name-First: Ad Author-X-Name-Last: Bogers Title: Increasing cardio-thoracic productivity at Erasmus MC Abstract: 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. Journal: Health Systems Pages: 68-74 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1848357 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1848357 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:68-74 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1848356_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ramna Thakur Author-X-Name-First: Ramna Author-X-Name-Last: Thakur Author-Name: Shivendra Sangar Author-X-Name-First: Shivendra Author-X-Name-Last: Sangar Title: Socioeconomic differentials in the burden of paying for healthcare in India: a disaggregated analysis Abstract: 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 Journal: Health Systems Pages: 48-58 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1848356 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1848356 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:48-58 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1857663_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Guillaume Lamé Author-X-Name-First: Guillaume Author-X-Name-Last: Lamé Author-Name: Sonya Crowe Author-X-Name-First: Sonya Author-X-Name-Last: Crowe Author-Name: Matthew Barclay Author-X-Name-First: Matthew Author-X-Name-Last: Barclay Title: “What’s the evidence?”—Towards more empirical evaluations of the impact of OR interventions in healthcare Abstract: 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. Journal: Health Systems Pages: 59-67 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1857663 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1857663 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:59-67 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1848355_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mohd Shoaib Author-X-Name-First: Mohd Author-X-Name-Last: Shoaib Author-Name: Utkarsh Prabhakar Author-X-Name-First: Utkarsh Author-X-Name-Last: Prabhakar Author-Name: Sumit Mahlawat Author-X-Name-First: Sumit Author-X-Name-Last: Mahlawat Author-Name: Varun Ramamohan Author-X-Name-First: Varun Author-X-Name-Last: Ramamohan Title: A discrete-event simulation model of the kidney transplantation system in Rajasthan, India Abstract: 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. Journal: Health Systems Pages: 30-47 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1848355 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1848355 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:30-47 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1813056_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Gustavo M. Bacelar-Silva Author-X-Name-First: Gustavo M. Author-X-Name-Last: Bacelar-Silva Author-Name: James F. Cox Author-X-Name-First: James F. Author-X-Name-Last: Cox Author-Name: Pedro Pereira Rodrigues Author-X-Name-First: Pedro Pereira Author-X-Name-Last: Rodrigues Title: Outcomes of managing healthcare services using the Theory of Constraints: A systematic review Abstract: Despite ever-increasing resources devoted to healthcare, lack of capacity and timeliness are still chronic problems worldwide. This systematic review aims to present an overview of the Theory of Constraints (TOC) implementations in healthcare services and their outcomes. We analysed 42 TOC implementations (15 full-text articles, 12 video proceedings, and 2 theses/disserations) from major scientific electronic databases and TOC International Certification Organization Conferences. All implementations reported positive outcomes, both tangible and intangible. The two main improvements reported by authors were in productivity (98%; n = 41) – more patients treated – and in the timeliness of care (83%; n = 35). Furthermore, the selected studies reported dramatic improvements: 50% mean reductions in patient waiting time; 38% reduction in patient length of stay; 43% mean increase in operating room productivity and 34% mean increase in throughput. TOC implementations attained positive results in all levels of the health and social care chain. Most TOC recommendations and changes showed almost immediate results and required little or no additional cost to implement. Evidence supports TOC as a promising solution for the chronic healthcare problem, improving quality and timeliness, both necessary conditions for providing effective healthcare. Journal: Health Systems Pages: 1-16 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1813056 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1813056 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:1-16 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1822146_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Stephen McCarthy Author-X-Name-First: Stephen Author-X-Name-Last: McCarthy Author-Name: Ciara Fitzgerald Author-X-Name-First: Ciara Author-X-Name-Last: Fitzgerald Author-Name: Laura Sahm Author-X-Name-First: Laura Author-X-Name-Last: Sahm Author-Name: Colin Bradley Author-X-Name-First: Colin Author-X-Name-Last: Bradley Author-Name: Elaine K Walsh Author-X-Name-First: Elaine K Author-X-Name-Last: Walsh Title: Patient-held health IT adoption across the primary-secondary care interface: a Normalisation Process Theory perspective Abstract: Patient-held Health Information Technologies (HIT) can reduce medical error by improving communication between patients and the healthcare team. Despite the proposed benefits, the roll-out of patient-held HIT solutions remains nascent, leaving considerable gaps in our understanding of the adoption challenges inherent. This paper adopts Normalisation Process Theory to study the factors which support or impede the adoption and “normalisation” of patient-held HIT, particularly across the primary-secondary care interface. The authors conducted an in-depth case study of HIT adoption across four GP practices, and the wards of a 350 bed hospital. 35 semi-structured interviews were completed. Findings point towards both user-specific and network-specific factors as significant challenges to normalisation across primary-secondary care. This includes factors related to interactional workability, skill set workability, relational integration, and contextual integration. We also discuss challenges specific to patient-held HIT adoption e.g., understanding the patient/clinician experience, supporting informal clinician networks, and spanning across IT boundaries. Journal: Health Systems Pages: 17-29 Issue: 1 Volume: 11 Year: 2022 Month: 01 X-DOI: 10.1080/20476965.2020.1822146 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1822146 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:1:p:17-29 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1700764_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Richard M Wood Author-X-Name-First: Richard M Author-X-Name-Last: Wood Title: Unravelling the dynamics of referral-to-treatment in the NHS Abstract: Despite being the principal measure of elective performance in Great Britain’s National Health Service, there is little on-the-ground awareness of the dynamics at play behind the referral-to-treatment (RTT) standard. Through a simple worked analogy, it is shown how this performance measure – calculated as the proportion of unresolved RTT pathways within 18 weeks from referral – is dependent on the interplay between elective demand and capacity. Bringing in activity (cost) and waiting list size, the presented theory unifies the five key components of the pathway dynamics for the first time within the published literature. A computer simulation model based on these principles is thereafter constructed as part of a more quantitative analysis using publicly available national data for 2017–2018. In this, referral rates and capacity are varied in line with a range of “what if” scenarios known to be of interest to service planners, with the effect on performance and cost objectively assessed. Journal: Health Systems Pages: 131-137 Issue: 2 Volume: 10 Year: 2021 Month: 04 X-DOI: 10.1080/20476965.2019.1700764 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1700764 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:2:p:131-137 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1700763_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Vikas Agrawal Author-X-Name-First: Vikas Author-X-Name-Last: Agrawal Author-Name: Aber Elsaleiby Author-X-Name-First: Aber Author-X-Name-Last: Elsaleiby Author-Name: Yue Zhang Author-X-Name-First: Yue Author-X-Name-Last: Zhang Author-Name: P. S. Sundararaghavan Author-X-Name-First: P. S. Author-X-Name-Last: Sundararaghavan Author-Name: Andrew Casabianca Author-X-Name-First: Andrew Author-X-Name-Last: Casabianca Title: Minimax cth percentile of makespan in surgical scheduling Abstract: In this paper, we address the problem of finding an assignment of n surgeries to be performed in one of m parallel identical operating rooms (ORs), given each surgery has a stochastic duration with a known mean and standard deviation. The objective is to minimise the maximum of the cth percentile of makespan of any OR. We formulate this problem as a nonlinear integer program, and small-sized instances are solved using the GAMS BONMIN solver. We develop a greedy heuristic and a genetic algorithm procedure for solving large-sized instances. Using real data from a major U.S. teaching hospital and benchmarking datasets from the literature, we report on the performance of the heuristics as compared to the GAMS BONMIN solver. Journal: Health Systems Pages: 118-130 Issue: 2 Volume: 10 Year: 2021 Month: 04 X-DOI: 10.1080/20476965.2019.1700763 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1700763 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:2:p:118-130 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1666036_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Fanny Camiat Author-X-Name-First: Fanny Author-X-Name-Last: Camiat Author-Name: Marìa I. Restrepo Author-X-Name-First: Marìa I. Author-X-Name-Last: Restrepo Author-Name: Jean-Marc Chauny Author-X-Name-First: Jean-Marc Author-X-Name-Last: Chauny Author-Name: Nadia Lahrichi Author-X-Name-First: Nadia Author-X-Name-Last: Lahrichi Author-Name: Louis-Martin Rousseau Author-X-Name-First: Louis-Martin Author-X-Name-Last: Rousseau Title: Productivity-driven physician scheduling in emergency departments Abstract: The objective of this study is two-fold: to propose an alternative approach for computing the productivity of physicians in emergency departments (EDs); and, to allocate productivity-driven schedules to ED physicians so as to align physician productivity with demand (patient arrivals), without decreasing fairness between physicians, in order to improve patient wait times. Historical data between 2008 and 2017 from the Sacré-Coeur Montreal Hospital ED is analysed and used to predict the demand and to estimate the productivity of each physician. These estimates are incorporated into a mathematical programming model that identifies feasible schedules to physicians that minimise the difference between patients’ demand and physicians’ productivity, along with the violation of physicians’ preferences and fairness in the distribution of shifts. Results on real-world-based data show that when physician productivity is included in the allocation of schedules, demand under-covering is reduced by 10.85% and the fairness between physicians is maintained. However, physicians’ preferences (e.g., sum of the differences between the number of wanted shifts and the number of allocated shifts) deteriorates by 7.61%. By incorporating the productivity of physicians in the scheduling process, we see a reduction in EDs overcrowding and an improvement in the overall quality of health-care services. Journal: Health Systems Pages: 104-117 Issue: 2 Volume: 10 Year: 2021 Month: 04 X-DOI: 10.1080/20476965.2019.1666036 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1666036 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:2:p:104-117 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1663974_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Benjamin Schooley Author-X-Name-First: Benjamin Author-X-Name-Last: Schooley Author-Name: Tonia San Nicolas-Rocca Author-X-Name-First: Tonia Author-X-Name-Last: San Nicolas-Rocca Author-Name: Richard Burkhard Author-X-Name-First: Richard Author-X-Name-Last: Burkhard Title: Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation Abstract: Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps. Journal: Health Systems Pages: 89-103 Issue: 2 Volume: 10 Year: 2021 Month: 04 X-DOI: 10.1080/20476965.2019.1663974 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1663974 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:2:p:89-103 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1729666_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: José Carlos Ferrão Author-X-Name-First: José Carlos Author-X-Name-Last: Ferrão Author-Name: Mónica Duarte Oliveira Author-X-Name-First: Mónica Duarte Author-X-Name-Last: Oliveira Author-Name: Filipe Janela Author-X-Name-First: Filipe Author-X-Name-Last: Janela Author-Name: Henrique M. G. Martins Author-X-Name-First: Henrique M. G. Author-X-Name-Last: Martins Author-Name: Daniel Gartner Author-X-Name-First: Daniel Author-X-Name-Last: Gartner Title: Can structured EHR data support clinical coding? A data mining approach Abstract: Structured data formats are gaining momentum in electronic health records and can be leveraged for decision support and research. Nevertheless, such structured data formats have not been explored for clinical coding, which is an essential process requiring significant manual workload in health organisations. This article explores the extent to which fully structured clinical data can support assignment of clinical codes to inpatient episodes, through a methodology that tackles high dimensionality issues, addresses the multi-label nature of coding and optimises model parameters. The methodology encompasses transformation of raw data to define a feature set, build a data matrix representation, and testing combinations of feature selection methods with machine learning models to predict code assignment. The methodology was tested with a real hospital dataset and showed varying predictive power across codes, while demonstrating the potential of leveraging structuring data to reduce workload and increase efficiency in clinical coding. Journal: Health Systems Pages: 138-161 Issue: 2 Volume: 10 Year: 2021 Month: 04 X-DOI: 10.1080/20476965.2020.1729666 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1729666 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:2:p:138-161 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1732013_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sue S. Feldman Author-X-Name-First: Sue S. Author-X-Name-Last: Feldman Title: Health informatics, healthcare quality and safety, and healthcare simulation: continuing the discussion to advance healthcare operations Abstract: This issue is the second in the series to explore the intersection of health informatics, healthcare quality and safety, and healthcare simulation. The uses of all three domains to advance healthcare operations has been diverse and intentional across a variety of domestic and international organisations. This issue focuses primarily on studies that use throughput modelling and system modelling. Findings from this special collection of papers demonstrate the value of modelling techniques and their role in predicting and enhancing healthcare operations. Journal: Health Systems Pages: 1-1 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2020.1732013 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1732013 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:1-1 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1680260_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Daniel Bouzon Nagem Assad Author-X-Name-First: Daniel Author-X-Name-Last: Bouzon Nagem Assad Author-Name: Thaís Spiegel Author-X-Name-First: Thaís Author-X-Name-Last: Spiegel Title: Improving emergency department resource planning: a multiple case study Abstract: Sizing and allocating health-care professionals are a critical problem in the management of emergency departments (EDs) managed by a public company in Rio de Janeiro (Brazil). An efficient ED configuration that is cost and time effective must be developed by this company for hospital managers. In this paper, the problem of health-care professional configurations in EDs is modelled to minimise the total labour cost while satisfying patient queues and waiting times as defined by the actual ED capacity and current clinical protocols. To solve this issue, mixed integer linear programming (MILP) that allocates health-care professionals and specifies the amount of professionals who must be hired is proposed. To consider the uncertainties in this environment and evaluate their impacts, a discrete-event simulation model is developed to reflect patient flow. An optimisation and simulation approach is used to search for efficiency leads for different ED configurations. These configurations change depending on the shift and the day of the week. Journal: Health Systems Pages: 2-30 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2019.1680260 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1680260 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:2-30 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1561161_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Muhammed Ordu Author-X-Name-First: Muhammed Author-X-Name-Last: Ordu Author-Name: Eren Demir Author-X-Name-First: Eren Author-X-Name-Last: Demir Author-Name: Chris Tofallis Author-X-Name-First: Chris Author-X-Name-Last: Tofallis Title: A decision support system for demand and capacity modelling of an accident and emergency department Abstract: Accident and emergency (A&E) departments in England have been struggling against severe capacity constraints. In addition, A&E demands have been increasing year on year. In this study, our aim was to develop a decision support system combining discrete event simulation and comparative forecasting techniques for the better management of the Princess Alexandra Hospital in England. We used the national hospital episodes statistics data-set including period April, 2009 – January, 2013. Two demand conditions are considered: the expected demand condition is based on A&E demands estimated by comparing forecasting methods, and the unexpected demand is based on the closure of a nearby A&E department due to budgeting constraints. We developed a discrete event simulation model to measure a number of key performance metrics. This paper presents a crucial study which will enable service managers and directors of hospitals to foresee their activities in future and form a strategic plan well in advance. Journal: Health Systems Pages: 31-56 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2018.1561161 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1561161 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:31-56 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1599702_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: M. Rita Thissen Author-X-Name-First: M. Rita Author-X-Name-Last: Thissen Author-Name: Katherine M. Mason Author-X-Name-First: Katherine M. Author-X-Name-Last: Mason Title: Planning security architecture for health survey data storage and access Abstract: Sensitive data from health research surveys need to be protected from loss, damage or unwanted release, especially when data include personally identifying information, protected health information or other private material. Researchers and practitioners must ensure privacy and confidentiality in the architecture of data systems and in access to the data. Internal and external risks may be deliberate or accidental, involving unintended loss, modification or exposure. To prevent risk while allowing access requires balancing concerns against providing an environment that does not impede work. The authors’ purpose in this paper is to draw attention to basic data security needs for health survey data from the perspective of both the health researcher/practitioner and infrastructure/programming staff to ensure that data are securely and adequately protected. We describe risk classifications and how they affect system architecture, drawing on recent experience with systems for storage of and access to electronic health survey data. Journal: Health Systems Pages: 57-63 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2019.1599702 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1599702 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:57-63 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1561159_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nasim Sabounchi Author-X-Name-First: Nasim Author-X-Name-Last: Sabounchi Author-Name: Nasser Sharareh Author-X-Name-First: Nasser Author-X-Name-Last: Sharareh Author-Name: Fatima Irshaidat Author-X-Name-First: Fatima Author-X-Name-Last: Irshaidat Author-Name: Serdar Atav Author-X-Name-First: Serdar Author-X-Name-Last: Atav Title: Spatial dynamics of access to primary care for the medicaid population Abstract: Primary care (PC) has always been underestimated and underinvested by the United States health system. Our goal was to investigate the effect of Medicaid expansion and the Affordable Care Act (ACA) provisions on PC access in Broome County, NY, a county that includes both rural and urban areas, and can serve as a benchmark for other regions. We developed a spatial system dynamics model to capture different stages of PC access for the Medicaid population by using the health belief model constructs and simulate the effect of several hypothetical interventions on PC utilisation. The government data portals used as data sources for calibrating our model include the New York State Department of Health, the Medicaid Delivery System Reform Incentive Payment (DSRIP) dashboards, and the US census. In our unique approach, we integrated the simulation results within Geographical Information System (GIS) maps, to assess the influence of geospatial factors on PC access. Our results identify hot spot demographic areas that have poor access to PC service facilities due to transportation constraints and a shortage in PC providers. Our decision support tool informs policymakers about programmes with the strongest impact on improving access to care, considering spatial and temporal characteristics of a region. Journal: Health Systems Pages: 64-75 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2018.1561159 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1561159 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:64-75 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1604086_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Antoniya Hauerwaas Author-X-Name-First: Antoniya Author-X-Name-Last: Hauerwaas Author-Name: Ursula Weisenfeld Author-X-Name-First: Ursula Author-X-Name-Last: Weisenfeld Title: The impact of systemic innovations for transforming transplant systems. Lessons learned from the German lung transplantation system. A qualitative study Abstract: The aim of this paper is to demonstrate the potential of the systemic innovations approach for transforming transplantation systems. It explores potential leverage points for intervening in the LTx-system as well as possible paths of transformation. We present possible transition pathways giving the example of the German Lung transplantation system that teeters on the brink of collapse due to system failures and organ scarcity and illustrate systemic innovations as core mechanisms for systems change in health systems. Desk research and semi-structured experts interviews provided qualitative data for a deductive-inductive coding and a rigorous qualitative content analysis of the data. Depending on the systemic innovations chosen to achieve systems change, transplant systems follow different transformational paths: from a collapse to a leapfrogging towards a non-human transplantation system. Thus, global health areas like transplantation benefit from analysis on systemic innovations as these support researchers, public policy and regulators by developing transformative strategies in healthcare systems. Journal: Health Systems Pages: 76-93 Issue: 1 Volume: 9 Year: 2020 Month: 1 X-DOI: 10.1080/20476965.2019.1604086 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1604086 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:1:p:76-93 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1440925_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Diana Prieto Author-X-Name-First: Diana Author-X-Name-Last: Prieto Author-Name: Milton Soto-Ferrari Author-X-Name-First: Milton Author-X-Name-Last: Soto-Ferrari Author-Name: Rindy Tija Author-X-Name-First: Rindy Author-X-Name-Last: Tija Author-Name: Lorena Peña Author-X-Name-First: Lorena Author-X-Name-Last: Peña Author-Name: Leandra Burke Author-X-Name-First: Leandra Author-X-Name-Last: Burke Author-Name: Lisa Miller Author-X-Name-First: Lisa Author-X-Name-Last: Miller Author-Name: Kelsey Berndt Author-X-Name-First: Kelsey Author-X-Name-Last: Berndt Author-Name: Brian Hill Author-X-Name-First: Brian Author-X-Name-Last: Hill Author-Name: Jafar Haghsenas Author-X-Name-First: Jafar Author-X-Name-Last: Haghsenas Author-Name: Ethan Maltz Author-X-Name-First: Ethan Author-X-Name-Last: Maltz Author-Name: Evan White Author-X-Name-First: Evan Author-X-Name-Last: White Author-Name: Maggie Atwood Author-X-Name-First: Maggie Author-X-Name-Last: Atwood Author-Name: Earl Norman Author-X-Name-First: Earl Author-X-Name-Last: Norman Title: Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality Abstract: In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time. Journal: Health Systems Pages: 75-98 Issue: 2 Volume: 8 Year: 2019 Month: 5 X-DOI: 10.1080/20476965.2018.1440925 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1440925 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:2:p:75-98 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1529378_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Miloslava Plachkinova Author-X-Name-First: Miloslava Author-X-Name-Last: Plachkinova Author-Name: Vanessa Kettering Author-X-Name-First: Vanessa Author-X-Name-Last: Kettering Author-Name: Samir Chatterjee Author-X-Name-First: Samir Author-X-Name-Last: Chatterjee Title: Increasing exposure to complementary and alternative medicine treatment options through the design of a social media tool Abstract: The current study outlines the creation of an online community designed to connect patients to providers of Complementary and Alternative Medicine (CAM) and western biomedicine. The purpose of the site was to create a forum for patients and healthcare providers to share information and social support regarding eight popular CAM treatments. First, we created a prototype and pilot tested it through a usability analysis. Second, we conducted semi-structured interviews with 12 key stakeholders from the CAM, biomedicine, and patient populations. Third, we conducted a content analysis of the discussion forums to examine common posting behaviour. We found that CAM providers were the most active contributors to the forums. This project provides proof of concept for using an online community platform to connect patients and CAM providers. Future work should attempt to engage Western medicine providers while studying techniques and features that best engage users. Journal: Health Systems Pages: 99-116 Issue: 2 Volume: 8 Year: 2019 Month: 5 X-DOI: 10.1080/20476965.2018.1529378 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1529378 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:2:p:99-116 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1524405_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Michael Emes Author-X-Name-First: Michael Author-X-Name-Last: Emes Author-Name: Stella Smith Author-X-Name-First: Stella Author-X-Name-Last: Smith Author-Name: Suzanne Ward Author-X-Name-First: Suzanne Author-X-Name-Last: Ward Author-Name: Alan Smith Author-X-Name-First: Alan Author-X-Name-Last: Smith Title: Improving the patient discharge process: implementing actions derived from a soft systems methodology study Abstract: In the period from January 2013 to July 2014, three process change initiatives were undertaken at a major UK hospital to improve the patient discharge process. These initiatives were inspired by the findings of a study of the discharge process using Soft Systems Methodology. The first initiative simplified time-consuming paperwork and the second introduced more regular reviews of patient progress through daily multi-disciplinary “Situation Reports”. These two initiatives were undertaken in parallel across the hospital, and for the average patient they jointly led to a 41% reduction between a patient being declared medically stable and their being discharged from the hospital. The third initiative implemented more proactive alerting of Social Care Practitioners to patients with probable social care needs at the front door, and simplified capture of important patient information (using a “SPRING” form). This initiative saw a 20% reduction in total length of stay for 88 patients on three wards where the SPRING form was used, whilst 248 patients on five control wards saw no significant change in total length of stay in the same period. Taken together, these initiatives have reduced total length of stay by 67% from 55.8 days to 18.6 days for the patients studied. Journal: Health Systems Pages: 117-133 Issue: 2 Volume: 8 Year: 2019 Month: 5 X-DOI: 10.1080/20476965.2018.1524405 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1524405 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:2:p:117-133 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1496875_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ehsan Ahmadi Author-X-Name-First: Ehsan Author-X-Name-Last: Ahmadi Author-Name: Dale T. Masel Author-X-Name-First: Dale T. Author-X-Name-Last: Masel Author-Name: Ashley Y. Metcalf Author-X-Name-First: Ashley Y. Author-X-Name-Last: Metcalf Author-Name: Kristin Schuller Author-X-Name-First: Kristin Author-X-Name-Last: Schuller Title: Inventory management of surgical supplies and sterile instruments in hospitals: a literature review Abstract: Operating rooms are considered a significant revenue source, as well as the main source of waste and cost, among the hospital’s departments. Any cost savings in operating rooms will have a broad financial impact. Over the last decades, many researchers and practitioners have conducted studies to deal with the issue of managing surgical supplies and instruments, which are highly affected by surgeons’ preferences. The purpose of this article is to present an up-to-date review of research in the field of inventory management of surgical supplies and instruments. We have analysed the literature in a systematic manner and organised the identified papers into two groups: the papers that were published by scientific researchers and developed optimisation techniques and the papers that were published by practitioners and reported their observations of the current issues in the operating room. We also identify the future research directions leading to operating room inventory cost reduction. Journal: Health Systems Pages: 134-151 Issue: 2 Volume: 8 Year: 2019 Month: 5 X-DOI: 10.1080/20476965.2018.1496875 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1496875 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:2:p:134-151 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933284_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jennifer R Warren Author-X-Name-First: Jennifer R Author-X-Name-Last: Warren Title: Communicating identity congruence in e-health information seeking: a preliminary investigation Abstract: The current study analyzed the perceptions of online health information seekers regarding identity-congruent information to learn whether identity matching is a factor in motivation and confidence in seeking and using this information if attainable. African Americans and European Americans were recruited to participate in an online survey. Results showed that the degree of identity congruence varied among groups, as did motivation to use sites representing these identities. Both groups established a strong preference for searching for, finding, and using health websites that represented their neighborhood or place-based identity. The significance of place-based identity has practical implications for the design of web-based health information and public health research that examines the impact of neighborhoods on individual health. Journal: Health Systems Pages: 43-51 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2014.24 File-URL: http://hdl.handle.net/10.1057/hs.2014.24 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:43-51 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933285_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jerome Niyirora Author-X-Name-First: Jerome Author-X-Name-Last: Niyirora Author-Name: Jennifer Klimek-Yingling Author-X-Name-First: Jennifer Author-X-Name-Last: Klimek-Yingling Title: Using social network analysis to identify the most central services in an emergency department Abstract: In the past decade, emergency department (ED) overcrowding has become an internationally recognized problem that is associated with adverse patient care and safety. ED overcrowding is caused by multi-factorial system issues, many of which are outside the control of ED managers. In this paper we propose service-based approaches to improving ED throughput via social network analysis. We first construct a service network using Current Procedural Terminology codes. Then degree, betweenness, and eigenvector centrality measures are applied to rank each service. Combined with practical knowledge of ED operations, the rankings help us identify the most central services that are likely to help improve throughput, if administered at the point of care or resources are allocated to them appropriately. Journal: Health Systems Pages: 29-42 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2014.30 File-URL: http://hdl.handle.net/10.1057/hs.2014.30 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:29-42 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933286_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Rita Snyder Author-X-Name-First: Rita Author-X-Name-Last: Snyder Author-Name: José Vidal Author-X-Name-First: José Author-X-Name-Last: Vidal Author-Name: Bo Cai Author-X-Name-First: Bo Author-X-Name-Last: Cai Author-Name: Nathan Huynh Author-X-Name-First: Nathan Author-X-Name-Last: Huynh Title: The edit distance approach: an alternate method for assessing multi-observer agreement in process studies Abstract: Direct observation of complex health-care processes typically involves multi-observer recording of sequential process tasks. Inference, the key validity threat to multi-observer recording, is controlled with observer training and assessment for the degree of recording consistency across observers. The gold standard for assessing recording consistency is the Kappa statistic, which assumes an exact task sequence match among observers. This assumption, however, is often difficult to meet with health-care process observations where task speed and complexity can result in uneven task sequence recording among observers. The edit distance approach, derived from information string theory, is not predicated on an exact task sequence match and offers an alternative to the Kappa statistic for assessing multi-observer agreement. The paper uses simultaneously recorded process observations with uneven task sequences made by three observers to compare agreement results for the edit distance approach and Kappa statistic. Edit distance approach strengths and limitations are discussed. Journal: Health Systems Pages: 6-12 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2014.32 File-URL: http://hdl.handle.net/10.1057/hs.2014.32 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:6-12 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933287_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Allison J Morgan Author-X-Name-First: Allison J Author-X-Name-Last: Morgan Title: Identity and the health information consumer: a research agenda Abstract: There is currently a need to better understand the impacts of emerging technologies used to support health and health information needs as they relate to users. In the discussion of health information searching behavior, human individual differences and identity are factors to be considered. Identity, specifically, is a key to understanding the health-related self-maintenance behaviors of individuals with a variety of illnesses. As a result, this position paper will identify a research program that supports the investigation of identity in the context of the human information consumer. A number of research questions will be posed that are meant to encourage further research, debate, and discussion around developing e-health technologies that are tailored to a patient’s individual health background and needs. Thus, beginning to situate the user appropriately within these characteristics is a challenge that will yield more understanding of the individual and increase the usability of the technology for health-related purposes. Journal: Health Systems Pages: 1-5 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2015.1 File-URL: http://hdl.handle.net/10.1057/hs.2015.1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:1-5 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933288_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Gunjan Mansingh Author-X-Name-First: Gunjan Author-X-Name-Last: Mansingh Author-Name: Kweku-Muata Osei-Bryson Author-X-Name-First: Kweku-Muata Author-X-Name-Last: Osei-Bryson Author-Name: Monika Asnani Author-X-Name-First: Monika Author-X-Name-Last: Asnani Title: Exploring the antecedents of the quality of life of patients with sickle cell disease: using a knowledge discovery and data mining process model-based framework Abstract: Sickle cell disease (SCD) is the most common single-gene disorder worldwide and has multiple and variable manifestations. The many medical complications associated with SCD such as acute chest syndrome and painful crises, along with a lack of normal functioning, may lead to various psychosocial problems such as depression, loneliness and impaired quality of life (QOL). A few studies have sought to examine the relationships between demographics, disease severity, depression, loneliness and the QOL of patients with SCD. In this paper we apply an integrated knowledge discovery and data mining (IKDDM) process to explore the factors that impact the QOL of patients with SCD in Jamaica to explicate knowledge that can be used by medical professionals. Following the IKDDM process provides several benefits: (1) it ensures that adequate experimentation is done to ensure that the best model will be generated and (2) it provides guidance in generating and evaluating models. We use different data mining techniques such as Decision Trees Induction, Regression and Regression Splines to analyze the data and multiple performance measures to evaluate the models in order to identify the best set of models to present to the medical professionals. This allows the medical professionals to select model(s) that will assist them in the decision-making process. The results of this study confirm prior hypotheses regarding the variables predictive of the QOL of SCD patients and additionally provide new insights by identifying the values for these variables. Journal: Health Systems Pages: 52-65 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2015.3 File-URL: http://hdl.handle.net/10.1057/hs.2015.3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:52-65 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933289_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Kayne Putman Author-X-Name-First: Kayne Author-X-Name-Last: Putman Author-Name: Alex Anstey Author-X-Name-First: Alex Author-X-Name-Last: Anstey Author-Name: Paul R Harper Author-X-Name-First: Paul R Author-X-Name-Last: Harper Author-Name: Vince A Knight Author-X-Name-First: Vince A Author-X-Name-Last: Knight Title: Modelling of psoriasis patient flows for the reconfiguration of secondary care services and treatments Abstract: This paper describes work in collaboration with a large dermatology directorate in South Wales to map out current patient flow and activity levels for psoriasis management. Psoriasis is a chronic skin disease that often has a high impact on patient quality of life. Clinical services for patients with moderate to severe psoriasis tend to be located in secondary care hospitals. The range of services that were studied, their geographical location in relation to the distribution of population, and the population demographics in this health board were not unique; similar profiles for these factors can be found throughout the NHS in England and Wales. The model was created to analyse patient flow through different therapies, with the aim of maximising throughput of patients, eliminating bottlenecks, improving patient access to services and improving patient safety. It was shown that reducing waiting times and improving access to phototherapy would lower overall service costs, as fewer patients would subsequently require systemic and biologic therapies. The model has been used to quantify how recent year-on-year increases in overall spend on psoriasis treatments might be slowed and eventually halted. This would require reallocation of notional cost-savings generated by reducing the rate of increase in the drug spend to fund the development of a more balanced and accessible network of more basic psoriasis services. Journal: Health Systems Pages: 13-20 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2015.4 File-URL: http://hdl.handle.net/10.1057/hs.2015.4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:13-20 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933290_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Bengisu Tulu Author-X-Name-First: Bengisu Author-X-Name-Last: Tulu Author-Name: Andrew C Trapp Author-X-Name-First: Andrew C Author-X-Name-Last: Trapp Author-Name: Diane M Strong Author-X-Name-First: Diane M Author-X-Name-Last: Strong Author-Name: Sharon A Johnson Author-X-Name-First: Sharon A Author-X-Name-Last: Johnson Author-Name: Muyeedul Hoque Author-X-Name-First: Muyeedul Author-X-Name-Last: Hoque Author-Name: John Trudel Author-X-Name-First: John Author-X-Name-Last: Trudel Author-Name: Lawrence Garber Author-X-Name-First: Lawrence Author-X-Name-Last: Garber Title: An analysis of patient portal utilization: what can we learn about online patient behavior by examining portal click data? Abstract: This paper presents a study of online patient portal utilization through the analysis of system logs. We analyze click data generated between August 2009 and July 2011 by 1886 users of an online patient portal. We investigate variations in utilization for Login and the top five system features (Appointment Review, Lab Tests, Medical Advice Request, Messaging and Result Component Graphing), and examine how age and gender influence these variations. Our findings indicate that the effects of age and gender on system use vary by feature, and that efficiency of use (how clicks are spread across sessions) varies across age, gender and feature. We provide a new approach for understanding system use through click data analysis utilizing system logs (an underutilized data source available to all health-care organizations), an example of how big data can help health-care organizations learn more about their patients’ utilization of patient portals. Journal: Health Systems Pages: 66-79 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2015.5 File-URL: http://hdl.handle.net/10.1057/hs.2015.5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:66-79 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933291_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sameer Kumar Author-X-Name-First: Sameer Author-X-Name-Last: Kumar Author-Name: Muer Yang Author-X-Name-First: Muer Author-X-Name-Last: Yang Title: Analyzing patient choices for routine procedures in the United States vs overseas before and after the affordable care act: a case study Abstract: Low prices and good medical care have caused an increasing number of Americans to travel abroad for affordable health care (medical tourism). This study analyzes the viability of medical tourism as an alternative to United States (U.S.) hospitals for routine surgical procedures by considering the total charges paid by U.S. insurance companies and by patients (out of pocket) to hospitals. A mathematical model based on rational choice theory is developed to approximate the most-favorable decisions for both patients and payers, and this is illustrated through an example involving the decision to undergo coronary artery bypass graft (CABG) surgery in India or the U.S. Before the Affordable Care Act (ACA), medical tourism positively offset the total treatment charges associated with CABG procedures, some fully insured and underinsured patients would often opt for overseas treatment. After the enactment of the ACA, more fully insured patients and more people from a much smaller set of underinsured patients may opt for overseas CABG treatment. This paper finds that the ACA pushes individual decisions closer to the system optimal situation, and that if the U.S. health-care industry is unable to eliminate waste and inefficiency and thus curb rising costs, it will continue to lose surgical revenue to foreign health providers. Journal: Health Systems Pages: 21-28 Issue: 1 Volume: 5 Year: 2016 Month: 3 X-DOI: 10.1057/hs.2015.7 File-URL: http://hdl.handle.net/10.1057/hs.2015.7 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:1:p:21-28 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933208_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Vincent A Knight Author-X-Name-First: Vincent A Author-X-Name-Last: Knight Author-Name: Paul R Harper Author-X-Name-First: Paul R Author-X-Name-Last: Harper Title: Modelling emergency medical services with phase-type distributions Abstract: Effective and efficient emergency medical services (EMS) are a critical part of a national healthcare system. This paper describes research to model EMS by better capturing ambulance service times using Coxian phase-type (PH) distributions. Distributions are fitted to both the overall cycle time for different classes of patient priorities, as well as to sub-cycles. Sub-cycles are the distinct identifiable parts of the ambulance cycle time, such as travel times, time on scene and turnaround time at the hospital. The Coxian PH fits have then been used within a priority simulation model to provide guidance on the number of ambulances required to meet response time targets. Results from using various numbers of phases from the fitted Coxian distributions are compared. The proposed benefit of using sub-cycle fits is that it more readily permits scenario modelling within the simulation, such as evaluating the impact of reducing the turnaround time on the overall response times in the ambulance system. Journal: Health Systems Pages: 58-68 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.1 File-URL: http://hdl.handle.net/10.1057/hs.2012.1 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:58-68 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933209_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ana R Vila-Parrish Author-X-Name-First: Ana R Author-X-Name-Last: Vila-Parrish Author-Name: Julie S Ivy Author-X-Name-First: Julie S Author-X-Name-Last: Ivy Author-Name: Russell E King Author-X-Name-First: Russell E Author-X-Name-Last: King Author-Name: Steven R Abel Author-X-Name-First: Steven R Author-X-Name-Last: Abel Title: Patient-based pharmaceutical inventory management: a two-stage inventory and production model for perishable products with Markovian demand Abstract: Drug shortages have increased over the past decade, tripling since 2006. Pharmacy material managers are challenged with developing inventory policies given changing demand, limited suppliers, and regulations affecting supply. Pharmaceutical inventory management and patient care are inextricably linked; suboptimal control impacts both patient treatment and the cost of care. We study a perishable inventory problem motivated by challenges in pharmaceutical management. Inpatient hospital pharmacies stock medications in two stages, raw material and finished good (e.g. intravenous). While both stages of material are perishable, the finished form is highly perishable. Pharmacy demand depends on the population and patient conditions. We use a stochastic ‘demand state’ as a surrogate for patient condition and develop a Markov decision process to determine optimal, state-dependent two-stage inventory and production policies. We define two ordering and production scenarios, prove the existence of optimal solutions for both scenarios, and apply this framework to the management of Meropenem. Journal: Health Systems Pages: 69-83 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.2 File-URL: http://hdl.handle.net/10.1057/hs.2012.2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:69-83 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933210_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Woodrow W Winchester III Author-X-Name-First: Woodrow W Author-X-Name-Last: Winchester III Author-Name: Troy D Abel Author-X-Name-First: Troy D Author-X-Name-Last: Abel Author-Name: Jose Bauermeister Author-X-Name-First: Jose Author-X-Name-Last: Bauermeister Title: The use of partner-seeking computer-mediated communication applications by young men that have sex with men (YMSM): uncovering human-computer interaction (HCI) design opportunities in HIV prevention Abstract: HIV/AIDS incidence among young men who have sex with men (YMSM), both in the United States and globally, remains a public health priority. Using Activity Theory as a framework, and YMSM as a target population, we examine the intricate three-way relationship between safer sex (i.e., condom) negotiation, HIV status disclosure behaviors, and the use of computer-mediated communication applications as a means of seeking sexual partners, particularly casual partners (e.g., one night stands, hookups). We offer a human-computer interaction (HCI) research framework that could uncover more impactful design opportunities for HIV prevention. Journal: Health Systems Pages: 26-35 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.3 File-URL: http://hdl.handle.net/10.1057/hs.2012.3 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:26-35 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933211_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Husniyah Abdus-Salaam Author-X-Name-First: Husniyah Author-X-Name-Last: Abdus-Salaam Author-Name: Lauren B Davis Author-X-Name-First: Lauren B Author-X-Name-Last: Davis Title: Impact of batch appointments on no-show rates: a public vs private clinic perspective Abstract: Much of the appointment-scheduling literature has characterized the impact of no-show rates with respect to individual appointment requests. However, little is known about the impact of appointments that are grouped by household. This study is concerned with understanding the prevalence of these family group appointments and identifying the appointment characteristics that significantly influence no-show rates. Using historical data from one public and one private pediatric clinic, multiway frequency analysis is used to characterize the association between appointment characteristics and appointment size. A logistic regression model is also developed to identify the factors that contribute to no-show rates for both clinics. The results of the study indicate that more than one-third of the appointments scheduled by both clinics were associated with batch appointment requests. In addition, no-show rates for batch appointments in the public clinic were higher than those of the private clinic. We identify appointment size as a significant predictor in determining no-show rates for both public and private clinics. Since no-show rates adversely impact clinic efficiency, scheduling coordinators should consider the impact of grouping-related appointments when determining how to best allocate resources. Journal: Health Systems Pages: 36-45 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.4 File-URL: http://hdl.handle.net/10.1057/hs.2012.4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:36-45 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933212_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Johannes Heurix Author-X-Name-First: Johannes Author-X-Name-Last: Heurix Author-Name: Michael Karlinger Author-X-Name-First: Michael Author-X-Name-Last: Karlinger Author-Name: Thomas Neubauer Author-X-Name-First: Thomas Author-X-Name-Last: Neubauer Title: PERiMETER – pseudonymization and personal metadata encryption for privacy-preserving searchable documents Abstract: The average costs of data leakage are steadily on the rise. Especially in healthcare, the disclosure of sensitive information may have unfavorable consequences for the patient. As a consequence, several data security and access control mechanisms have been introduced, ranging from data encryption to intrusion detection or role-based access control, doing a great work in protecting sensitive information. However, the majority of these concepts are centrally controlled by administrators who are a major threat to the patients’ privacy. Apart from administrators, other internal persons, such as hospital staff members, may exploit their access rights to snoop around in private health data. This work presents PERiMETER, a security protocol for data privacy that is strictly controlled by the data owner. It integrates pseudonymization and encryption to create a methodology that uses pseudonyms as access control mechanism, protects secret cryptographic keys by a layer-based security model, and provides privacy-preserving querying. Journal: Health Systems Pages: 46-57 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.5 File-URL: http://hdl.handle.net/10.1057/hs.2012.5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:46-57 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933213_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James F Burgess Author-X-Name-First: James F Author-X-Name-Last: Burgess Title: Innovation and efficiency in health care: does anyone really know what they mean? Abstract: This paper challenges common perceptions and definitions of innovation and efficiency in health care. Once one accepts that optimum levels of innovation and efficiency will not be driven purely by market forces, as all countries in the world except the United States clearly have, then this is a serious problem. Moreover, even in the United States, this paper documents numerous circular or flawed definitions that are commonly employed for efficiency, and presents opportunities for directions to improve or develop new ways of defining efficiency in health care in ways that may promote innovation more effectively. Establishing more shared understanding of these important concepts in an interdisciplinary systems framework is crucial for making progress in achieving better outcomes for patients with better allocations of scarce resources. Journal: Health Systems Pages: 7-12 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.6 File-URL: http://hdl.handle.net/10.1057/hs.2012.6 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:7-12 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933214_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: George Demiris Author-X-Name-First: George Author-X-Name-Last: Demiris Title: New era for the consumer health informatics research agenda Abstract: Advances in information technology have signified a shift from institution-centric systems to patient- or consumer-centric ones that support not only disease management but also wellness promotion. These trends are a catalyst for the growth of Consumer Health Informatics (CHI), a sub-domain of biomedical and health informatics that focuses on understanding consumer preferences and information needs in the health care context, and on designing and implementing tools and systems to meet these needs. One of the promising CHI applications is the personal health record (PHR). Several challenges such as the effective interoperability between personal health records and electronic medical record systems, the barriers of the digital divide, various levels of health literacy and access to care, need to be carefully examined in the context of designing, implementing and evaluating PHR systems. Ethical, legal and practical implications of innovative technologies such as wearable sensors and other home-based monitoring technologies also require an in-depth analysis of unintended consequences. This position paper outlines opportunities for CHI researchers to further the evidence base in this ever growing domain of health informatics. Journal: Health Systems Pages: 13-16 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.7 File-URL: http://hdl.handle.net/10.1057/hs.2012.7 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:13-16 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933215_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Murat M Gunal Author-X-Name-First: Murat M Author-X-Name-Last: Gunal Title: A guide for building hospital simulation models Abstract: Healthcare systems aspire to offer an effective and efficient provision of health service without compromising on quality. Hospitals are important links in the healthcare service chain, and Operational Research/Management Science methods have an essential role to play in helping to improve the planning and management of hospitals. In particular, simulation methods have been widely used by healthcare researchers and practitioners. This paper is written as a guide for building hospital simulation models and is based on the author's experience and the published literature. Two points of view emerge in this paper supporting each other: a conceptual view and a technical view. Initially, conceptual issues are discussed, including topics such as framing and specification, level of model detail, and data requirements. Second, a technical point of view buttresses the discussion from the methodological side and three simulation methods are evaluated, namely: Discrete Event Simulation, System Dynamics, and Agent-Based Simulation. Journal: Health Systems Pages: 17-25 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.8 File-URL: http://hdl.handle.net/10.1057/hs.2012.8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:17-25 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933216_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sally Brailsford Author-X-Name-First: Sally Author-X-Name-Last: Brailsford Author-Name: Paul Harper Author-X-Name-First: Paul Author-X-Name-Last: Harper Author-Name: Cynthia LeRouge Author-X-Name-First: Cynthia Author-X-Name-Last: LeRouge Author-Name: Fay Cobb Payton Author-X-Name-First: Fay Cobb Author-X-Name-Last: Payton Title: Editorial Journal: Health Systems Pages: 1-6 Issue: 1 Volume: 1 Year: 2012 Month: 6 X-DOI: 10.1057/hs.2012.9 File-URL: http://hdl.handle.net/10.1057/hs.2012.9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:1:p:1-6 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933271_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: John Grundy Author-X-Name-First: John Author-X-Name-Last: Grundy Author-Name: Elizabeth Hoban Author-X-Name-First: Elizabeth Author-X-Name-Last: Hoban Author-Name: Steve Allender Author-X-Name-First: Steve Author-X-Name-Last: Allender Title: The social and political construction of health-care systems – historical observations from selected countries in Asia Abstract: Across the Asian region, models of health administration vary from centralized management arrangements to more open decentralized systems. Utilizing a historical perspective, this review compares and contrasts health systems transition in seven countries (the Democratic People’s Republic of Korea, Myanmar, Timor Leste, Bhutan, Mongolia, Cambodia and the Philippines) against the background of macro-political and economic reform, and then considers the implications of these findings for approaches to health policy analysis. Four management areas are presented to demonstrate variation in health system design over the last 40 years: centralization and decentralization, human resource management, health financing and constituency emergence. Historical records illustrate that these functions have evolved through political reform eras of centralist, early reform, established reform and pluralist models of administration, with the main driver of system change being periodic historical shifts in the design of the macro-political and socio-economic order. The cross referencing of management variables with these stages of transition illustrates the degree to which health policy parameters are reset by periodic historical shifts in the political and social order. The findings in these case studies call for a more nuanced classificatory system for health systems and policy analysis that unites a technical perspective with a wider social and political field of vision, and, in doing so, builds a more comprehensive picture of the way in which health systems function in the real world. Journal: Health Systems Pages: 124-137 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.14 File-URL: http://hdl.handle.net/10.1057/hs.2014.14 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:124-137 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933272_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mark Gaynor Author-X-Name-First: Mark Author-X-Name-Last: Gaynor Author-Name: Catherine Bass Author-X-Name-First: Catherine Author-X-Name-Last: Bass Author-Name: Bryan Duepner Author-X-Name-First: Bryan Author-X-Name-Last: Duepner Title: A tale of two standards: strengthening HIPAA security regulations using the PCI-DSS Abstract: This paper both illustrates the inadequacy of current Health Insurance Portability and Accountability Act (HIPAA) regulations in protecting health-care information and proposes a more cohesive strategy to protect such information based on the organizational model that undergirds the Payment Card Industry Data Security Standards (PCI-DSS). The evidence indicates that the industry consortium model used to develop the PCI-DSS works rapidly and effectively. The success of these standards suggests that their strengths provide a favorable base from which to develop a robust set of standards to enhance information security within health care. A national organization consisting of industry representatives that is devoted to creating a more comprehensive and less vague set of security standards is required to protect health-care information more effectively than is possible under the current HIPAA approach. Journal: Health Systems Pages: 111-123 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.17 File-URL: http://hdl.handle.net/10.1057/hs.2014.17 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:111-123 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933273_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Husniyah Abdus-Salaam Author-X-Name-First: Husniyah Author-X-Name-Last: Abdus-Salaam Author-Name: Lauren B Davis Author-X-Name-First: Lauren B Author-X-Name-Last: Davis Title: Tactical allocation and acceptance of multiple patient classes in the presence of no-shows Abstract: Clinics that provide pediatric care are frequently confronted with family group appointment requests, where parents desire their children to be scheduled simultaneously or consecutively. This is potentially beneficial to the family by minimizing the number of trips to the provider’s office. However, offering prescheduled group appointments have the risk of reducing provider utilization, particularly if the entire group fails to meet their scheduled appointment. Similarly, reserving appointment slots for same day group appointment requests may also decrease utilization and impact profitability. This paper explores the impact of family group appointments on clinic performance in terms of provider utilization and profit. A finite-horizon, stochastic dynamic programming problem is presented to determine the optimal scheduling strategy given both individual and group appointment requests can be tactically accommodated via overbooking. On the basis of a computational study, we quantify the risk to clinic profitability and productivity resulting from the no-show behavior of prescheduled appointments. We also characterize the behavior of the optimal scheduling strategy as a function of prescheduled appointment allocations among the patient classes. Journal: Health Systems Pages: 93-103 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.18 File-URL: http://hdl.handle.net/10.1057/hs.2014.18 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:93-103 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933274_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Alvin Tarrell Author-X-Name-First: Alvin Author-X-Name-Last: Tarrell Author-Name: Lisa Grabenbauer Author-X-Name-First: Lisa Author-X-Name-Last: Grabenbauer Author-Name: James McClay Author-X-Name-First: James Author-X-Name-Last: McClay Author-Name: John Windle Author-X-Name-First: John Author-X-Name-Last: Windle Author-Name: Ann L Fruhling Author-X-Name-First: Ann L Author-X-Name-Last: Fruhling Title: Toward improved heuristic evaluation of EHRs Abstract: Electronic Health Records (EHRs) can improve the quality, safety, and efficiency of patient care. Migration to EHRs is progressing, but has been slowed by concerns related to interoperability, security, cost, patient safety, and usability. This paper focuses on EHR usability, specifically heuristic evaluation, or utilizing accepted guidelines for assessing EHR interface design. Health-care researchers initially applied industry-standard heuristics to EHRs, but subsequently health-care-specific groups have adapted and expanded these standard heuristics, calling for development and use of heuristics specific to EHRs. This paper first summarizes the evolution of heuristic evaluation of EHRs, then discusses the similarities and differences between these various approaches. This is an important step in developing community consensus on integrated heuristics, the basis of successful heuristic evaluation of EHRs. We then discuss the ‘Theory of Fit’ as a means of explaining the existence of these somewhat different heuristics, and close with suggestions for further research. Journal: Health Systems Pages: 138-150 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.19 File-URL: http://hdl.handle.net/10.1057/hs.2014.19 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:138-150 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933275_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jonathan H Klein Author-X-Name-First: Jonathan H Author-X-Name-Last: Klein Author-Name: Terry Young Author-X-Name-First: Terry Author-X-Name-Last: Young Title: Health care: a case of hypercomplexity? Abstract: This position paper argues that the lack of take-up of management science (MS) modelling in health care is a particularly severe example of a more general problem for MS, articulated by many authorities. We relate this severity to the extreme complexity of the health care domain, which might be termed ‘hypercomplexity’. We argue that, for a variety of reasons, the health care domain is different to other domains in this respect, and we explore the mechanisms by which hypercomplexity might have inhibited the use of modelling within the domain. We conclude with some tentative suggestions for making progress, including the possibility of taking deliberate steps to reduce health care hypercomplexity. Journal: Health Systems Pages: 104-110 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.21 File-URL: http://hdl.handle.net/10.1057/hs.2014.21 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:104-110 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933276_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ryan J Shaw Author-X-Name-First: Ryan J Author-X-Name-Last: Shaw Author-Name: Monica M Horvath Author-X-Name-First: Monica M Author-X-Name-Last: Horvath Author-Name: Dave Leonard Author-X-Name-First: Dave Author-X-Name-Last: Leonard Author-Name: Jeffrey M Ferranti Author-X-Name-First: Jeffrey M Author-X-Name-Last: Ferranti Author-Name: Constance M Johnson Author-X-Name-First: Constance M Author-X-Name-Last: Johnson Title: Developing a user-friendly interface for a self-service healthcare research portal: cost-effective usability testing Abstract: Usability is a critical but often overlooked factor in the design and development of healthcare information technology systems. One system increasingly being leveraged as a research and quality improvement tool is an online research portal that allows self-service access to electronic health record (EHR) data. We discuss the usability testing of such a portal through a low-cost usability inspection method: heuristic evaluation. Using heuristic evaluation methods, we identified 20 usability errors: 15.0% (3/20) were cosmetic, 35.0% (7/20) were minor, 40.0% (8/20) were major, and 10.0% (2/20) were catastrophic. Our heuristic evaluation demonstrates an affordable and efficient method to identify and correct a significant number of problems, thus improving the system using limited effort and resources. A user-friendly environment that follows accepted heuristics for good interface design is essential for ensuring accessibility and usability of data extracted from EHRs for quality improvement and research projects. Journal: Health Systems Pages: 151-158 Issue: 2 Volume: 4 Year: 2015 Month: 7 X-DOI: 10.1057/hs.2014.26 File-URL: http://hdl.handle.net/10.1057/hs.2014.26 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:2:p:151-158 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1754733_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Luca Grieco Author-X-Name-First: Luca Author-X-Name-Last: Grieco Author-Name: Mariya Melnychuk Author-X-Name-First: Mariya Author-X-Name-Last: Melnychuk Author-Name: Angus Ramsay Author-X-Name-First: Angus Author-X-Name-Last: Ramsay Author-Name: Abigail Baim-Lance Author-X-Name-First: Abigail Author-X-Name-Last: Baim-Lance Author-Name: Simon Turner Author-X-Name-First: Simon Author-X-Name-Last: Turner Author-Name: Andrew Wilshere Author-X-Name-First: Andrew Author-X-Name-Last: Wilshere Author-Name: Naomi Fulop Author-X-Name-First: Naomi Author-X-Name-Last: Fulop Author-Name: Steve Morris Author-X-Name-First: Steve Author-X-Name-Last: Morris Author-Name: Martin Utley Author-X-Name-First: Martin Author-X-Name-Last: Utley Title: Operational analysis of school-based delivery models to vaccinate children against influenza Abstract: Large-scale immunisation programmes against seasonal influenza are characterised by logistical challenges related to the need for vaccinating large cohorts of people in a short amount of time. Careful operational planning of resources is essential for a successful implementation of such programmes. We focused on the process of child vaccination in schools and analysed the staffing and workflow aspects of a school-aged children vaccination programme in England. Our objectives were to document vaccination processes and analyse times and costs associated with different models deployed across England. We collected data through direct non-participatory observations. Statistical data analysis enabled us to identify potential factors influencing vaccine delivery time and informed the development of a tool to simulate vaccination sessions. Using this tool, we carried out scenario analyses and explored trade-offs between session times and costs in different settings. Our work ultimately supported the local implementation of school-based vaccination. Journal: Health Systems Pages: 212-221 Issue: 3 Volume: 10 Year: 2021 Month: 07 X-DOI: 10.1080/20476965.2020.1754733 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1754733 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:3:p:212-221 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1709908_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ryan F. Slocum Author-X-Name-First: Ryan F. Author-X-Name-Last: Slocum Author-Name: Herbert L. Jones Author-X-Name-First: Herbert L. Author-X-Name-Last: Jones Author-Name: Matthew T. Fletcher Author-X-Name-First: Matthew T. Author-X-Name-Last: Fletcher Author-Name: Brandon M. McConnell Author-X-Name-First: Brandon M. Author-X-Name-Last: McConnell Author-Name: Thom J. Hodgson Author-X-Name-First: Thom J. Author-X-Name-Last: Hodgson Author-Name: Javad Taheri Author-X-Name-First: Javad Author-X-Name-Last: Taheri Author-Name: James R. Wilson Author-X-Name-First: James R. Author-X-Name-Last: Wilson Title: Improving chemotherapy infusion operations through the simulation of scheduling heuristics: a case study Abstract: Over the last decade, chemotherapy treatments have dramatically shifted to outpatient services such that nearly 90% of all infusions are now administered outpatient. This shift has challenged oncology clinics to make chemotherapy treatment as widely available as possible while attempting to treat all patients within a fixed period of time. Historical data from a Veterans Affairs chemotherapy clinic in the United States and staff input informed a discrete event simulation model of the clinic. The case study examines the impact of altering the current schedule, where all patients arrive at 8:00 AM, to a schedule that assigns patients to two or three different appointment times based on the expected length of their chemotherapy infusion. The results identify multiple scheduling policies that could be easily implemented with the best solutions reducing both average patient waiting time and average nurse overtime requirements. Journal: Health Systems Pages: 163-178 Issue: 3 Volume: 10 Year: 2021 Month: 07 X-DOI: 10.1080/20476965.2019.1709908 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1709908 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:3:p:163-178 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1740613_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Timothy Bolt Author-X-Name-First: Timothy Author-X-Name-Last: Bolt Author-Name: Steffen Bayer Author-X-Name-First: Steffen Author-X-Name-Last: Bayer Author-Name: Maria Kapsali Author-X-Name-First: Maria Author-X-Name-Last: Kapsali Author-Name: Sally Brailsford Author-X-Name-First: Sally Author-X-Name-Last: Brailsford Title: An analytical framework for group simulation model building Abstract: This paper presents a framework for understanding and improving the process of simulation model building involving a group of domain experts, classifying the different roles the model may play at various stages of its development. The framework consists of four different “object roles”, defined along two dimensions: a functional dimension (boundary object vs. representational object) and a knowledge dimension (epistemic object vs. technical object). A model can take different roles during the development process, e.g. for facilitating communication, for gaining insight into the real-world system, or for experimentation and policy evaluation. The use of the framework is illustrated by two case studies in healthcare. Its relevance and applicability are examined through a survey on model use. The survey was conducted among a group of modelling consultants with experience of using both discrete-event simulation and system dynamics within the NHS, and indicated the potential usefulness of the framework. Journal: Health Systems Pages: 198-211 Issue: 3 Volume: 10 Year: 2021 Month: 07 X-DOI: 10.1080/20476965.2020.1740613 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1740613 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:3:p:198-211 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1758596_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Beverley M. Essue Author-X-Name-First: Beverley M. Author-X-Name-Last: Essue Author-Name: Lydia Kapiriri Author-X-Name-First: Lydia Author-X-Name-Last: Kapiriri Title: Priority setting for health system strengthening in low income countries. A qualitative case study illustrating the complexities Abstract: Health systems are critical to the realisation of Universal Health Coverage. There has been insufficient attention to the evaluation of priority setting for health system strengthening within low income countries, including evaluation of the local capacity to implement priorities. This study evaluated the extent to which health system strengthening was prioritized in Uganda. The Kapiriri & Martin framework was used to evaluate health system priority setting from 2005–2015. A document analysis was triangulated with interview data (n = 67) from global, national and subnational stakeholders and analysed using content analysis. Health system strengthening was perceived to be circumvented by a lack of resources as well as influential actors with disease focused, rather than system-oriented, interests. There were defined processes with explicit criteria for identifying priorities and evidence was highly valued. But sub-optimal transparency and weak accountability often compromised the integrity of priority setting and contributed to stalling progress on health system strengthening and achieving health system outcomes. The strengths in the current planning processes should be harnessed. In addition, a systematic approach to priority setting, potentially through the establishment of an independent body, and stronger oversight mechanisms, would strengthen health system planning in this setting. Journal: Health Systems Pages: 222-237 Issue: 3 Volume: 10 Year: 2021 Month: 07 X-DOI: 10.1080/20476965.2020.1758596 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1758596 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:3:p:222-237 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1710582_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: William N. Robinson Author-X-Name-First: William N. Author-X-Name-Last: Robinson Author-Name: Tianjie Deng Author-X-Name-First: Tianjie Author-X-Name-Last: Deng Author-Name: Andrea Aria Author-X-Name-First: Andrea Author-X-Name-Last: Aria Title: Monitoring behaviours with model divergence: emailing studies of users with cognitive impairments Abstract: Users with cognitive impairments use an assistive technology email system, CogLink, for socialisation and help in their activities of daily living. As users interact with the AT email client, the logged stream of events is monitored and analysed to aid decision-making. When caregivers receive monitor notifications, they know that the user has had a significant change in her emailing behaviour. Consequently, caregivers select adaptations to the email client that can challenge the user to gain still more emailing skills. The monitor in this emailing system analyzes user data to recognise when significant changes in user behaviour warrants caregiver attention. Moreover, the monitor can distinguish newly learned skills from new, but transient behaviours. This article summarises the CogLink assistive technology monitoring techniques, introduces the learning likelihood algorithm, which distinguishes transient from learned behaviour, and provides lessons learnt from a decade of monitoring CogLink users. Journal: Health Systems Pages: 179-197 Issue: 3 Volume: 10 Year: 2021 Month: 07 X-DOI: 10.1080/20476965.2019.1710582 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1710582 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:3:p:179-197 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933261_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sergei Koulayev Author-X-Name-First: Sergei Author-X-Name-Last: Koulayev Author-Name: Emilia Simeonova Author-X-Name-First: Emilia Author-X-Name-Last: Simeonova Title: Can health IT adoption reduce health disparities? Abstract: There are large and persistent racial differences in health-care utilization and outcomes for chronic conditions in the United States. The recent uptake in electronic health records in outpatient care settings could affect these disparities. This research shows that the adoption of electronic health records reduces the racial gap in outpatient care outcomes. We provide a basic conceptual framework that demonstrates some of the mechanisms that may drive these results. Journal: Health Systems Pages: 55-63 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.10 File-URL: http://hdl.handle.net/10.1057/hs.2014.10 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:55-63 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933262_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Andy Weeger Author-X-Name-First: Andy Author-X-Name-Last: Weeger Author-Name: Heiko Gewald Author-X-Name-First: Heiko Author-X-Name-Last: Gewald Title: Acceptance and use of electronic medical records: An exploratory study of hospital physicians’ salient beliefs about HIT systems Abstract: If a hospital keeps electronic medical records (EMRs), the underlying health information system is the primary repository and source of patient-related data for hospital physicians. Even though the benefits and improvements attained through health information technology (HIT) are widely acknowledged, EMR adoption rates are surprisingly low in German hospitals. Since there is no ‘pull’ to use EMR systems, we theorize that low penetration of EMR systems could be in part explained by physicians’ antipathy towards computerized medical records. In order to examine physicians’ salient beliefs about EMRs and EMR usage and to identify the processes that form them, we conducted a multi-case study in German hospitals, drawing on concepts from Social Cognitive Theory and the Unified Theory of Acceptance and Use of Technology (UTAUT) to elicit beliefs and structure our analysis. This study sheds light on different types of beliefs and the belief-forming process and their impact on HIT acceptance and use. Our findings indicate that HIT acceptance and use is not solely impacted by cognitive behavioural and environmental factors, as proposed by UTAUT, but also by personal factors such as self-efficacy and emotions. Furthermore, our study provides evidence of continuous reciprocal causation across behavioural, personal and environmental beliefs. The findings indicate that existing technology acceptance models need to be modified for the specific health-care context by adapting the range, meaning and scope of constructs. Journal: Health Systems Pages: 64-81 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.11 File-URL: http://hdl.handle.net/10.1057/hs.2014.11 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:64-81 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933263_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Stephan Kudyba Author-X-Name-First: Stephan Author-X-Name-Last: Kudyba Author-Name: Thad Perry Author-X-Name-First: Thad Author-X-Name-Last: Perry Title: A data mining approach for estimating patient demand for mental health services Abstract: The ability to better estimate future demand for health services is a critical element to maintaining a stable quality of care. With greater knowledge of how particular events can impact demand, health-care service providers can better allocate available resources to more effectively treat patients’ needs. The incorporation of data mining analytics can leverage available data to identify recurring patterns among relevant variables, and these patterns provide actionable information to corresponding decision markers at health-care organizations. The demand for mental health services can be subject to variation from time of year (seasonality) and economic factors. This study illustrates the effectiveness of data mining analytics in identifying seasonality and economic factors as measured by time that affect patient demand for mental health services. It incorporates a neural network analytic method that is applied to patient demand data at a U.S. medical center. The results indicate that day of week, month of year, and a yearly trend significantly impact the demand for patient services. Journal: Health Systems Pages: 5-11 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.12 File-URL: http://hdl.handle.net/10.1057/hs.2014.12 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:5-11 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933264_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Anita R Vila-Parrish Author-X-Name-First: Anita R Author-X-Name-Last: Vila-Parrish Author-Name: Julie Simmons Ivy Author-X-Name-First: Julie Simmons Author-X-Name-Last: Ivy Author-Name: Beixiang He Author-X-Name-First: Beixiang Author-X-Name-Last: He Title: Impact of the influenza season on a hospital from a pharmaceutical inventory management perspective Abstract: The outbreak of an infectious disease may put significant pressure on a healthcare system, especially when there is a surge of patients. In this paper, we develop two simulation models: (1) disease outbreak model and (2) a medication inventory model. These two models are used to identify inventory policies for managing medication during disease outbreaks. Specifically, we use historical influenza data as an input to the inventory simulation model, which incorporates the impact of disease spread, patients’ health conditions, and medication shelf life. We formulate a dynamic program and use a reduced version of this model to provide inputs to our inventory simulation model. We compare three different simulation-based policies and perform sensitivity analysis on several parameters such as the gross attack rate and inventory holding cost parameters. Our results provide insight regarding the management of perishable medication inventory at hospitals during an outbreak of an infectious disease. Journal: Health Systems Pages: 12-28 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.13 File-URL: http://hdl.handle.net/10.1057/hs.2014.13 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:12-28 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933265_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Kun Zhang Author-X-Name-First: Kun Author-X-Name-Last: Zhang Author-Name: David H Howard Author-X-Name-First: David H Author-X-Name-Last: Howard Title: Hospital and skilled nursing facility patient flows during Hurricane Katrina and the Midwest floods of 2008 Abstract: Simulation and surge studies benefit from realistic assumptions about changes in patient flows during disasters. We sought to determine the impact of Hurricane Katrina and the 2008 Midwest floods on hospital and skilled nursing facility (SNF) discharge patterns. We used Medicare claims to identify beneficiaries admitted to hospitals or SNFs in the affected areas for each disaster. We used Cox proportional hazards regression with time-varying covariates for disasters to assess the impact of disasters on the likelihood that a patient would be discharged. Discharges from SNFs and hospitals declined in the week following Hurricane Katrina. Discharges from SNFs declined in the 3-week period during the Midwest floods but hospital discharge rates were unaffected. Reductions in discharge rates may reduce the ability of health-care facilities to create surge capacity during disasters. Journal: Health Systems Pages: 29-40 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.16 File-URL: http://hdl.handle.net/10.1057/hs.2014.16 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:29-40 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933266_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Songnian Zhao Author-X-Name-First: Songnian Author-X-Name-Last: Zhao Author-Name: John Wu Author-X-Name-First: John Author-X-Name-Last: Wu Author-Name: David Ben-Arieh Author-X-Name-First: David Author-X-Name-Last: Ben-Arieh Title: Modeling infection spread and behavioral change using spatial games Abstract: This paper presents a methodology that combines information transmission, contact networks, and changes of human behaviors in modeling the dynamics of infectious diseases. The methodology presented is based on a spatial evolutionary game with additional information representing human behavior. This approach is used to model the transmission process of infectious disease, which emphasizes the human response and information transmission in a social context. It combines the advantages of evolutionary game theory with modeling the spontaneous changes of human behaviors based on the balance of benefits and costs. The model assumes rational participants who use information acquired to make individual decisions. This novel modeling approach shows the global spread of infection considering an individual human behavior. Journal: Health Systems Pages: 41-53 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.22 File-URL: http://hdl.handle.net/10.1057/hs.2014.22 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:41-53 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933267_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jeanne Wendel Author-X-Name-First: Jeanne Author-X-Name-Last: Wendel Author-Name: Dana Edberg Author-X-Name-First: Dana Author-X-Name-Last: Edberg Title: Outlook for state-designated health information exchange: Learning from the information systems and economics literatures Abstract: Some states used Health Information Technology for Economic and Clinical Health Act funds to create Public-Private Partnerships to deliver health information exchange services to end users. As these entities work to identify sustainable business models within increasingly competitive markets, the states and partnerships face three issues. First, while the partnership structure offers potential advantages and disadvantages for exchanges facing competition, they must position themselves strategically to enjoy the potential benefits. Second, the choice of technical architecture has important implications for the partnership’s market niche; thus, exchanges should view the selection as a business, rather than a technical, decision. Third, states face potential conflicts of interest as they participate on partnership governing boards, purchase exchange services, and regulate providers of exchange services. These potential conflicts require careful consideration of funding for last-resort services, pricing for services purchased to support state programs, and separation of the regulatory function from business functions. Journal: Health Systems Pages: 82-90 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.28 File-URL: http://hdl.handle.net/10.1057/hs.2014.28 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:82-90 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933268_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Julie Simmons Ivy Author-X-Name-First: Julie Simmons Author-X-Name-Last: Ivy Author-Name: Jennifer Horney Author-X-Name-First: Jennifer Author-X-Name-Last: Horney Author-Name: Jean-Marie Maillard Author-X-Name-First: Jean-Marie Author-X-Name-Last: Maillard Title: Using systems modeling to enhance public health preparedness Abstract: As global public health threats increase in number and worldwide impact, we must explore novel and more advanced approaches to address the complex challenges associated with public health preparedness. Public health outbreaks do not adhere to municipal, state, or national boundaries, which makes the role of systems modeling all the more critical for developing effective and efficient public health preparedness strategies. In response to the need for global and multifaceted preparedness and response efforts, this special issue highlights novel systems modeling approaches that can be applied to public health preparedness. Through these illustrative papers, one goal of this special issue is to serve as a medium for communicating systems methods to public health practice and to increase practitioners’ awareness of the role that systems methods can play in addressing complex planning and implementation issues associated with public health preparedness. Journal: Health Systems Pages: 1-4 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.31 File-URL: http://hdl.handle.net/10.1057/hs.2014.31 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:1-4 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933269_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: The Editors Title: Thank You to our Reviewers and Area Editors Journal: Health Systems Pages: 91-91 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.33 File-URL: http://hdl.handle.net/10.1057/hs.2014.33 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:91-91 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933270_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Elizabeth J Davidson Author-X-Name-First: Elizabeth J Author-X-Name-Last: Davidson Author-Name: Guodong (Gordon) Gao Author-X-Name-First: Guodong (Gordon) Author-X-Name-Last: Gao Author-Name: Jeffrey S McCullough Author-X-Name-First: Jeffrey S Author-X-Name-Last: McCullough Title: Health IT and economics Journal: Health Systems Pages: 54-54 Issue: 1 Volume: 4 Year: 2015 Month: 3 X-DOI: 10.1057/hs.2014.34 File-URL: http://hdl.handle.net/10.1057/hs.2014.34 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:4:y:2015:i:1:p:54-54 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933217_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Onur Asan Author-X-Name-First: Onur Author-X-Name-Last: Asan Author-Name: Enid Montague Author-X-Name-First: Enid Author-X-Name-Last: Montague Title: Physician interactions with electronic health records in primary care Abstract: Objective: It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician–patient interactions. Study Design: Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Methods: Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated coding methodology in order to examine how physicians interact with EHRs. Results: Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. Conclusion: A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed. Journal: Health Systems Pages: 96-103 Issue: 2 Volume: 1 Year: 2012 Month: 12 X-DOI: 10.1057/hs.2012.11 File-URL: http://hdl.handle.net/10.1057/hs.2012.11 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:2:p:96-103 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933218_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jane E J Ebert Author-X-Name-First: Jane E J Author-X-Name-Last: Ebert Author-Name: Brian G Southwell Author-X-Name-First: Brian G Author-X-Name-Last: Southwell Author-Name: Jonathan S Slater Author-X-Name-First: Jonathan S Author-X-Name-Last: Slater Author-Name: Christina L Nelson Author-X-Name-First: Christina L Author-X-Name-Last: Nelson Title: Campaigns in context: promotion, seasonal variation, and resource factors predict mammography program participation Abstract: We consider the impact of health promotion efforts on the timing of health behavior in a real-world setting alongside effects of temporally predictable and other environmental factors. By better understanding the systemic context of promotions, we sought to explain, and suggest timing strategies to enhance, campaign effectiveness in ways often overlooked by health promotion staff. We assessed call volume in response to promotions from May 2004 to December 2008 by a state program in the United States that provides free mammograms to underinsured women. Weekly data were analyzed using OLS regression, using predictor variables representing program promotions, breast cancer awareness, season, and other factors. Call volume was greater following television or direct mail promotions, during periods with higher unemployment rates, during school-term time, and in favorable climate conditions. These results highlight predictable temporal variations in the response to these promotions, suggesting important implications for the timing of health promotion efforts. Journal: Health Systems Pages: 118-128 Issue: 2 Volume: 1 Year: 2012 Month: 12 X-DOI: 10.1057/hs.2012.12 File-URL: http://hdl.handle.net/10.1057/hs.2012.12 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:2:p:118-128 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933219_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mustafa Ozkaynak Author-X-Name-First: Mustafa Author-X-Name-Last: Ozkaynak Author-Name: Patricia Flatley Brennan Author-X-Name-First: Patricia Flatley Author-X-Name-Last: Brennan Title: Characterizing patient care in hospital emergency departments Abstract: The purpose of this study is to characterize the early stage (i.e., until first prescriber order) of patient care in emergency departments (EDs) by focusing on the temporal sequence of activities by multiple roles. A hundred and eight patient care episodes in three EDs were observed and modeled as patient-oriented workflows. Capturing individual episodes allowed us to account for cooperative work in EDs. Data analysis revealed a high level of variability across patient care episodes. We also identified six patterns differentiated primarily by whether the prescriber is a physician or midlevel clinician. Secondary differentiators included whether the patient arrived in the ED as walk-in or via ambulance, and in which ED the patient care occurred. The high level of workflow variability reported in this study should be recognized in the design of ED work systems. Moreover, work interventions should not limit EDs’ capacity to handle sequential variability in patient care. Journal: Health Systems Pages: 104-117 Issue: 2 Volume: 1 Year: 2012 Month: 12 X-DOI: 10.1057/hs.2012.14 File-URL: http://hdl.handle.net/10.1057/hs.2012.14 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:2:p:104-117 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933220_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ray J Paul Author-X-Name-First: Ray J Author-X-Name-Last: Paul Author-Name: Inas Ezz Author-X-Name-First: Inas Author-X-Name-Last: Ezz Author-Name: Jasna Kuljis Author-X-Name-First: Jasna Author-X-Name-Last: Kuljis Title: Healthcare information systems: a patient-user perspective Abstract: The user in this paper is not a medical specialist but a real user of healthcare, a patient. The paper starts by looking at the lack of impact of information systems (ISs) in healthcare, examining the causes as published in the literature. An overview of these causes is enriched by the concerns arising from the first author's personal experiences as a Parkinson's disease patient (about 4 million suffer worldwide) for over 12 years. Seven short ethnographic studies are told as the basis for supporting this user's perspective of these concerns. The concerns are used as the basis for discussing a new way of thinking about healthcare. It is not suggested that the new way of thinking will be adopted, merely that discussion around the ideas may help clarify what healthcare ISs are about. In particular, the theme of the paper is that ignoring the patient cannot lead to the success of ISs. Journal: Health Systems Pages: 85-95 Issue: 2 Volume: 1 Year: 2012 Month: 12 X-DOI: 10.1057/hs.2012.17 File-URL: http://hdl.handle.net/10.1057/hs.2012.17 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:2:p:85-95 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933221_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Peter J H Hulshof Author-X-Name-First: Peter J H Author-X-Name-Last: Hulshof Author-Name: Nikky Kortbeek Author-X-Name-First: Nikky Author-X-Name-Last: Kortbeek Author-Name: Richard J Boucherie Author-X-Name-First: Richard J Author-X-Name-Last: Boucherie Author-Name: Erwin W Hans Author-X-Name-First: Erwin W Author-X-Name-Last: Hans Author-Name: Piet J M Bakker Author-X-Name-First: Piet J M Author-X-Name-Last: Bakker Title: Taxonomic classification of planning decisions in health care: a structured review of the state of the art in OR/MS Abstract: We provide a comprehensive overview of the typical decisions to be made in resource capacity planning and control in health care, and a structured review of relevant articles from the field of Operations Research and Management Sciences (OR/MS) for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making. Journal: Health Systems Pages: 129-175 Issue: 2 Volume: 1 Year: 2012 Month: 12 X-DOI: 10.1057/hs.2012.18 File-URL: http://hdl.handle.net/10.1057/hs.2012.18 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:1:y:2012:i:2:p:129-175 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933292_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mihail Mihaylov Author-X-Name-First: Mihail Author-X-Name-Last: Mihaylov Author-Name: Pieter Smet Author-X-Name-First: Pieter Author-X-Name-Last: Smet Author-Name: Wim Van Den Noortgate Author-X-Name-First: Wim Author-X-Name-Last: Van Den Noortgate Author-Name: Greet Vanden Berghe Author-X-Name-First: Greet Author-X-Name-Last: Vanden Berghe Title: Facilitating the transition from manual to automated nurse rostering Abstract: After several decades of academic research in the field of automated nurse rostering, few results find their way to practice. Often, the configuration of a software system for automated rostering presents a task considered too time-consuming and difficult. The present article introduces a methodology for automating part of the costly and unintuitive configuration process by automatically determining the relative importance of soft constraints based on historical data. Naturally, this automated approach can only be reliable in the absence of transient effects and drastic changes. The approach is evaluated on retrospective and prospective case studies, and is validated by health-care practitioners partaking in an experimental study. The results show that, given relevant historical data, the presented approach simplifies the transition from manual to automated rostering, thus bringing academic research on nurse rostering closer to its practical application. Journal: Health Systems Pages: 120-131 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.12 File-URL: http://hdl.handle.net/10.1057/hs.2015.12 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:120-131 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933293_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Brenton Faber Author-X-Name-First: Brenton Author-X-Name-Last: Faber Author-Name: Renata A Konrad Author-X-Name-First: Renata A Author-X-Name-Last: Konrad Author-Name: Christine Tang Author-X-Name-First: Christine Author-X-Name-Last: Tang Author-Name: Andrew C Trapp Author-X-Name-First: Andrew C Author-X-Name-Last: Trapp Title: Examining the impact of regular physician visits on heart failure patients: a use case with electronic health data Abstract: The rapid adoption of electronic health records (EHRs) presents opportunities to study care management within health systems. We examine the efficacy of using EHR data to assess the outcomes of outpatient care for chronic disease management. A retrospective-prospective study was conducted using 6 years of archived EHR data from patients treated for heart failure at a rural community hospital. Patients were placed into two cohorts, ‘Regular’ and ‘Non-Regular’, based on the frequency of provider contact. A hospital charge ratio was used to calculate cost. Patient mortality and the frequency of unintended events were used to assess patient outcomes. Case study results suggest that sporadic outpatient care was associated with greater utilization of more intensive health-care services. When inpatient and Emergency Department utilization became necessary for both groups, the Regular outpatient cohort had lower mortality rates, fewer readmissions, and incurred lower and less variable costs. Overall, the study showed great potential for using EHR data for assessing care outcomes, notwithstanding some key limitations. We conclude by discussing the types of insights possible and shortcomings attributed from health systems research derived from EHR data. Journal: Health Systems Pages: 132-139 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.13 File-URL: http://hdl.handle.net/10.1057/hs.2015.13 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:132-139 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933294_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Fanwen Meng Author-X-Name-First: Fanwen Author-X-Name-Last: Meng Author-Name: Chee Kheong Ooi Author-X-Name-First: Chee Kheong Author-X-Name-Last: Ooi Author-Name: Christopher Kok Keng Soh Author-X-Name-First: Christopher Kok Author-X-Name-Last: Keng Soh Author-Name: Kiok Liang Teow Author-X-Name-First: Kiok Author-X-Name-Last: Liang Teow Author-Name: Palvannan Kannapiran Author-X-Name-First: Palvannan Author-X-Name-Last: Kannapiran Title: Quantifying patient flow and utilization with patient flow pathway and diagnosis of an emergency department in Singapore Abstract: Patient treatment and care in emergency departments (ED) is complex because of differences in patients’ acuity, co-morbidities and diagnoses. This paper aims to study how different diagnosis groups impact the utilization, which we estimate from patients’ touch points, of various functional areas at ED. We first mapped patient flow pathways across key functional areas in ED, and illustrated them using a network graph. We measured the utilization of these key areas and stratified them by diagnosis groups. The contribution of each diagnosis group to the area utilization was then estimated. A mathematical model was developed to perform impact analysis on the demand based on the utilization pattern. In particular, we estimated the changes in patients’ touch points in the key areas with the changes to the volumes of different diagnosis groups. The study showed that different diagnosis groups have different impact on the demand at the functional areas. In particular, patients with the diagnosis ‘Symptoms, signs and ill-defined conditions’ had the highest impact on the demand in almost all ED areas. The diagnosis ‘Acute respiratory infections’ appeared to have higher impact on the demand in the areas of Fever and Fever Observation. Journal: Health Systems Pages: 140-148 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.15 File-URL: http://hdl.handle.net/10.1057/hs.2015.15 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:140-148 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933295_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Raquel Teasley Author-X-Name-First: Raquel Author-X-Name-Last: Teasley Author-Name: Jessye Bemley Author-X-Name-First: Jessye Author-X-Name-Last: Bemley Author-Name: Lauren B Davis Author-X-Name-First: Lauren B Author-X-Name-Last: Davis Author-Name: Alan Erera Author-X-Name-First: Alan Author-X-Name-Last: Erera Author-Name: Yanling Chang Author-X-Name-First: Yanling Author-X-Name-Last: Chang Title: A Markov chain model for quantifying consumer risk in food supply chains Abstract: According to the Centers for Disease Control and Prevention, approximately 48 million people experience foodborne illnesses per year. The majority of the illnesses are attributed to the presence of bacteria in food products. However, there is some concern about the likelihood of food contamination resulting from intentional acts of sabotage. This research presents a stochastic model to quantify food supply chain vulnerability in terms of the number of people who become ill from consuming a contaminated food product. We specifically use a discrete time, discrete state Markov chain model with rewards and estimate consumer illness by product and distribution channel. The results of our computational study show the relationship between purchasing behavior, product shelf life, and consumer risk. We propose a classification scheme that can be used to categorize the level of vulnerability among different food distribution channels. We also show the impact of purchasing behavior on the speed with which the products are sold at each distribution channel. The proposed model has the potential to provide insight into timely interventions and influence how intervention policies would need to be tailored to each distribution channel in the event that a chemical contamination occurs. Journal: Health Systems Pages: 149-161 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.16 File-URL: http://hdl.handle.net/10.1057/hs.2015.16 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:149-161 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933296_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Emine Yaylali Author-X-Name-First: Emine Author-X-Name-Last: Yaylali Author-Name: Julie S Ivy Author-X-Name-First: Julie S Author-X-Name-Last: Ivy Author-Name: Reha Uzsoy Author-X-Name-First: Reha Author-X-Name-Last: Uzsoy Author-Name: Erika Samoff Author-X-Name-First: Erika Author-X-Name-Last: Samoff Author-Name: Anne Marie Meyer Author-X-Name-First: Anne Marie Author-X-Name-Last: Meyer Author-Name: Jean Marie Maillard Author-X-Name-First: Jean Marie Author-X-Name-Last: Maillard Title: Modeling the effect of public health resources and alerting on the dynamics of pertussis spread Abstract: We consider the response of a local health department (LHD) to a pertussis outbreak using a composite discrete event simulation model with a stochastic branching process. The model captures the effect of epidemiologic spread of disease as a function of the health alert levels and the resource availability of the LHD. The primary response mode in the model is contact tracing that is assumed to be a resource-based delay with an iterative tracing policy. The effect of the threshold for initiating contact tracing and its relationship with the resource availability of the LHD is explored. The model parameters associated with contact tracing are estimated using North Carolina (NC), U.S.A. pertussis case data and data from the NC Public Health Information Network. The infectivity parameters are derived from literature. The results suggest that the time to initiate contact tracing significantly affects the magnitude and duration of the outbreak. The resource levels for contact tracing have less significant impact on the outbreak outcomes. However, when the nurse schedule is constrained, that is, if the total hours devoted to contact tracing a week is restricted, the effect of the resource level becomes significant. In fact, some outbreaks could not be controlled within the 1-year time limit of simulation. Journal: Health Systems Pages: 81-97 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.6 File-URL: http://hdl.handle.net/10.1057/hs.2015.6 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:81-97 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933297_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Muge Gultekin Kesercioglu Author-X-Name-First: Muge Gultekin Author-X-Name-Last: Kesercioglu Author-Name: Stephen D Roberts Author-X-Name-First: Stephen D Author-X-Name-Last: Roberts Author-Name: Reha Uzsoy Author-X-Name-First: Reha Author-X-Name-Last: Uzsoy Title: Computing the number of acute-care beds within NC Certificate of Need Abstract: North Carolina’s Certificate of Need legislation is intended to limit unnecessary growth in the number of acute-care beds throughout the state. In contrast to the current method of computing bed needs based on existing administrative units (counties), we estimate the service area of each acute-care facility using Voronoi diagrams such that the maximum distance from any point in the region to the nearest acute-care facility is minimized. The population in the service area is then used to determine the appropriate bed capacity for the hospital serving that region. The approach is applied to the problem of determining the appropriate number of acute-care beds for each hospital in the state. The discrepancies between the existing hospital sizes and the needed acute-care beds indicate areas where geographical inequities may need attention. Journal: Health Systems Pages: 98-108 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.8 File-URL: http://hdl.handle.net/10.1057/hs.2015.8 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:98-108 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933298_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sean Barnes Author-X-Name-First: Sean Author-X-Name-Last: Barnes Author-Name: Margrét Bjarnadóttir Author-X-Name-First: Margrét Author-X-Name-Last: Bjarnadóttir Author-Name: Xue Guo Author-X-Name-First: Xue Author-X-Name-Last: Guo Title: Centers for medicare and medicaid services provider characteristics fail to explain billing variability Abstract: We aim to explain the variation in provider charges based on Centers for Medicare and Medicaid Services’s (CMS) recently released data containing information on payments to and charges by health-care providers. The large data set includes operational, financial, and quality measures, as well as service identifiers. We evaluate how CMS’s published payment models explain payments and charges for inpatient and outpatient services, and employ additional models that incorporate available service- and provider-specific information. We found that the variation in payments is explained extremely well by CMS’s payment models, but these same models only explain provider charges to a limited extent. Efforts to include service- and provider-specific data and segment the data only marginally improve the fit of provider charges, leaving almost 30% of the variation of charges unexplained for all global models. Our analysis demonstrates that provider charges are highly variable and providers are using potentially diverse information and different methods to determine their prices. Journal: Health Systems Pages: 109-119 Issue: 2 Volume: 5 Year: 2016 Month: 6 X-DOI: 10.1057/hs.2015.9 File-URL: http://hdl.handle.net/10.1057/hs.2015.9 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:2:p:109-119 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1405873_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ki-Hwan Bae Author-X-Name-First: Ki-Hwan Author-X-Name-Last: Bae Author-Name: Molly Jones Author-X-Name-First: Molly Author-X-Name-Last: Jones Author-Name: Gerald Evans Author-X-Name-First: Gerald Author-X-Name-Last: Evans Author-Name: Demetra Antimisiaris Author-X-Name-First: Demetra Author-X-Name-Last: Antimisiaris Title: Simulation modelling of patient flow and capacity planning for regional long-term care needs: a case study Abstract: The need for Long-Term Care (LTC) arises in the elderly population, especially those reaching age 65 each year. This elderly population will grow tremendously in the United States over the next decade, resulting in short- and long-term challenges of matching resource capacity with uncertain demand for hospitals and other healthcare providers. This paper describes research involving the development of a simulation model of patient flow in order to understand the relationship between capacity and demand, and to investigate the impacts on performance measures such as average wait times for LTC patients. We propose an aggregate capacity model to consider patient flow among various types of care providers by integrating hospitals, nursing homes, assisted living facilities, and home health care. Using the data including patient demographics and service provider information, we forecast patient demand for LTC. The computational results demonstrate the efficacy of a simulation-based optimisation solution approach for capacity planning. Journal: Health Systems Pages: 1-16 Issue: 1 Volume: 8 Year: 2019 Month: 1 X-DOI: 10.1080/20476965.2017.1405873 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1405873 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:1:p:1-16 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1405874_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Dinesh R. Pai Author-X-Name-First: Dinesh R. Author-X-Name-Last: Pai Author-Name: Hengameh Hosseini Author-X-Name-First: Hengameh Author-X-Name-Last: Hosseini Author-Name: Richard S. Brown Author-X-Name-First: Richard S. Author-X-Name-Last: Brown Title: Does efficiency and quality of care affect hospital closures? Abstract: In recent decades, a large number of hospitals in Pennsylvania and across the United States have been forced to close entirely, or to transform their beds for alternative uses including outpatient care. Hospital closures have severe repercussions for the stakeholders. A better understanding of hospital closures could help take corrective measures to alleviate the adverse impact closures have on communities. Using Pennsylvania Department of Health data compiled from various sources, we address the following questions: Are less efficient hospitals less likely to survive in the long run? What are the effects of quality of care on hospital closures? Does teaching status and location (urban or rural) have any impact on the probability of hospital closure? The result demonstrates several factors of varying significance affect hospital closures/survivals. Hospitals with higher ratio of registered nurses per bed, higher operating margin, lower percentage of revenues from Medicare and Medicaid, and lower competition were less likely to close. Efficiency measures such as DEA efficiency, cost per patient day, and cost per discharge were not found to have a significant impact on hospital closures. The results suggest that hospital administrators may focus more on quality of care and less on cost reduction and efficiency. Journal: Health Systems Pages: 17-30 Issue: 1 Volume: 8 Year: 2019 Month: 1 X-DOI: 10.1080/20476965.2017.1405874 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1405874 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:1:p:17-30 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1406568_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Katheryn R. Christy Author-X-Name-First: Katheryn R. Author-X-Name-Last: Christy Author-Name: Jakob D. Jensen Author-X-Name-First: Jakob D. Author-X-Name-Last: Jensen Author-Name: Brian Britt Author-X-Name-First: Brian Author-X-Name-Last: Britt Author-Name: Courtney L. Scherr Author-X-Name-First: Courtney L. Author-X-Name-Last: Scherr Author-Name: Christina Jones Author-X-Name-First: Christina Author-X-Name-Last: Jones Author-Name: Natasha R. Brown Author-X-Name-First: Natasha R. Author-X-Name-Last: Brown Title: I want to talk to a real person: theorising avoidance in the acceptance and use of automated technologies Abstract: Automated communication systems are increasingly common in mobile and ehealth contexts. Yet, there is a reason to believe that some high-risk segments of the population might be prone to avoid automated systems even though they are often designed to reach these groups. To facilitate research in this area, avoidance of automated communication (AAC) is theorised – and a measurement instrument validated – across two studies. In study 1, an AAC scale was found to be unidimensional and internally reliable as well as negatively correlated with comfort, perceptions, and intentions to use technology. Moreover, individuals with social phobia had lower AAC scores which was consistent with the idea that they preferred non-human interaction facilitated by automated communication. In study 2, confirmatory factor analysis supported the unidimensional structure of the measure and the instrument once again proved to be reliable. Individuals with lower AAC had greater intentions to utilise automated communication, EHRs, and an automated virtual nurse programme. AAC is a disposition that predicts significant variance in intentions and comfort with various automated communication technologies. Avoidance increases with age but may be mitigated by systems that allow participants to opt-out or immediately interact with a live person. Journal: Health Systems Pages: 31-43 Issue: 1 Volume: 8 Year: 2019 Month: 1 X-DOI: 10.1080/20476965.2017.1406568 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1406568 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:1:p:31-43 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1414740_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nick Carcioppolo Author-X-Name-First: Nick Author-X-Name-Last: Carcioppolo Author-Name: Katheryn R. Christy Author-X-Name-First: Katheryn R. Author-X-Name-Last: Christy Author-Name: Jakob D. Jensen Author-X-Name-First: Jakob D. Author-X-Name-Last: Jensen Author-Name: Andy J. King Author-X-Name-First: Andy J. Author-X-Name-Last: King Author-Name: Julie Goonewardene Author-X-Name-First: Julie Author-X-Name-Last: Goonewardene Author-Name: Daniel Raftery Author-X-Name-First: Daniel Author-X-Name-Last: Raftery Title: Biomarker profiling for breast cancer detection: translational research to determine acceptance of a novel breast cancer screening technique Abstract: The current study seeks to determine how the psychosocial predictors of the health belief model are related to willingness to adopt biomarker screening practices among women above and below current screening age recommendations, as biomarker profiling can potentially detect cancer much earlier than current breast cancer detection methods. Patients (N = 205) at an Obstetrician/Gynaecology office in a mid-sized Midwest city. Participants completed a survey in the waiting room before their doctor appointment. Results revealed that benefits (p < .001), barriers (p = .02), cancer worry severity (p = .01), and self-efficacy (p = .002) were significant predictors of willingness to adopt biomarker profiling, and susceptibility was marginally related (p = .09). The direct effects are qualified by two interactions between psychosocial predictors of the health belief model and participants’ age. The model predicted willingness to adopt biomarker screening well (R2 = 28%), and may be used successfully as a framework to assess the diffusion of biomarker screening acceptability. Journal: Health Systems Pages: 44-51 Issue: 1 Volume: 8 Year: 2019 Month: 1 X-DOI: 10.1080/20476965.2017.1414740 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1414740 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:1:p:44-51 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1414741_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Christina E. Saville Author-X-Name-First: Christina E. Author-X-Name-Last: Saville Author-Name: Honora K. Smith Author-X-Name-First: Honora K. Author-X-Name-Last: Smith Author-Name: Katarzyna Bijak Author-X-Name-First: Katarzyna Author-X-Name-Last: Bijak Title: Operational research techniques applied throughout cancer care services: a review Abstract: Cancer is a disease affecting increasing numbers of people. In the UK, the proportion of people affected by cancer is projected to increase from 1 in 3 in 1992, to nearly 1 in 2 by 2020. Health services to tackle cancer can be grouped broadly into prevention, diagnosis, staging, and treatment. We review examples of Operational Research (OR) papers addressing decisions encountered in each of these areas. In conclusion, we find many examples of OR research on screening strategies, as well as on treatment planning and scheduling. On the other hand, our search strategy uncovered comparatively few examples of OR models applied to reducing cancer risks, optimising diagnostic procedures, and staging. Improvements to cancer care services have been made as a result of successful OR modelling. There is potential for closer working with clinicians to enable the impact of other OR studies to be of greater benefit to cancer sufferers. Journal: Health Systems Pages: 52-73 Issue: 1 Volume: 8 Year: 2019 Month: 1 X-DOI: 10.1080/20476965.2017.1414741 File-URL: http://hdl.handle.net/10.1080/20476965.2017.1414741 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:8:y:2019:i:1:p:52-73 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1436909_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: A. G. Leeftink Author-X-Name-First: A. G. Author-X-Name-Last: Leeftink Author-Name: I. A. Bikker Author-X-Name-First: I. A. Author-X-Name-Last: Bikker Author-Name: I. M. H. Vliegen Author-X-Name-First: I. M. H. Author-X-Name-Last: Vliegen Author-Name: R. J. Boucherie Author-X-Name-First: R. J. Author-X-Name-Last: Boucherie Title: Multi-disciplinary planning in health care: a review Abstract: Multi-disciplinary planning in health care is an emerging research field that applies to many health care areas with similar underlying planning characteristics. We provide a review of the literature and describe cross-relations between different applications. We identify multiple fields to classify the literature upon. These fields relate to the system characteristics, decision characteristics, and applicability. The relevant papers for each of these fields are discussed, which provides a broad and thorough overview of the present research, and guides readers towards identifying the applicable literature for their research based on the characteristics of their problem. Furthermore, we disclose research gaps and present open challenges for further research. Journal: Health Systems Pages: 95-118 Issue: 2 Volume: 9 Year: 2020 Month: 04 X-DOI: 10.1080/20476965.2018.1436909 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1436909 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:2:p:95-118 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1758000_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ozgur M. Araz Author-X-Name-First: Ozgur M. Author-X-Name-Last: Araz Author-Name: Adrian Ramirez-Nafarrate Author-X-Name-First: Adrian Author-X-Name-Last: Ramirez-Nafarrate Author-Name: Megan Jehn Author-X-Name-First: Megan Author-X-Name-Last: Jehn Author-Name: Fernando A. Wilson Author-X-Name-First: Fernando A. Author-X-Name-Last: Wilson Title: The importance of widespread testing for COVID-19 pandemic: systems thinking for drive-through testing sites Abstract: On 11 March 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic. Early epidemiological estimates show that COVID-19 is highly transmissible, infecting populations across the globe in a short amount of time. WHO has recommended widespread clinical testing in order to contain COVID-19. However, mass testing in emergency department (ED) settings may result in crowded EDs and increase transmission risk for healthcare staff and other ED patients. Drive-through COVID-19 testing sites are an effective solution to quickly collect samples from suspected cases with minimal risk to healthcare personnel and other patients. Nevertheless, there are many logistical and operational challenges, such as shortages of testing kits, limited numbers of healthcare staff and long delays for collecting samples. Solving these problems requires an understanding of disease dynamics and epidemiology, as well as the logistics of mass distribution. In this position paper, we provide a conceptual framework for addressing these challenges, as well as some insights from prior literature and experience on developing decision support tools for public health departments. Journal: Health Systems Pages: 119-123 Issue: 2 Volume: 9 Year: 2020 Month: 04 X-DOI: 10.1080/20476965.2020.1758000 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1758000 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:2:p:119-123 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1471439_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James F. Cox III Author-X-Name-First: James F. Author-X-Name-Last: Cox III Author-Name: Lynn H. Boyd Author-X-Name-First: Lynn H. Author-X-Name-Last: Boyd Title: Using the theory of constraints’ processes of ongoing improvement to address the provider appointment scheduling system design problem Abstract: Health care is in crisis today: costs are rising, demand exceeds supply, quality is questioned and patient wait times are excessive while providers and staff are simultaneously overworked and frustrated. No one has a comprehensive system solution to providing more, cheaper, better, and faster health care, even in primary care practices, the first link in the health care supply chain. Additionally, this link like others frequently experiences the combination of complexity, uncertainty, and local optimisation simultaneously to create a chaotic environment. Health care problems have been called ill-structured (also “wicked”) and because of their tangled web of stakeholders with different and conflicting objectives defy traditional optimisation research methodologies. Proper design and management of the provider appointment scheduling system (PASS) provides a direction for a win–win health care solution (more, cheaper, better, and faster). Our objective is to provide a generic strawman process for developing a robust PASS for most environments. A theory of constraints thinking processes (TP) analysis was conducted on the academic research using a primary care practice to validate both entity and causality existence. From this integrated analysis, a robust process for designing a PASS resulted. Last, we show that Goldratt’s TP provides a logical, rigorous framework for qualitative research and design science. Journal: Health Systems Pages: 124-158 Issue: 2 Volume: 9 Year: 2020 Month: 04 X-DOI: 10.1080/20476965.2018.1471439 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1471439 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:2:p:124-158 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1485615_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Parisa Eimanzadeh Author-X-Name-First: Parisa Author-X-Name-Last: Eimanzadeh Author-Name: Heather Gloede Author-X-Name-First: Heather Author-X-Name-Last: Gloede Author-Name: Joyce Soule Author-X-Name-First: Joyce Author-X-Name-Last: Soule Author-Name: Ehsan Salari Author-X-Name-First: Ehsan Author-X-Name-Last: Salari Title: Accounting for patient heterogeneity in nurse staffing using a queueing-theory approach Abstract: Evidence from observational studies suggests that inadequate nurse staffing in hospitals and heavy nurse workload may compromise patient safety and quality of care. There are recommended minimum nurse-to-patient ratios for different types of inpatient care settings. However, nursing-care intensity may vary across different patients within an inpatient unit depending on the severity of their medical condition, potentially rendering fixed nurse-to-patient ratios ineffective. This study aims at developing nurse-staffing strategies that explicitly account for patient heterogeneity. Using queueing theory, we develop a stochastic framework to model direct nursing care provided in inpatient-care units. The stochastic model is then used to measure different performance metrics that evaluate the efficiency and timeliness of inpatient-care delivery. The trade-off between those performance metrics and the nursing staff level is quantified, which can assist clinicians with determining minimum nursing staff levels that ensure timely delivery of nursing care to a given patient mix. Journal: Health Systems Pages: 159-177 Issue: 2 Volume: 9 Year: 2020 Month: 04 X-DOI: 10.1080/20476965.2018.1485615 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1485615 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:2:p:159-177 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1908176_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Enoch Kung Author-X-Name-First: Enoch Author-X-Name-Last: Kung Author-Name: Sarah E. Seaton Author-X-Name-First: Sarah E. Author-X-Name-Last: Seaton Author-Name: Padmanabhan Ramnarayan Author-X-Name-First: Padmanabhan Author-X-Name-Last: Ramnarayan Author-Name: Christina Pagel Author-X-Name-First: Christina Author-X-Name-Last: Pagel Title: Using a genetic algorithm to solve a non-linear location allocation problem for specialised children’s ambulances in England and Wales Abstract: 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. Journal: Health Systems Pages: 161-171 Issue: 3 Volume: 11 Year: 2022 Month: 07 X-DOI: 10.1080/20476965.2021.1908176 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1908176 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:3:p:161-171 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2080006_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Leila Abuabara Author-X-Name-First: Leila Author-X-Name-Last: Abuabara Author-Name: Katarzyna Werner-Masters Author-X-Name-First: Katarzyna Author-X-Name-Last: Werner-Masters Author-Name: Alberto Paucar-Caceres Author-X-Name-First: Alberto Author-X-Name-Last: Paucar-Caceres Title: Daily food planning for families under Covid-19: combining analytic hierarchy processes and linear optimisation Abstract: In many households, preparation of food in normal times proves to be problematic, particularly when parents endeavour to keep their children on a balanced diet. The COVID-19 pandemic has further exacerbated this problem imposing the requirement of social distancing, which led to disruptions in the food supply chain and multiplication of responsibilities faced by families with children. The present study revisits the standard “Diet Problem” to address these challenges and to develop a participatory approach to provide a diversified weekly meal plan that is easy and fun but simultaneously complies with the unique requirements of each participant. This is done by providing a novel framework, which combines linear optimisation with the Parsimonious Analytic Hierarchy Process, a method for individual choices. This novel approach to participatory modelling is tested within two young family settings in Brazil. The model produced through this contemporary framework provides a weekly menu that best meets expectations of the members of a young family in the context of the COVID-19 pandemic. Journal: Health Systems Pages: 232-250 Issue: 3 Volume: 11 Year: 2022 Month: 07 X-DOI: 10.1080/20476965.2022.2080006 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2080006 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:3:p:232-250 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1924085_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: M. Dashtban Author-X-Name-First: M. Author-X-Name-Last: Dashtban Author-Name: Weizi Li Author-X-Name-First: Weizi Author-X-Name-Last: Li Title: Predicting non-attendance in hospital outpatient appointments using deep learning approach Abstract: 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. Journal: Health Systems Pages: 189-210 Issue: 3 Volume: 11 Year: 2022 Month: 07 X-DOI: 10.1080/20476965.2021.1924085 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1924085 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:3:p:189-210 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1952113_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Placide Poba-Nzaou Author-X-Name-First: Placide Author-X-Name-Last: Poba-Nzaou Author-Name: Sylvestre Uwizeyemungu Author-X-Name-First: Sylvestre Author-X-Name-Last: Uwizeyemungu Author-Name: Mamadou Dakouo Author-X-Name-First: Mamadou Author-X-Name-Last: Dakouo Author-Name: Anicet Tchibozo Author-X-Name-First: Anicet Author-X-Name-Last: Tchibozo Author-Name: Bocar Mboup Author-X-Name-First: Bocar Author-X-Name-Last: Mboup Title: Patterns of health information exchange strategies underlying health information technologies capabilities building Abstract: The combination of electronic health records (EHRs), health information exchange (HIE), and telehealthholds a high potential for improving the coordination of care and saving lives. As well, the benefits of the three HIT on hospitals’ depend on the patterns of capabilities that are available and used by clinicians. However, little is known about how the three HIT, actually empirically coexist and about the strategies underlying the use of HIE in hospital settings. Based on data from a European Union survey, we use a combination of hierarchical and non-hierarchical clustering and discriminant analysis to identify patterns of hospitals’ HIT capabilities. Five statistically significantly separated configurations were derived from a data set of 1038 acute care hospitals. The actual empirical coexistence of the three HIT capabilities and associated HIE strategies revealed by this study can be counter-intuitive and shed light on misalignments that may impede the realisation of the potential benefits. Journal: Health Systems Pages: 211-231 Issue: 3 Volume: 11 Year: 2022 Month: 07 X-DOI: 10.1080/20476965.2021.1952113 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1952113 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:3:p:211-231 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1908851_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Safa Chabouh Author-X-Name-First: Safa Author-X-Name-Last: Chabouh Author-Name: Sondes Hammami Author-X-Name-First: Sondes Author-X-Name-Last: Hammami Author-Name: Eric Marcon Author-X-Name-First: Eric Author-X-Name-Last: Marcon Author-Name: Hanen Bouchriha Author-X-Name-First: Hanen Author-X-Name-Last: Bouchriha Title: A pull-strategy for the appointment scheduling of surgical patients in a hospital-integrated facility Abstract: 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. Journal: Health Systems Pages: 172-188 Issue: 3 Volume: 11 Year: 2022 Month: 07 X-DOI: 10.1080/20476965.2021.1908851 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1908851 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:3:p:172-188 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933299_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mário Amorim Lopes Author-X-Name-First: Mário Author-X-Name-Last: Amorim Lopes Author-Name: Carlos Soares Author-X-Name-First: Carlos Author-X-Name-Last: Soares Author-Name: Álvaro Almeida Author-X-Name-First: Álvaro Author-X-Name-Last: Almeida Author-Name: Bernardo Almada-Lobo Author-X-Name-First: Bernardo Author-X-Name-Last: Almada-Lobo Title: Comparing comparables: an approach to accurate cross-country comparisons of health systems for effective healthcare planning and policy guidance Abstract: With rising healthcare costs, using health personnel and resources efficiently and effectively is critical. International cross-country and simple worker-to-population ratio comparisons are frequently used for improving the efficiency of health systems, planning of health human resources and guiding policy changes. These comparisons are made between countries typically of the same continental region. However, if used imprudently, inconsistencies arising from frail comparisons of health systems may outweigh the positive benefits brought by new policy insights. In this work, we propose a different approach to international health system comparisons. We present a methodology to group similar countries in terms of mortality, morbidity, utilisation levels, and human and physical resources, which are all factors that influence health gains. Instead of constructing an absolute rank or comparing against the average, the method finds countries that share similar ground, upon which more reliable comparisons can then be conducted, including performance analysis. We apply this methodology using data from the World Health Organization’s Health for All database, and we present some interesting empirical relationships between indicators that may provide new insights into how such information can be used to promote better healthcare planning and policy guidance. Journal: Health Systems Pages: 192-212 Issue: 3 Volume: 5 Year: 2016 Month: 10 X-DOI: 10.1057/hs.2015.21 File-URL: http://hdl.handle.net/10.1057/hs.2015.21 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:3:p:192-212 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933300_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Roberto Aringhieri Author-X-Name-First: Roberto Author-X-Name-Last: Aringhieri Author-Name: Vincent Knight Author-X-Name-First: Vincent Author-X-Name-Last: Knight Author-Name: Honora Smith Author-X-Name-First: Honora Author-X-Name-Last: Smith Title: ESI XXXI: OR applied to health in a modern world Journal: Health Systems Pages: 163-165 Issue: 3 Volume: 5 Year: 2016 Month: 10 X-DOI: 10.1057/s41306-016-0012-5 File-URL: http://hdl.handle.net/10.1057/s41306-016-0012-5 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:3:p:163-165 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933301_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sheetal Prakash Silal Author-X-Name-First: Sheetal Prakash Author-X-Name-Last: Silal Author-Name: Francesca Little Author-X-Name-First: Francesca Author-X-Name-Last: Little Author-Name: Karen I Barnes Author-X-Name-First: Karen I Author-X-Name-Last: Barnes Author-Name: Lisa Jane White Author-X-Name-First: Lisa Jane Author-X-Name-Last: White Title: Sensitivity to model structure: a comparison of compartmental models in epidemiology Abstract: Compartmental models have provided a framework for understanding disease transmission dynamics for over 100 years. The predictions from these models are often policy relevant and need to be robust to model assumptions, parameter values and model structure. A selection of compartmental models with the same parameter values but different model structures (ranging from simple structures to complex ones) were compared in the absence and presence of several policy interventions to assess sensitivity to model structure. Models were fitted to data to assess if this might reduce this sensitivity. The compartmental models produced wide-ranging estimates of outcome measures but when fitted to data, the estimates obtained were robust to model structure. This finding suggests that there may be an argument for selecting simple models over complex ones, but the complexity of the model should be determined by the purpose of the model and the use to which it will be put. Journal: Health Systems Pages: 178-191 Issue: 3 Volume: 5 Year: 2016 Month: 10 X-DOI: 10.1057/hs.2015.2 File-URL: http://hdl.handle.net/10.1057/hs.2015.2 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:3:p:178-191 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933302_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jennifer Sian Morgan Author-X-Name-First: Jennifer Sian Author-X-Name-Last: Morgan Author-Name: Val Belton Author-X-Name-First: Val Author-X-Name-Last: Belton Author-Name: Susan Howick Author-X-Name-First: Susan Author-X-Name-Last: Howick Title: Lessons from mixing OR methods in practice: using DES and SD to explore a radiotherapy treatment planning process Abstract: Mixing Operational Research (OR) methods is becoming more commonplace. Discrete-Event Simulation (DES) and System Dynamics (SD) are popular modelling methods previously applied to a range of situations for various purposes, which are starting to be mixed in healthcare. However, the practicalities of mixing DES and SD in practice remain unclear. Radiotherapy treatment is a complex multi-stage process where technology and best practice continue to evolve. This paper describes a project undertaken to explore the treatment planning process using mixed OR methods. It presents insights obtained through mixing OR methods within a real-world project. The model development process, the role of each modelling method and the benefits of undertaking a mixed OR methods project design are described. Lessons for mixing DES and SD, and more generally mixing OR methods, are discussed. Journal: Health Systems Pages: 166-177 Issue: 3 Volume: 5 Year: 2016 Month: 10 X-DOI: 10.1057/hs.2016.4 File-URL: http://hdl.handle.net/10.1057/hs.2016.4 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:3:p:166-177 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_11933303_J.xml processed with: repec_from_tfjats.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Andrea Lodi Author-X-Name-First: Andrea Author-X-Name-Last: Lodi Author-Name: Paolo Tubertini Author-X-Name-First: Paolo Author-X-Name-Last: Tubertini Author-Name: Roberto Grilli Author-X-Name-First: Roberto Author-X-Name-Last: Grilli Author-Name: Angelina Mazzocchetti Author-X-Name-First: Angelina Author-X-Name-Last: Mazzocchetti Author-Name: Corrado Ruozi Author-X-Name-First: Corrado Author-X-Name-Last: Ruozi Author-Name: Francesca Senese Author-X-Name-First: Francesca Author-X-Name-Last: Senese Title: Needs forecast and fund allocation of medical specialty positions in Emilia-Romagna (Italy) by system dynamics and integer programming Abstract: Each year Emilia-Romagna health managers have to negotiate the number of medical specialization grants to be financed by the National government and define the number of additional grants to be funded by the regional budget. The final goal of this study is to provide a Decision Support System for grant allocation to medical specializations within Emilia-Romagna over a 20-year planning horizon. We have developed a System Dynamics (SD) model that represents regional medical specialist human resources and forecasts population needs over the planning horizon. The SD model provides a requirement indicator for each medical specialization. On the basis of these indicators, an Integer Programming model computes optimal assignments of medical specialization grants. We then define three demand scenarios and show how regional and national funded grants can be managed in order to reduce future gaps by comparing our results with current policies. Journal: Health Systems Pages: 213-236 Issue: 3 Volume: 5 Year: 2016 Month: 10 X-DOI: 10.1057/hs.2015.11 File-URL: http://hdl.handle.net/10.1057/hs.2015.11 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:5:y:2016:i:3:p:213-236 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1457134_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Emmanuel Eze Author-X-Name-First: Emmanuel Author-X-Name-Last: Eze Author-Name: Rob Gleasure Author-X-Name-First: Rob Author-X-Name-Last: Gleasure Author-Name: Ciara Heavin Author-X-Name-First: Ciara Author-X-Name-Last: Heavin Title: Mobile health solutions in developing countries: a stakeholder perspective Abstract: Infrastructural deficiencies, limited access to medical care, and shortage of health care workers are just a few of the barriers to health care in developing countries. mHealth has the potential to overcome at least some of these challenges. To address this, a stakeholder perspective is adopted and an analysis of existing research is undertaken to look at mHealth delivery in developing countries. This study focuses on four key stakeholder groups i.e., health care workers, patients, system developers, and facilitators. A systematic review identifies 108 peer-reviewed articles, which are analysed to determine the extent these articles investigate the different types of stakeholder interactions, and to identify high-level themes emerging within these interactions. This analysis illustrates two key gaps. First, while interactions involving health care workers and/or patients have received significant attention, little research has looked at the role of patient-to-patient interactions. Second, the interactions between system developers and the other stakeholder groups are strikingly under-represented. Journal: Health Systems Pages: 179-201 Issue: 3 Volume: 9 Year: 2020 Month: 07 X-DOI: 10.1080/20476965.2018.1457134 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1457134 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:3:p:179-201 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1524407_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: David Ben-Tovim Author-X-Name-First: David Author-X-Name-Last: Ben-Tovim Author-Name: Tim Bogomolov Author-X-Name-First: Tim Author-X-Name-Last: Bogomolov Author-Name: Jerzy Filar Author-X-Name-First: Jerzy Author-X-Name-Last: Filar Author-Name: Paul Hakendorf Author-X-Name-First: Paul Author-X-Name-Last: Hakendorf Author-Name: Shaowen Qin Author-X-Name-First: Shaowen Author-X-Name-Last: Qin Author-Name: Campbell Thompson Author-X-Name-First: Campbell Author-X-Name-Last: Thompson Title: Hospital’s instability wedges Abstract: In this study, we define a hospital congestion episode as a situation where the number of new patients needing admission is greater than the number of available beds in the hospital, and investigate the likelihood that the current day’s midnight occupancy will exceed any specified threshold level. We demonstrate that this measure of risk exhibits a characteristic sensitivity phenomenon that we have named as hospital’s instability wedge. In particular, it is seen that frequently even small changes in the numbers of patients admitted or discharged can dramatically change the risk of exceeding the threshold, thereby changing the risk of subsequent congestion episodes. While this finding captures a salient difficulty of operating a modern public hospital, it also opens up an opportunity for monitoring and alleviating the above defined risk with only small changes in admission, discharge, and cancellation rates. A case study with recent patient journey data from Flinders Medical Centre in South Australia is presented. Journal: Health Systems Pages: 202-211 Issue: 3 Volume: 9 Year: 2020 Month: 07 X-DOI: 10.1080/20476965.2018.1524407 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1524407 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:3:p:202-211 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1569480_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Abdullah Alibrahim Author-X-Name-First: Abdullah Author-X-Name-Last: Alibrahim Author-Name: Shinyi Wu Author-X-Name-First: Shinyi Author-X-Name-Last: Wu Title: Modelling competition in health care markets as a complex adaptive system: an agent-based framework Abstract: Health market reforms necessitate continuous re-evaluation of initiatives, competitive regulations, and antitrust policies. Synergistic implications, evolution, and behaviour changes associated with the market competition are often overlooked due to methodological limitations. To rectify these limitations, parallels between defining features of health care markets (HCM) and complex adaptive systems (CAS) are drawn. The science of CAS develops complex system-level models of dynamic interactions to allow insights for heterogeneous agents and emergent behaviours. Agent-based modelling (ABM) is a computational tool of CAS science suitable for investigating competition in HCM. The proposed agent-based framework conceptualises agents, environment, and interactions, and formalises agent-specific attributes and modules that achieve agent roles to recreate HCM dynamics. The framework conceptualises competition in HCM into an implementable ABM for a CAS assessment, identifies data sources, and develops face-validity procedures. Developments in data, computational power, and decisions theory compel CAS approach to complement studies on pressing HCM issues. Journal: Health Systems Pages: 212-225 Issue: 3 Volume: 9 Year: 2020 Month: 07 X-DOI: 10.1080/20476965.2019.1569480 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1569480 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:3:p:212-225 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1534037_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Yavuz A. Bozer Author-X-Name-First: Yavuz A. Author-X-Name-Last: Bozer Author-Name: Chate Eamrungroj Author-X-Name-First: Chate Author-X-Name-Last: Eamrungroj Title: Analysis of patient-mover dispatching and equipment-marshalling areas: a simulation study at the University of Michigan Hospital Abstract: We study the intra-facility patient movement problem in large, multi-floor hospitals, where many patients are moved each year by patient movers using wheelchairs or gurneys. Using a simulation model, and the University of Michigan Health System (UMHS) hospital as the problem setting, we compare alternative rules for dispatching the patient movers via a centralised, computer-controlled system. Included in the comparison is the rule used currently at the hospital as well as new alternative dispatching rules we develop for the study. Our results suggest that significant improvements in system performance can be obtained by using better dispatching rules that consider not only the proximity of the patient mover to the patient pick-up point but also the type of equipment needed (wheelchair versus gurney) and the location of the equipment marshalling areas, which also play a key role. In conjunction with the dispatching rules, we investigate the number and location of the marshalling areas, and show empirically that carefully locating them based on usage improves the system performance as much as, if not more than, a more efficient dispatching rule. Although the UMHS hospital serves as the problem setting, our study would apply to most hospitals with dedicated patient movers and centralised dispatching. Journal: Health Systems Pages: 226-252 Issue: 3 Volume: 9 Year: 2020 Month: 07 X-DOI: 10.1080/20476965.2018.1534037 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1534037 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:3:p:226-252 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1548255_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Terry Young Author-X-Name-First: Terry Author-X-Name-Last: Young Author-Name: Sada Soorapanth Author-X-Name-First: Sada Author-X-Name-Last: Soorapanth Author-Name: Jim Wilkerson Author-X-Name-First: Jim Author-X-Name-Last: Wilkerson Author-Name: Lance Millburg Author-X-Name-First: Lance Author-X-Name-Last: Millburg Author-Name: Todd Roberts Author-X-Name-First: Todd Author-X-Name-Last: Roberts Author-Name: David Morgareidge Author-X-Name-First: David Author-X-Name-Last: Morgareidge Title: The costs and value of modelling-based design in healthcare delivery: five case studies from the US Abstract: In the nineties and noughties, Hollocks surveyed the use of Discrete Event Simulation (DES) in industry and listed (although he could not quantify the value of) benefits. This paper explores how DES is now used to design healthcare facilities and services, developing a value-for-money case with a protocol on collecting information. We present a set of five DES case studies from the US care system and, following Hollocks, focus on modelling as part of a rigorous design process, capturing as many of the benefits as possible. Healthcare offers the possibility of ascribing value to health improvement, but in these cases it is primarily the operational benefits of a better service that are reported and monetarised. By estimated the cost of modelling and the value of the operation gains, this paper contributes significantly to the literature. We conclude with a protocol for collecting information and a discussion of methods by which different types of benefit may be captured. Journal: Health Systems Pages: 253-262 Issue: 3 Volume: 9 Year: 2020 Month: 07 X-DOI: 10.1080/20476965.2018.1548255 File-URL: http://hdl.handle.net/10.1080/20476965.2018.1548255 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:9:y:2020:i:3:p:253-262 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1652547_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Emma Aspland Author-X-Name-First: Emma Author-X-Name-Last: Aspland Author-Name: Daniel Gartner Author-X-Name-First: Daniel Author-X-Name-Last: Gartner Author-Name: Paul Harper Author-X-Name-First: Paul Author-X-Name-Last: Harper Title: Clinical pathway modelling: a literature review Abstract: Hospital information systems are increasingly used as part of decision support tools for planning at strategic, tactical and operational decision levels. Clinical pathways are an effective and efficient approach in standardising the progression of treatment, to support patient care and facilitate clinical decision making. This literature review proposes a taxonomy of problems related to clinical pathways and explores the intersection between Information Systems (IS), Operational Research (OR) and industrial engineering. A structured search identified 175 papers included in the taxonomy and analysed in this review. The findings suggest that future work should consider industrial engineering integrated with OR techniques, with an aim to improving the handling of multiple scopes within one model, while encouraging interaction between the disjoint care levels and with a more direct focus on patient outcomes. Achieving this would continue to bridge the gap between OR, IS and industrial engineering, for clinical pathways to aid decision support. Journal: Health Systems Pages: 1-23 Issue: 1 Volume: 10 Year: 2021 Month: 01 X-DOI: 10.1080/20476965.2019.1652547 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1652547 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:1:p:1-23 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1817801_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Usama Kadri Author-X-Name-First: Usama Author-X-Name-Last: Kadri Title: Variation of quantified infection rates of mixed samples to enhance rapid testing during an epidemic Abstract: Rapid testing of appropriate samples from patients suspected for a disease during an epidemic, such as the current Coronavirus outbreak, is of a great importance for disease management and control. We propose a method to enhance processing large amounts of collected samples. The method is based on mixing samples in testing tubes (pooling) in a specific configuration, as opposed to testing single samples in each tube, and recognise infected samples from variations of the total infection rates in each tube. To illustrate the efficiency of the suggested method, we carry out numerical tests for actual scenarios under various test conditions. Applying the proposed method allows testing many more patients using the same number of testing tubes, where all positives are identified with no false negatives, and no need for independent testing, and the effective testing time can be reduced drastically even when the uncertainty in the test is relatively high. Journal: Health Systems Pages: 24-30 Issue: 1 Volume: 10 Year: 2021 Month: 01 X-DOI: 10.1080/20476965.2020.1817801 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1817801 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:1:p:24-30 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1857214_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Paul R. Harper Author-X-Name-First: Paul R. Author-X-Name-Last: Harper Author-Name: Joshua W. Moore Author-X-Name-First: Joshua W. Author-X-Name-Last: Moore Author-Name: Thomas E. Woolley Author-X-Name-First: Thomas E. Author-X-Name-Last: Woolley Title: Covid-19 transmission modelling of students returning home from university Abstract: We provide an open-source model to estimate the number of secondary Covid-19 infections caused by potentially infectious students returning from university to private homes with other occupants. Using a Monte-Carlo method and data derived from UK sources, we predict that an infectious student would, on average, infect 0.94 other household members. Or, as a rule of thumb, each infected student would generate (just less than) one secondary within-household infection. The total number of secondary cases for all returning students is dependent on the virus prevalence within each student population at the time of their departure from campus back home. Although the proposed estimation method is general and robust, the results are sensitive to the input data. We provide Matlab code and a helpful online app (http://bit.ly/Secondary_infections_app) that can be used to estimate numbers of secondary infections based on local parameter values. This can be used worldwide to support policy making. Journal: Health Systems Pages: 31-40 Issue: 1 Volume: 10 Year: 2021 Month: 01 X-DOI: 10.1080/20476965.2020.1857214 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1857214 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:1:p:31-40 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1646105_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James F. Cox Author-X-Name-First: James F. Author-X-Name-Last: Cox Title: Using the theory of constraints’ processes of ongoing improvement to address the provider appointment scheduling system execution problem Abstract: Many primary care clinics suffer from chaos. In scheduling, providers are continually trying unsuccessfully to balance supply and demand, and in execution, to manage disruptions to provider focus and patient flow. In this research the theory of constraints’ (TOC) three processes of ongoing improvement (POOGI) provide a direction for the solution to achieving more, cheaper, better, and faster healthcare. This research is the second of a two-part study examining the appointment scheduling literature, identifying the core problem (using a case study for validation) and providing a generic process for developing effective provider appointment scheduling systems (PASS). In the first part, PASS design was studied and in this second part PASS execution is studied. A strawman process is developed to apply across outpatient medical practices. With this generic process implemented across outpatient scheduling systems cost could be reduced significantly while the quality and timeliness could be increased significantly. Journal: Health Systems Pages: 41-72 Issue: 1 Volume: 10 Year: 2021 Month: 01 X-DOI: 10.1080/20476965.2019.1646105 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1646105 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:1:p:41-72 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1664941_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Mark T. Mackay Author-X-Name-First: Mark T. Author-X-Name-Last: Mackay Author-Name: Leonid Churilov Author-X-Name-First: Leonid Author-X-Name-Last: Churilov Author-Name: Anna Moon Author-X-Name-First: Anna Author-X-Name-Last: Moon Author-Name: Ian McKenzie Author-X-Name-First: Ian Author-X-Name-Last: McKenzie Author-Name: Geoffrey A. Donnan Author-X-Name-First: Geoffrey A. Author-X-Name-Last: Donnan Author-Name: Paul Monagle Author-X-Name-First: Paul Author-X-Name-Last: Monagle Author-Name: Qi Li Author-X-Name-First: Qi Author-X-Name-Last: Li Author-Name: Franz E. Babl Author-X-Name-First: Franz E. Author-X-Name-Last: Babl Title: Identification of barriers and enablers to rapid diagnosis along the paediatric stroke chain of recovery using Value-Focused Process Engineering Abstract: Coordinated systems of care are required to improve access to reperfusion therapies in paediatric stroke. A conceptual model was developed to map the process-of-care from symptom onset to confirmation of diagnosis. Value-Focused Process Engineering with event-driven process modelling was used to identify barriers and enablers to timely and accurate paediatric stroke diagnosis. Stakeholder interviews were conducted to inform model design, development, demonstration and validation. Barriers included: (i) ambulance dispatcher failure to allocate high-priority response, (ii) childrens’ exclusion from paramedic clinical practice guidelines, (ii) non-allocation of high triage category on hospital arrival, (iii) absence of emergency department guidelines for focal neurological deficits, and (iv) computed tomography as the first imaging investigation.Enablers included: (i) public awareness programs, (ii) childrens’ inclusion in prehospital emergency stroke algorithms, (iii) re-organisation of health services, with primary paediatric stroke centres, (iv) implementation of triage and neuroimaging decision support tools, and (iv) rapid stroke MRI imaging protocols. Journal: Health Systems Pages: 73-88 Issue: 1 Volume: 10 Year: 2021 Month: 01 X-DOI: 10.1080/20476965.2019.1664941 File-URL: http://hdl.handle.net/10.1080/20476965.2019.1664941 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:10:y:2021:i:1:p:73-88 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1906764_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Geraint Ian Palmer Author-X-Name-First: Geraint Ian Author-X-Name-Last: Palmer Author-Name: Paul Harper Author-X-Name-First: Paul Author-X-Name-Last: Harper Author-Name: Vincent Knight Author-X-Name-First: Vincent Author-X-Name-Last: Knight Author-Name: Cathy Brooks Author-X-Name-First: Cathy Author-X-Name-Last: Brooks Title: Modelling changes in healthcare demand through geographic data extrapolation 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. Journal: Health Systems Pages: 109-125 Issue: 2 Volume: 11 Year: 2022 Month: 04 X-DOI: 10.1080/20476965.2021.1906764 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1906764 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:2:p:109-125 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1906762_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Benny Wai Author-X-Name-First: Benny Author-X-Name-Last: Wai Author-Name: Krisztina Vasarhelyi Author-X-Name-First: Krisztina Author-X-Name-Last: Vasarhelyi Author-Name: Alexander R Rutherford Author-X-Name-First: Alexander R Author-X-Name-Last: Rutherford Author-Name: Chris Buchner Author-X-Name-First: Chris Author-X-Name-Last: Buchner Author-Name: Reka Gustafson Author-X-Name-First: Reka Author-X-Name-Last: Gustafson Author-Name: Miranda Compton Author-X-Name-First: Miranda Author-X-Name-Last: Compton Author-Name: Mark Hull Author-X-Name-First: Mark Author-X-Name-Last: Hull Author-Name: Jf Williams Author-X-Name-First: Jf Author-X-Name-Last: Williams Author-Name: Rolando Barrios Author-X-Name-First: Rolando Author-X-Name-Last: Barrios Title: A qualitative model of the HIV care continuum in Vancouver, Canada Abstract: 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) activity diagram to capture patient and provider activities and to guide the construction of a UML state machine diagram. 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. Journal: Health Systems Pages: 84-97 Issue: 2 Volume: 11 Year: 2022 Month: 04 X-DOI: 10.1080/20476965.2021.1906762 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1906762 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:2:p:84-97 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1860654_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Fanwen Meng Author-X-Name-First: Fanwen Author-X-Name-Last: Meng Author-Name: Aidan Lyanzhiang Tan Author-X-Name-First: Aidan Lyanzhiang Author-X-Name-Last: Tan Author-Name: Bee Hoon Heng Author-X-Name-First: Bee Hoon Author-X-Name-Last: Heng Author-Name: Melvin Khee Shing Leow Author-X-Name-First: Melvin Khee Shing Author-X-Name-Last: Leow Author-Name: Palvannan Kannapiran Author-X-Name-First: Palvannan Author-X-Name-Last: Kannapiran Title: Feasibility analysis of a prevention programme for patients with early chronic disease using A mathematical model Abstract: The increasing prevalence of the chronic disease is of considerable concern to health-care organisations. Prevention programmes to patients with early chronic disease have the potential to improve individual health and quality of life through disease avoidance or delay and to save the medical cost of the health care system. Due to the limited budget in healthcare this study seeks to analyse the feasibility of a programme prior to implementation. A mathematical model is developed to determine incidence reduction rate at which the underlying cost break-even can be achieved; consequently, the programme would be feasible. We show the existence and uniqueness of the underlying incidence reduction and establish the feasibility frontier concerning the trade-offs between intervention effective period and incidence reduction rate. We use a diabetes prevention programme to demonstrate the efficiency and advantage of the model. The proposed model would inform decision-makers scientific principles in determining an intervention for implementation. Journal: Health Systems Pages: 75-83 Issue: 2 Volume: 11 Year: 2022 Month: 04 X-DOI: 10.1080/20476965.2020.1860654 File-URL: http://hdl.handle.net/10.1080/20476965.2020.1860654 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:2:p:75-83 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1906763_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Lucy Aragon Author-X-Name-First: Lucy Author-X-Name-Last: Aragon Author-Name: Karen Schieman Author-X-Name-First: Karen Author-X-Name-Last: Schieman Author-Name: Laila Cure Author-X-Name-First: Laila Author-X-Name-Last: Cure Title: Incorporating the six aims for quality in the analysis of trauma care Abstract: The Institute of Medicine proposed six aims for healthcare quality improvement. Nevertheless, trauma care quality research still focuses on one aim at a time. This research investigates how to incorporate all aims into trauma care quality assessments using data from the Michigan Trauma Quality Improvement Program. Through a literature review, we identified quantifiable metrics for most aims, except for equity and patient-centeredness. We proposed two approaches to build composite scores accounting for equity via an adjustment procedure based on observed disparities. The single- and multi-aim approaches were compared through correlation, concordance of trauma centre categorisations, and hypothetical incentives. The differences in the approaches stemmed mainly from the weights allocated to the different aims. Results indicated the potential value of multi-aim quality assessment and provided insights about implementation challenges and opportunities. The methods are applicable to the preferred metrics; nevertheless, further research is needed in measuring patient-centeredness. Journal: Health Systems Pages: 98-108 Issue: 2 Volume: 11 Year: 2022 Month: 04 X-DOI: 10.1080/20476965.2021.1906763 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1906763 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:2:p:98-108 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1876533_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: James F. Cox Author-X-Name-First: James F. Author-X-Name-Last: Cox Title: Using the theory of constraints to create a paradigm shift in organisation performance at a large primary care provider practice 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. Journal: Health Systems Pages: 126-159 Issue: 2 Volume: 11 Year: 2022 Month: 04 X-DOI: 10.1080/20476965.2021.1876533 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1876533 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:11:y:2022:i:2:p:126-159 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2141141_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Md. Merajul Islam Author-X-Name-First: Md. Merajul Author-X-Name-Last: Islam Author-Name: Md. Jahanur Rahman Author-X-Name-First: Md. Jahanur Author-X-Name-Last: Rahman Author-Name: Md. Menhazul Abedin Author-X-Name-First: Md. Author-X-Name-Last: Menhazul Abedin Author-Name: Benojir Ahammed Author-X-Name-First: Benojir Author-X-Name-Last: Ahammed Author-Name: Mohammad Ali Author-X-Name-First: Mohammad Author-X-Name-Last: Ali Author-Name: N.A.M Faisal Ahmed Author-X-Name-First: N.A.M Faisal Author-X-Name-Last: Ahmed Author-Name: Md. Maniruzzaman Author-X-Name-First: Md. Author-X-Name-Last: Maniruzzaman Title: Identification of the risk factors of type 2 diabetes and its prediction using machine learning techniques Abstract: This study identified the risk factors for type 2 diabetes (T2D) and proposed a machine learning (ML) technique for predicting T2D. The risk factors for T2D were identified by multiple logistic regression (MLR) using p-value (p<0.05). Then, five ML-based techniques, including logistic regression, naïve Bayes, J48, multilayer perceptron, and random forest (RF) were employed to predict T2D. This study utilized two publicly available datasets, derived from the National Health and Nutrition Examination Survey, 2009-2010 and 2011-2012. About 4922 respondents with 387 T2D patients were included in 2009-2010 dataset, whereas 4936 respondents with 373 T2D patients were included in 2011-2012. This study identified six risk factors (age, education, marital status, SBP, smoking, and BMI) for 2009-2010 and nine risk factors (age, race, marital status, SBP, DBP, direct cholesterol, physical activity, smoking, and BMI) for 2011-2012. RF-based classifier obtained 95.9% accuracy, 95.7% sensitivity, 95.3% F-measure, and 0.946 area under the curve. Journal: Health Systems Pages: 243-254 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2022.2141141 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2141141 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:243-254 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2015251_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Jacob Novignon Author-X-Name-First: Jacob Author-X-Name-Last: Novignon Author-Name: Genevieve Aryeetey Author-X-Name-First: Genevieve Author-X-Name-Last: Aryeetey Author-Name: Justice Nonvignon Author-X-Name-First: Justice Author-X-Name-Last: Nonvignon Author-Name: Keziah Malm Author-X-Name-First: Keziah Author-X-Name-Last: Malm Author-Name: Nana Yaw Peprah Author-X-Name-First: Nana Yaw Author-X-Name-Last: Peprah Author-Name: Samuel Agyei Agyemang Author-X-Name-First: Samuel Agyei Author-X-Name-Last: Agyemang Author-Name: Samuel Amon Author-X-Name-First: Samuel Author-X-Name-Last: Amon Author-Name: Moses Aikins Author-X-Name-First: Moses Author-X-Name-Last: Aikins Title: Efficiency of malaria service delivery in selected district-level hospitals in Ghana Abstract: Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria. Journal: Health Systems Pages: 198-207 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2021.2015251 File-URL: http://hdl.handle.net/10.1080/20476965.2021.2015251 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:198-207 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2030655_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Roberto Rosario Corsini Author-X-Name-First: Roberto Rosario Author-X-Name-Last: Corsini Author-Name: Antonio Costa Author-X-Name-First: Antonio Author-X-Name-Last: Costa Author-Name: Sergio Fichera Author-X-Name-First: Sergio Author-X-Name-Last: Fichera Author-Name: Alessandro Pluchino Author-X-Name-First: Alessandro Author-X-Name-Last: Pluchino Title: A configurable computer simulation model for reducing patient waiting time in oncology departments Abstract: Nowadays, the increase in patient demand and the decline in resources are lengthening patient waiting times in many chemotherapy oncology departments. Therefore, enhancing healthcare services is necessary to reduce patient complaints. Reducing the patient waiting times in the oncology departments represents one of the main goals of healthcare managers. Simulation models are considered an effective tool for identifying potential ways to improve patient flow in oncology departments. This paper presents a new agent-based simulation model designed to be configurable and adaptable to the needs of oncology departments which have to interact with an external pharmacy. When external pharmacies are utilised, a courier service is needed to deliver the individual therapies from the pharmacy to the oncology department. An oncology department located in southern Italy was studied through the simulation model and different scenarios were compared with the aim of selecting the department configuration capable of reducing the patient waiting times. Journal: Health Systems Pages: 208-222 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2022.2030655 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2030655 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:208-222 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_1997651_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Shiva Faeghi Author-X-Name-First: Shiva Author-X-Name-Last: Faeghi Author-Name: Kunibert Lennerts Author-X-Name-First: Kunibert Author-X-Name-Last: Lennerts Author-Name: Stefan Nickel Author-X-Name-First: Stefan Author-X-Name-Last: Nickel Title: Strategic planning of operating room session allocation using stability analysis Abstract: Operating room (OR) resources are limited, and for this reason there is usually a competition among surgeons to win them. However, the methods developed for allocating OR sessions are mostly based on optimisation methods which compensate the preferences of surgeons or surgical specialities in favour of the productivity of the entire OR department. This leads to conflict and dissatisfaction among surgeons. To overcome this problem, a methodology based on game theoretic solutions is presented in this paper that formulates the allocation problem as a simple game. The surgeons or specialities as players then jointly pursue the goal of achieving overall stability. Stability is defined and measured using a method called Power Index. The proposed method is then combined with the Monte-Carlo technique to deal with uncertainties. To demonstrate the capability of the suggested procedures, they are applied to a case study from the literature and a set of hypothetical scenarios. Journal: Health Systems Pages: 167-180 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2021.1997651 File-URL: http://hdl.handle.net/10.1080/20476965.2021.1997651 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:167-180 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2206446_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sudhanshu Joshi Author-X-Name-First: Sudhanshu Author-X-Name-Last: Joshi Author-Name: Manu Sharma Author-X-Name-First: Manu Author-X-Name-Last: Sharma Title: Assessment of implementation barriers of blockchain technology in public healthcare: evidences from developing countries Abstract: The widespread use of Blockchain technology (BT) in nations that are developing remains in its early stages, necessitating a more comprehensive evaluation using efficient and adaptable approaches. The need for digitalization to boost operational effectiveness is growing in the healthcare sector. Despite BT's potential as a competitive option for the healthcare sector, insufficient research has prevented it being fully utilised. This study intends to identify the main sociological, economical, and infrastructure obstacles to BT adoption in developing nations' public health systems. To accomplish this goal, the study employs a multi-level analysis of blockchain hurdles using hybrid approach. The study's findings provide decision- makers with guidance on how to proceed, as well as insight into implementation challenges. Journal: Health Systems Pages: 223-242 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2023.2206446 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2206446 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:223-242 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2004933_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Marzieh Ghiyasinasab Author-X-Name-First: Marzieh Author-X-Name-Last: Ghiyasinasab Author-Name: Nadia Lahrichi Author-X-Name-First: Nadia Author-X-Name-Last: Lahrichi Author-Name: Nadia Lehoux Author-X-Name-First: Nadia Author-X-Name-Last: Lehoux Title: A simulation model to analyse automation scenarios in decontamination centers Abstract: Decontamination centres provide sterilisation services (sort, disinfect, package, and sterilise) for reusable surgical instruments that have a vital impact on patient safety. The market trend is to increase the level of automation in the decontamination process, to increase productivity, and reduce the risk of human error and musculoskeletal injuries. The goal of this research is to study the use of automated guided vehicles (AGVs) in sterilisation departments, to improve safety and efficiency. A generic simulation model is created based on data gathering of various decontamination centres and is validated for a specific centre to analyse various aspects of applying AGVs to automate the internal transfer. Centre’s potential to increase capacity through AGV application is analysed and a Design of Experiments is conducted to identify the most promising implementation scenarios. Results show reductions in treatment time and work in process, while ,maintaining the accessibility of medical instruments, and ensuring worker safety. Journal: Health Systems Pages: 181-197 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2021.2004933 File-URL: http://hdl.handle.net/10.1080/20476965.2021.2004933 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:181-197 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2035260_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Sheema Noorain Author-X-Name-First: Sheema Author-X-Name-Last: Noorain Author-Name: Maria Paola Scaparra Author-X-Name-First: Maria Author-X-Name-Last: Paola Scaparra Author-Name: Kathy Kotiadis Author-X-Name-First: Kathy Author-X-Name-Last: Kotiadis Title: Mind the gap: a review of optimisation in mental healthcare service delivery Abstract: Well-planned care arrangements with effective distribution of available resources have the potential to address inefficiencies in mental health services. We begin by exploring the complexities associated with mental health and describe how these influence service delivery. We then conduct a scoping literature review of studies employing optimisation techniques that address service delivery issues in mental healthcare. Studies are classified based on criteria such as the type of planning decision addressed, the purpose of the study and care setting. We analyse the modelling methodologies used, objectives, constraints and model solutions. We find that the application of optimisation to mental healthcare is in its early stages compared to the rest of healthcare. Commonalities between mental healthcare service provision and other services are discussed, and the future research agenda is outlined. We find that the existing application of optimisation in specific healthcare settings can be transferred to mental healthcare. Also highlighted are opportunities for addressing specific issues faced by mental healthcare services. Journal: Health Systems Pages: 133-166 Issue: 2 Volume: 12 Year: 2023 Month: 04 X-DOI: 10.1080/20476965.2022.2035260 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2035260 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:2:p:133-166 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2062461_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Nanne A. Dieleman Author-X-Name-First: Nanne A. Author-X-Name-Last: Dieleman Author-Name: Martijn Buitink Author-X-Name-First: Martijn Author-X-Name-Last: Buitink Author-Name: René Bekker Author-X-Name-First: René Author-X-Name-Last: Bekker Author-Name: Dennis Moeke Author-X-Name-First: Dennis Author-X-Name-Last: Moeke Title: A three-step framework for capacity planning in a nursing home context Abstract: This paper presents a three-step conceptual framework that can be used to structure the care-related capacity planning process in a nursing home context. The proposed framework provides a sound practical vehicle to organise client-centred care without overstretching available capacity. Within this framework, an MILP for shift scheduling and a Genetic Algorithm (GA) for task-scheduling are proposed. To investigate the performance of the proposed framework, it is benchmarked against the current situation. The results show that considerable improvements can be achieved in terms of efficiency and waiting time. More specifically, it is shown that very modest waiting times can be achieved without exceeding available capacity, despite the fluctuations in care demand across the day. Journal: Health Systems Pages: 299-316 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2022.2062461 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2062461 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:299-316 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2174453_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Meetali Kakad Author-X-Name-First: Meetali Author-X-Name-Last: Kakad Author-Name: Martin Utley Author-X-Name-First: Martin Author-X-Name-Last: Utley Author-Name: Fredrik A. Dahl Author-X-Name-First: Fredrik A. Author-X-Name-Last: Dahl Title: Using stochastic simulation modelling to study occupancy levels of decentralised admission avoidance units in Norway Abstract: Identifying alternatives to acute hospital admission is a priority for many countries. Over 200 decentralised municipal acute units (MAUs) were established in Norway to divert low-acuity patients away from hospitals. MAUs have faced criticism for low mean occupancy and not relieving pressures on hospitals. We developed a discrete time simulation model of admissions and discharges to MAUs to test scenarios for increasing absolute mean occupancy. We also used the model to estimate the number of patients turned away as historical data was unavailable. Our experiments suggest that mergers alone are unlikely to substantially increase MAU absolute mean occupancy as unmet demand is generally low. However, merging MAUs offers scope for up to 20% reduction in bed capacity, without affecting service provision. Our work has relevance for other admissions avoidance units and provides a method for estimating unconstrained demand for beds in the absence of historical data. Journal: Health Systems Pages: 317-331 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2023.2174453 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2174453 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:317-331 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2072777_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Ibrahim Sadek Author-X-Name-First: Ibrahim Author-X-Name-Last: Sadek Author-Name: Bessam Abdulrazak Author-X-Name-First: Bessam Author-X-Name-Last: Abdulrazak Title: Contactless remote monitoring of sleep: evaluating the feasibility of an under-mattress sensor mat in a real-life deployment Abstract: Sleep is so important, particularly for the elderly. The lack of sleep may increase the risk of cognitive decline. Similarly, it may also increase the risk of Alzheimer’s disease. Nonetheless, many people underestimate the importance of getting enough rest and sleep. In-laboratory polysomnography is the gold-standard method for assessing the quality of sleep. This method is considered impractical in the clinical environment, seen as labour-intensive and expensive owing to its specialised equipment, leading to long waiting lists. Hence, user-friendly (remote and non-intrusive) devices are being developed to help patients monitor their sleep at home. In this paper, we first discuss commercially-available non-wearable devices that measure sleep, in which we highlight the features associated with each device, including sensor type, interface, outputs, dimensions, power supply, and connectivity. Second, we evaluate the feasibility of a non-wearable device in a free-living environment. The deployed device comprises a sensor mat with an integrated micro-bending multimode fibre. Raw sensor data were gathered from five senior participants living in a senior activity centre over a few to several weeks. We were able to analyse the participants’ sleep quality using various sleep parameters deduced from the sensor mat. These parameters include the wake-up time, bedtime, the time in bed, nap time. Vital signs, namely heart rate, respiratory rate, and body movements, were also reported to detect abnormal sleep patterns. We have employed pre-and post-surveys reporting each volunteer’s sleep hygiene to confirm the proposed system’s outcomes for detecting the various sleep parameters. The results of the system were strongly correlated with the surveys for reporting each sleep parameter. Furthermore, the system proved to be highly effective in detecting irregular patterns that occurred during sleep. Journal: Health Systems Pages: 264-280 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2022.2072777 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2072777 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:264-280 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2129471_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Gökhan Aydin Author-X-Name-First: Gökhan Author-X-Name-Last: Aydin Author-Name: Seda Kumru Author-X-Name-First: Seda Author-X-Name-Last: Kumru Title: Paving the way for increased e-health record use: elaborating intentions of Gen-Z Abstract: This paper presents the determinants of personal e-health records adoption by the Gen-Z population and reveals barriers to use. Gen-Z members are one of the most prominent users of digital health services that have an influence on older generations’ technology adoption but have often been overlooked in scholarly research. A survey of 1,000 Gen-Z university students based on modified UTAUT was used to address this research gap. The analysis revealed the vital role of social influence in paving the way for higher adoption among Gen-Z. Moreover, significant influences of performance expectancy, facilitating conditions, and e-health literacy on behavioural intentions were detected. Effort expectancy was found to be insignificant in impacting Gen-Z’s intentions to adopt electronic health record systems. Moreover, privacy concerns acted as a barrier to adoption, yet the offsetting effect of users’ trust in health systems was shown to be instrumental in overcoming such privacy-related barriers. Journal: Health Systems Pages: 281-298 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2022.2129471 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2129471 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:281-298 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2237745_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: William R. Hersh Author-X-Name-First: William R. Author-X-Name-Last: Hersh Author-Name: Robert E. Hoyt Author-X-Name-First: Robert E. Author-X-Name-Last: Hoyt Author-Name: Steven Chamberlin Author-X-Name-First: Steven Author-X-Name-Last: Chamberlin Author-Name: Jessica S. Ancker Author-X-Name-First: Jessica S. Author-X-Name-Last: Ancker Author-Name: Aditi Gupta Author-X-Name-First: Aditi Author-X-Name-Last: Gupta Author-Name: Tara B. Borlawsky-Payne Author-X-Name-First: Tara B. Author-X-Name-Last: Borlawsky-Payne Title: Beyond mathematics, statistics, and programming: data science, machine learning, and artificial intelligence competencies and curricula for clinicians, informaticians, science journalists, and researchers Abstract: Data science, machine learning and artificial intelligence applications impact clinicians, informaticians, science journalists, and researchers. Most biomedical data science training focuses on learning a programming language in addition to higher mathematics and advanced statistics. This approach is appropriate for graduate students but greatly reduces the number of individuals in healthcare who can be involved in data science. To serve these four stakeholder audiences, we describe several curricular strategies focusing on solving real problems of interest to these audiences. Relevant competencies for these audiences include using intuitive programming tools that facilitate data exploration with minimal programming background, creating data models, evaluating results of data analyses, and assessing data science research reports, among others. Offering the curricula described here more broadly could broaden the stakeholder groups knowledgeable about and engaged in data science. Journal: Health Systems Pages: 255-263 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2023.2237745 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2237745 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:255-263 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2174454_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20230119T200553 git hash: 724830af20 Author-Name: Fulvio D. Lopane Author-X-Name-First: Fulvio D. Author-X-Name-Last: Lopane Author-Name: Melanie Reuter-Oppermann Author-X-Name-First: Melanie Author-X-Name-Last: Reuter-Oppermann Author-Name: Andrea Raith Author-X-Name-First: Andrea Author-X-Name-Last: Raith Author-Name: Daniel J Exeter Author-X-Name-First: Daniel J Author-X-Name-Last: Exeter Author-Name: Ilze Ziedins Author-X-Name-First: Ilze Author-X-Name-Last: Ziedins Author-Name: Richard Dawson Author-X-Name-First: Richard Author-X-Name-Last: Dawson Title: A genetic algorithm-based strategic planning framework for optimising accessibility and costs of general practices in Northland, New Zealand Abstract: Shortage of general practitioners (GP) is a challenge worldwide, not only in Europe, but also in countries like New Zealand. Providing primary care in rural areas is especially challenging. In order to support decision makers, it is necessary to first assess the current GP coverage and then to determine different scenarios and plans for the future. In this paper, we first present a thorough overview of related literature on locating GP practices. Second, we propose an approach for assessing the GP coverage and determining future GP locations based on a genetic algorithm framework. As a use case, we have chosen the rural New Zealand region of Northland. We also perform a sensitivity analysis for the main input parameters. Journal: Health Systems Pages: 332-356 Issue: 3 Volume: 12 Year: 2023 Month: 07 X-DOI: 10.1080/20476965.2023.2174454 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2174454 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:3:p:332-356 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2029584_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Alan J. Card Author-X-Name-First: Alan J. Author-X-Name-Last: Card Title: The biopsychosociotechnical model: a systems-based framework for human-centered health improvement Abstract: The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism– both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more “practical theory” for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between “health status” and “health and needs assessment”, [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on “interventions” vs. “treatments” to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement. Journal: Health Systems Pages: 387-407 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2022.2029584 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2029584 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:387-407 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2075796_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Kelsey Berg Author-X-Name-First: Kelsey Author-X-Name-Last: Berg Author-Name: Chelsea Doktorchik Author-X-Name-First: Chelsea Author-X-Name-Last: Doktorchik Author-Name: Hude Quan Author-X-Name-First: Hude Author-X-Name-Last: Quan Author-Name: Vineet Saini Author-X-Name-First: Vineet Author-X-Name-Last: Saini Title: Automating data collection methods in electronic health record systems: a Social Determinant of Health (SDOH) viewpoint Abstract: Social Determinant of Health (SDOH) data are important targets for research and innovation in Health Information Systems (HIS). The ways we envision SDOH in “smart” information systems will play a considerable role in shaping future population health landscapes. Current methods for data collection can capture wide ranges of SDOH factors, in standardised and non-standardised formats, from both primary and secondary sources. Advances in automating data linkage and text classification show particular promise for enhancing SDOH in HIS. One challenge is that social communication processes embedded in data collection are directly related to the inequalities that HIS attempt to measure and redress. To advance equity, it is imperative thatcare-providers, researchers, technicians, and administrators attend to power dynamics in HIS standards and practices. We recommend: 1. Investing in interdisciplinary and intersectoral knowledge generation and translation. 2. Developing novel methods for data discovery, linkage and analysis through participatory research. 3. Channelling information into upstream evidence-informed policy. Journal: Health Systems Pages: 472-480 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2022.2075796 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2075796 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:472-480 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2284712_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Valeria Pannunzio Author-X-Name-First: Valeria Author-X-Name-Last: Pannunzio Author-Name: Maaike Kleinsmann Author-X-Name-First: Maaike Author-X-Name-Last: Kleinsmann Author-Name: Dirk Snelders Author-X-Name-First: Dirk Author-X-Name-Last: Snelders Author-Name: Jeroen Raijmakers Author-X-Name-First: Jeroen Author-X-Name-Last: Raijmakers Title: From digital health to learning health systems: four approaches to using data for digital health design Abstract: Digital health technologies, powered by digital data, provide an opportunity to improve the efficacy and efficiency of health systems at large. However, little is known about different approaches to the use of data for digital health design, or about their possible relations to system-level dynamics. In this contribution, we identify four existing approaches to the use of data for digital health design, namely the silent, the overt, the data-enabled, and the convergent. After characterising the approaches, we provide real-life examples of each. Furthermore, we compare the approaches in terms of selected desirable characteristics of the design process, highlighting relative advantages and disadvantages. Finally, we reflect on the system-level relevance of the differentiation between the approaches and point towards future research directions. Overall, the contribution provides researchers and practitioners with a broad conceptual framework to examine data-related challenges and opportunities in digital health design. Journal: Health Systems Pages: 481-494 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2284712 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2284712 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:481-494 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2072778_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Max Schoepen Author-X-Name-First: Max Author-X-Name-Last: Schoepen Author-Name: Ewout Vansteenkiste Author-X-Name-First: Ewout Author-X-Name-Last: Vansteenkiste Author-Name: Werner De Gersem Author-X-Name-First: Werner Author-X-Name-Last: De Gersem Author-Name: Jan Detand Author-X-Name-First: Jan Author-X-Name-Last: Detand Title: Systems thinking and designerly tools for medical device design in engineering curricula Abstract: BackgroundIn this paper we focus on medical device development (MDD) in Industrial Design Engineering (IDE) academia. We want to find which methods our MDD-students currently use, where our guidance has shortcomings and where it brings added value.MethodsWe have analysed 19 master and 3 doctoral MDD-theses in our IDE curriculum. The evaluation focusses around four main themes: 1) regulatory 2) testing 3) patient-centricity and 4) systemic design.ResultsRegulatory aspects and medical testing procedures seem to be disregarded frequently. We assume this is because of a lack of MDD experience and the small thesis timeframe. Furthermore, many students applied medical-oriented systemic tools, which enhances multiperspectivism. However, we found an important lack in the translation to the List of Specifications and to business models of these medical devices. Finally, students introduced various participatory techniques, but seem to struggle with implementing this in the setting of evidence-based medicine. Journal: Health Systems Pages: 461-471 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2022.2072778 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2072778 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:461-471 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2285555_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Guillaume Lamé Author-X-Name-First: Guillaume Author-X-Name-Last: Lamé Author-Name: Antuela Tako Author-X-Name-First: Antuela Author-X-Name-Last: Tako Author-Name: Maaike Kleinsmann Author-X-Name-First: Maaike Author-X-Name-Last: Kleinsmann Title: Using participatory systems approaches to improve healthcare delivery Journal: Health Systems Pages: 357-361 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2285555 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2285555 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:357-361 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2179947_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Liwen Zhang Author-X-Name-First: Liwen Author-X-Name-Last: Zhang Author-Name: Hervé Pingaud Author-X-Name-First: Hervé Author-X-Name-Last: Pingaud Author-Name: Franck Fontanili Author-X-Name-First: Franck Author-X-Name-Last: Fontanili Author-Name: Elyes Lamine Author-X-Name-First: Elyes Author-X-Name-Last: Lamine Author-Name: Cléa Martinez Author-X-Name-First: Cléa Author-X-Name-Last: Martinez Author-Name: Christophe Bortolaso Author-X-Name-First: Christophe Author-X-Name-Last: Bortolaso Author-Name: Mustapha Derras Author-X-Name-First: Mustapha Author-X-Name-Last: Derras Title: Balancing the satisfaction of stakeholders in home health care coordination: a novel OptaPlanner CSP model Abstract: Home Health Care Routing and Scheduling Problem (HHCRSP) has been widely investigated in operations research. In this paper, a model based on the Constraint Satisfaction Problem (CSP) is proposed, which is able to deal with daily HHCRSPs. Human factors are considered in our formulation of the problem and we seek a balance between the different stakeholders’ satisfaction criteria. The considered temporal constraints are soft and controlled by the stakeholders’ personalised tolerance and satisfaction rates. We will explain how this new Satisfaction-Oriented HHCRSP (SOH2CRSP) model is built and solved by using an open-source solver: the OptaPlanner. In order to examine the impact of human factors, a study will estimate the added value provided when satisfaction is considered in the problem formulation. The comparison is based on a use case derived from the dataset of an existing HHC organisation. The numerical results will show the benefits of our approach. Journal: Health Systems Pages: 408-428 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2179947 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2179947 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:408-428 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2175730_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Alison Harper Author-X-Name-First: Alison Author-X-Name-Last: Harper Author-Name: Navonil Mustafee Author-X-Name-First: Navonil Author-X-Name-Last: Mustafee Title: Participatory design research for the development of real-time simulation models in healthcare Abstract: The implementation challenges for modelling and simulation in health and social care are well-known and understood. Yet increasing availability of data and a better understanding of the value of Operational Research (OR) applications are strengthening opportunities to support healthcare delivery. Participative approaches in healthcare modelling have shown value through stakeholder engagement and commitment towards co-creation of models and knowledge but are limited in focus on model design and development. For simulation modelling, a participative design research methodology can support development for sustained use, emphasising model usefulness and usability using iterative cycles of development and evaluation. Within a structured methodology, measures of success are built into the design process, focusing on factors which contribute to success, with implicit goals of implementation and improvement. We illustrate this through a participative case study which demonstrates development of the component parts of a real-time simulation model aimed at reducing emergency department crowding. Journal: Health Systems Pages: 375-386 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2175730 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2175730 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:375-386 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2198580_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: W.P. Neumann Author-X-Name-First: W.P. Author-X-Name-Last: Neumann Author-Name: N. Purdy Author-X-Name-First: N. Author-X-Name-Last: Purdy Title: The better work, better care framework: 7 strategies for sustainable healthcare system process improvement Abstract: Healthcare systems are under pressure to control costs and improve performance. Efforts to apply improvement trends such as “Lean” and other industrial engineering approaches have led to degradation of the working environment for healthcare professionals. Research is increasingly demonstrating how poor working environments contribute to declines in care quality and has led to calls for a “quadruple aim” with a focus on the working environment alongside quality, cost, and patient experience factors. This paper contributes to the debate by using a “systems” perspective to propose seven strategies by which healthcare systems might be improved without compromising the working environment. This article presents a rationale for these strategies based on current organisational psychology and human factors research and how these strategies might be deployed in practice. The authors argue that better working conditions leads to better care for patients and presents a viable approach for both practitioners and researchers to pursue the “Better Work, Better Care” agenda. Journal: Health Systems Pages: 429-445 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2198580 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2198580 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:429-445 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2229391_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Alexander Komashie Author-X-Name-First: Alexander Author-X-Name-Last: Komashie Author-Name: Sarah Rae Author-X-Name-First: Sarah Author-X-Name-Last: Rae Author-Name: P. John Clarkson Author-X-Name-First: P. John Author-X-Name-Last: Clarkson Title: Towards a better understanding of mental health care delivery systems: From stories to system components Abstract: The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed. Journal: Health Systems Pages: 362-374 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2229391 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2229391 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:362-374 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2230632_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Emmanuel A Akinluyi Author-X-Name-First: Emmanuel A Author-X-Name-Last: Akinluyi Author-Name: Anne Greenough Author-X-Name-First: Anne Author-X-Name-Last: Greenough Author-Name: Keith Ison Author-X-Name-First: Keith Author-X-Name-Last: Ison Author-Name: P John Clarkson Author-X-Name-First: P John Author-X-Name-Last: Clarkson Title: Applying a participatory systems and value approach in a transdisciplinary exercise: on assessing the impact of training and education initiatives Abstract: Participatory systems approaches are readily used in multi- and inter-disciplinary exploration of shared processes, but are less-commonly applied in trans-disciplinary efforts eliciting principles that generalise across contexts. The authors were charged with developing a transdisciplinary framework for prospectively or retrospectively assessing initiatives to improve education and training within a multifaceted organisation. A common System Impact Model (SIM) was developed in a series of workshops involving thirty participants from different disciplines, clinical specialisms, and organisations. The model provided a greater understanding of the interrelationships between factors influencing the benefits of education and training and development as seen from various stakeholder perspectives. It was used to create a system for assessing the impact of initiatives on service-users/patients, trainees, and organisations. It was shown to enable a range of participants to connect on common challenges, to maximise cross-, multi-, and inter-disciplinary learning, and to uncover new strategies for delivering value, as system designers. Journal: Health Systems Pages: 446-460 Issue: 4 Volume: 12 Year: 2023 Month: 10 X-DOI: 10.1080/20476965.2023.2230632 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2230632 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:12:y:2023:i:4:p:446-460 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2115408_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Gustavo M. Bacelar-Silva Author-X-Name-First: Gustavo M. Author-X-Name-Last: Bacelar-Silva Author-Name: James F. Cox Author-X-Name-First: James F. Author-X-Name-Last: Cox Author-Name: Pedro Rodrigues Author-X-Name-First: Pedro Author-X-Name-Last: Rodrigues Title: Achieving rapid and significant results in healthcare services by using the theory of constraints Abstract: Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation – which included the drum-buffer-rope scheduling and buffer management – and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense. Journal: Health Systems Pages: 48-61 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2115408 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2115408 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:48-61 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2096487_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Ana Porroche-Escudero Author-X-Name-First: Ana Author-X-Name-Last: Porroche-Escudero Title: Health systems and quality of healthcare: bringing back missing discussions about gender and sexuality Abstract: Gender and sexuality are recognised as social determinants of health. While gender and sexuality are becoming important frameworks guiding many disciplines and studies, discussions about quality of healthcare (QHC) lack a sufficient focus on these. When QHC studies have considered gender and sexuality the primary focus tends to be on the practice of individual professionals, patients’ differential health seeking behaviours or outcomes. This commentary eapplies a gender and sexuality lens to Donabedian’s framework to further understand the influence of gender and sexuality in shaping QHC. The framework illustrates how the very foundations of QHC (institutional structures, processes and outcomes), can increase or reduce inequalities in QHC linked to gender, sexuality (as well as other factors). The commentary suggests practices that would reduce these inequalities. In the context of present debates over inequality in medicine, science and global health , this commentary is a reminder that health systems have a critical role to play in ensuring that QHC does not perpetuate them. . Journal: Health Systems Pages: 24-30 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2096487 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2096487 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:24-30 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2108729_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Carina Fagefors Author-X-Name-First: Carina Author-X-Name-Last: Fagefors Author-Name: Björn Lantz Author-X-Name-First: Björn Author-X-Name-Last: Lantz Author-Name: Peter Rosén Author-X-Name-First: Peter Author-X-Name-Last: Rosén Author-Name: Levi Siljemyr Author-X-Name-First: Levi Author-X-Name-Last: Siljemyr Title: Staff pooling in healthcare systems – results from a mixed-methods study Abstract: This study examines how staff pooling can be used to create a higher service level at a predetermined total capacity in the healthcare sector. We develop new empirical knowledge through a systematic empirical study, using a mixed-methods approach, with a preliminary interview study followed by a principal quantitative survey study, with data from a multihospital system. The purpose was to explore practical barriers for a staff pooling strategy in healthcare systems. Three barriers were identified:recruitment difficulties, community view, and specialisation. Significant differences in perceived height among these barriers were found. The results from this study have important managerial implications for healthcare systems when implementing a staff pooling approach. This study contributes to the existing literature since, to the best of our knowledge, no previous research has been done where barriers to staff pools are systematically identified using a holistic approach that includes all healthcare professions in a multihospital system. Journal: Health Systems Pages: 31-47 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2108729 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2108729 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:31-47 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2075797_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Manon G. Guillemette Author-X-Name-First: Manon G. Author-X-Name-Last: Guillemette Author-Name: Louis Raymond Author-X-Name-First: Louis Author-X-Name-Last: Raymond Author-Name: Guy Paré Author-X-Name-First: Guy Author-X-Name-Last: Paré Title: Assessing the maturity and performance of the IT function in acute-care hospitals: a configurational view Abstract: This study aims to characterises the maturity of IT management in hospitals, to identify the IT management configurations needed to achieve greater performance and to characterise the organisational and strategic IT contexts in which these configurations evolve. Drawing on survey data from 72 Canadian acute-care hospitals with the CIO as the main respondent, we used a configurational approach to assess the maturity of their IT functions. We classified participating hospitals in two distinct groups, each related to different levels of performance. Hospitals in the first group are characterised by a rather “immature” IT management model and presented low levels of IT performance. Hospitals in the second group showed more maturity in their IT management model and high levels of IT performance. Importantly, both the strategic influence of the CIO and the centrality of IT to the hospital’s strategic goals were found to be significantly greater in the mature group. Journal: Health Systems Pages: 11-23 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2075797 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2075797 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:11-23 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2125838_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Sathya Bama B Author-X-Name-First: Sathya Bama Author-X-Name-Last: B Author-Name: Bevish Jinila Y Author-X-Name-First: Bevish Jinila Author-X-Name-Last: Y Title: Vision-based gait analysis for real-time Parkinson disease identification and diagnosis system Abstract: Computer-assisted Parkinson’s disease-specific gait pattern recognition has gained more attention in the past decade due to its extensive application. In this research study, vision-based gait feature extraction is obtained from the observed skeleton points to support the real-time Parkinson disease prediction and diagnosis in the smart healthcare environment. So, a novel kernel-based principal component analysis (KPCA) is introduced for establishing respective feature extraction and dimensionality reduction on the patient’s video data. In this research study, a vision-based Parkinson disease identification system (VPDIS) is developed with a feature-weighted minimum distance classifier model to support the clinical assessment of Parkinson’s disease. At the time of experimentation, a steady-state walking style of the patient was captured using the cameras fixed in the smart healthcare environment. Then, the accumulated walking frames from the remote patients were transformed into the required binary silhouettes for the sake of noise minimisation and compression purpose. The resulting experimentation shows that the proposed feature extraction approach has significant improvements on the recognition of target gait patterns from the video-based gait analysis of Parkinson’s and normal patients. Accordingly, the proposed VPDIS using feature-weighted minimum distance classifier model provides better prediction time and classification accuracy against the existing healthcare systems that is developed using support vector machine and ensemble learning classifier models. Journal: Health Systems Pages: 62-72 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2125838 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2125838 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:62-72 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2062462_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20231214T103247 git hash: d7a2cb0857 Author-Name: Daniel Romero Rodriguez Author-X-Name-First: Daniel Author-X-Name-Last: Romero Rodriguez Author-Name: Walter Silva Author-X-Name-First: Walter Author-X-Name-Last: Silva Author-Name: Alex Savachkin Author-X-Name-First: Alex Author-X-Name-Last: Savachkin Author-Name: Tapas Das Author-X-Name-First: Tapas Author-X-Name-Last: Das Author-Name: Julio Daza Author-X-Name-First: Julio Author-X-Name-Last: Daza Title: Resilience as a measure of preparedness for pandemic influenza outbreaks Abstract: The global crisis generated by COVID-19 has heightened awareness of pandemic outbreaks. From a public health preparedness standpoint, it is essential to assess the impact of a pandemic and also the resilience of the affected communities, which is the ability to withstand and recover quickly after a pandemic outbreak. The infection attack rate has been the common metric to assess community response to a pandemic outbreak, while it focuses on the number of infected it does not capture other dimensions such as the recovery time. The aim of this research is to develop community resilience measures and demonstrate their estimation using a simulated pandemic outbreak in a region in the USA. Three scenarios are analysed with different combinations of virus transmissibility rates and non-pharmaceutical interventions. I The inclusion of the resilience framework in the pandemics outbreak analysis will enable decision makers to capture the multi dimensional nature of community response. Journal: Health Systems Pages: 1-10 Issue: 1 Volume: 13 Year: 2024 Month: 01 X-DOI: 10.1080/20476965.2022.2062462 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2062462 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:1:p:1-10 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2182238_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20240209T083504 git hash: db97ba8e3a Author-Name: Egil Øvrelid Author-X-Name-First: Egil Author-X-Name-Last: Øvrelid Title: Exploring adaptive mirroring in healthcare IT architectures Abstract: Digital transformation is demanding for incumbent organizations such as healthcare, where legacy-based IT architectures challenge the establishment of effective digital services. We refer to this as the IT silo problem, where multiple non-consolidated IT systems are implemented to support expert practices. In this paper, we analyze this challenge using a mirroring lens. Our research question is, how can we create efficient digital services, utilizing the existing legacy systems in healthcare IT architectures? Our empirical evidence comes from a Norwegian case and contributes to the literature on IT architecture within Healthcare. First, we demonstrate how strict mirroring leading to sub-optimization and silofication is a major cause for the presence of IT silos. Second, we describe a process towards adaptive mirroring, and the resulting adaptive mirroring architecture. Adaptive mirroring is an architectural combinatory device that facilitates the design and use of efficient services, while also improving the flexibility of IT architectures. Journal: Health Systems Pages: 109-120 Issue: 2 Volume: 13 Year: 2024 Month: 04 X-DOI: 10.1080/20476965.2023.2182238 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2182238 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:2:p:109-120 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2200526_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20240209T083504 git hash: db97ba8e3a Author-Name: Bahman Rostami-Tabar Author-X-Name-First: Bahman Author-X-Name-Last: Rostami-Tabar Author-Name: Jethro Browell Author-X-Name-First: Jethro Author-X-Name-Last: Browell Author-Name: Ivan Svetunkov Author-X-Name-First: Ivan Author-X-Name-Last: Svetunkov Title: Probabilistic forecasting of hourly emergency department arrivals Abstract: An accurate forecast of Emergency Department (ED) arrivals by an hour of the day is critical to meet patients’ demand. It enables planners to match ED staff to the number of arrivals, redeploy staff, and reconfigure units. In this study, we develop a model based on Generalised Additive Models and an advanced dynamic model based on exponential smoothing to generate an hourly probabilistic forecast of ED arrivals for a prediction window of 48 hours. We compare the forecast accuracy of these models against appropriate benchmarks, including TBATS, Poisson Regression, Prophet, and simple empirical distribution. We use Root Mean Squared Error to examine the point forecast accuracy and assess the forecast distribution accuracy using Quantile Bias, PinBall Score and Pinball Skill Score. Our results indicate that the proposed models outperform their benchmarks. Our developed models can also be generalised to other services, such as hospitals, ambulances or clinical desk services. Journal: Health Systems Pages: 133-149 Issue: 2 Volume: 13 Year: 2024 Month: 04 X-DOI: 10.1080/20476965.2023.2200526 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2200526 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:2:p:133-149 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2155256_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20240209T083504 git hash: db97ba8e3a Author-Name: Anas Ziat Author-X-Name-First: Anas Author-X-Name-Last: Ziat Author-Name: Naoufal Sefiani Author-X-Name-First: Naoufal Author-X-Name-Last: Sefiani Author-Name: Hamid Azzouzi Author-X-Name-First: Hamid Author-X-Name-Last: Azzouzi Author-Name: Kamal Reklaoui Author-X-Name-First: Kamal Author-X-Name-Last: Reklaoui Title: A generic sustainable performance management system for hospital supply chain: design & analysis Abstract: The assessment of the hospital supply chain management represents a key challenge by virtue of the complexity of the healthcare sector. The purpose of this study is to introduce a hybrid approach that helps hospital administrators to clearly identify, evaluate, and narrow the key performance criteria for their supply chain. The methodology attempts to minimise information loss, reduce the fuzziness and subjectivity of the collected data and describes the interdependence among criteria. The proposed generic framework can be valuable for hospitals organisations aiming for a sustainable performance decision-making process. The combination of the Fuzzy Delphi method and Structural Equation Modelling proved to be effective in determining the pillars driving the sustainable performance of the hospital supply chain. Journal: Health Systems Pages: 97-108 Issue: 2 Volume: 13 Year: 2024 Month: 04 X-DOI: 10.1080/20476965.2022.2155256 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2155256 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:2:p:97-108 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2150570_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20240209T083504 git hash: db97ba8e3a Author-Name: Saleigh Q. Derico Author-X-Name-First: Saleigh Q. Author-X-Name-Last: Derico Author-Name: Karen Hicklin Author-X-Name-First: Karen Author-X-Name-Last: Hicklin Author-Name: Lauren B. Davis Author-X-Name-First: Lauren B. Author-X-Name-Last: Davis Author-Name: Kim C. Brooks Author-X-Name-First: Kim C. Author-X-Name-Last: Brooks Title: Data-driven analyses to quantify information seeking behaviour for women with uterine fibroids Abstract: Uterine fibroids (UF) are noncancerous growths of the uterus and impact the livelihood of over 26 million women in the United States. Although UF may not have accompanying symptoms, for some women their presence leads to surgical treatment, which can be a difficult decision-making process. Web-scraping of online media is used to identify information-seeking behavior of women searching for UF treatment options. We synthesize the data to describe trends in UF treatment, including the identification of gaps between the information individuals are seeking (demand) and information that is publicly available as a resource (supply), which contributes to this study’s creation of the term “information desert.” We perform statistical analysis to understand information-seeking behavior, determine the gap between information supply and information demand, and determine the correlation between a doctor’s treatment recommendation and a patient’s treatment decision as a function of age, symptoms, and knowledge obtained about specific types of treatment. Journal: Health Systems Pages: 73-96 Issue: 2 Volume: 13 Year: 2024 Month: 04 X-DOI: 10.1080/20476965.2022.2150570 File-URL: http://hdl.handle.net/10.1080/20476965.2022.2150570 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:2:p:73-96 Template-Type: ReDIF-Article 1.0 # input file: THSS_A_2197023_J.xml processed with: repec_from_jats12.xsl darts-xml-transformations-20240209T083504 git hash: db97ba8e3a Author-Name: Utkarsh Verma Author-X-Name-First: Utkarsh Author-X-Name-Last: Verma Author-Name: Nayaran Rangaraj Author-X-Name-First: Nayaran Author-X-Name-Last: Rangaraj Author-Name: Viswanath Billa Author-X-Name-First: Viswanath Author-X-Name-Last: Billa Author-Name: Deepa Usulumarty Author-X-Name-First: Deepa Author-X-Name-Last: Usulumarty Title: Long term simulation analysis of deceased donor initiated chains in kidney exchange programs Abstract: Kidney exchange programs (KEPs) aim to find compatible kidneys for recipients with incompatible donors. Patients without a living donor depend upon deceased donor (DD) donations to get a kidney transplant. In India, a ©DD donates kidneys directly to a©DD wait-list. The idea of initiating an exchange chain starting from a ©DD kidney is proposed in a few articles (and executed in Italy in 2018), but no mathematical formulation has been given for this merger. We have introduced an integer programming formulation that creates ©DD-initiated chains, considering both paired exchange registry and ©DD allocations simultaneously and addressing the overlap issue between the exchange registry and ©DD wait-list as recipients can register for both registries independently. A long-term simulation study is done to ©analyse the gain of these DD-initiated chains over time. It suggests that even with small numbers of ©DDs, these chains can significantly increase potential transplants. Journal: Health Systems Pages: 121-132 Issue: 2 Volume: 13 Year: 2024 Month: 04 X-DOI: 10.1080/20476965.2023.2197023 File-URL: http://hdl.handle.net/10.1080/20476965.2023.2197023 File-Format: text/html File-Restriction: Access to full text is restricted to subscribers. Handle: RePEc:taf:thssxx:v:13:y:2024:i:2:p:121-132