Modeling and Simulation Analyses of Healthcare Delivery Operations for Inter-Hospital Patient Transfers

2014 ◽  
Vol 5 (1) ◽  
pp. 76-94 ◽  
Author(s):  
Chialin Chen ◽  
Samson X. Zhao
Keyword(s):  
Real World ◽  
Healthcare Delivery ◽  
Limited Resources ◽  
Local Health ◽  
Hospital Patient ◽  
Patient Transfers ◽  
Fleet Sizing ◽  
Common Strategy ◽  
Hospital Transfer ◽  
Transfer Services

Inter-hospital transfers of patients for different elements of care have been increasingly used as a common strategy for providing quality healthcares through sharing limited resources worldwide. In this paper, the authors study the problem of healthcare delivery operations for inter-hospital patient transfers motivated by a real-world case within the South East Local Health Integration Network of Ontario. The authors use a directed graph to develop a general model for obtaining the solution that minimizes the overall transportation time while satisfying all the inter-hospital transfer requests with identical or different start and end points. The authors also perform simulation analyses to study the fleet sizing problem through evaluating different service performances with different fleet sizes. A number of implementation issues for managing inter-hospital patient transfer services are also discussed.

Modeling and Simulation Analyses of Healthcare Delivery Operations for Inter-Hospital Patient Transfers

2017 ◽  
pp. 241-260
Author(s):  
Chialin Chen ◽  
Samson X. Zhao
Keyword(s):  
Real World ◽  
Healthcare Delivery ◽  
Patient Transfer ◽  
Local Health ◽  
Hospital Patient ◽  
Patient Transfers ◽  
Fleet Sizing ◽  
Common Strategy ◽  
Hospital Transfer ◽  
Transfer Services

Inter-hospital transfers of patients for different elements of care have been increasingly used as a common strategy for providing quality healthcares through sharing limited resources worldwide. In this paper, the authors study the problem of healthcare delivery operations for inter-hospital patient transfers motivated by a real-world case within the South East Local Health Integration Network of Ontario. The authors use a directed graph to develop a general model for obtaining the solution that minimizes the overall transportation time while satisfying all the inter-hospital transfer requests with identical or different start and end points. The authors also perform simulation analyses to study the fleet sizing problem through evaluating different service performances with different fleet sizes. A number of implementation issues for managing inter-hospital patient transfer services are also discussed.

scholarly journals Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

2021 ◽  
Author(s):  
Charlotte M Roy ◽  
E Brennan Bollman ◽  
Laura M Carson ◽  
Alexander J Northrop ◽  
Elizabeth F Jackson ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Health Effects ◽  
Scoping Review ◽  
Cardiovascular Health ◽  
Healthcare Delivery ◽  
Final Analysis ◽  
High Income ◽  
Future Research ◽  
Published Data ◽  
Local Health

Abstract Background The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects. Methods A scoping review of peer-reviewed literature using three search engines was performed. Results One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs). Conclusion Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic’s impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

scholarly journals Subclinical hypothyroidism in paediatric population treated with levothyroxine: a real-world study on 2001–2014 Italian administrative data

2017 ◽  
Vol 6 (6) ◽  
pp. 367-374 ◽  
Author(s):  
Nella Augusta Greggio ◽  
Elisa Rossi ◽  
Silvia Calabria ◽  
Alice Meneghin ◽  
Joaquin Gutierrez de Rubalcava ◽  
...  
Keyword(s):  
Real World ◽  
Subclinical Hypothyroidism ◽  
Paediatric Population ◽  
Mean Value ◽  
Administrative Databases ◽  
Slight Reduction ◽  
Local Health ◽  
Annual Dose ◽  
Historical Cohort ◽  
Low Dosage

Objective To estimate the prevalence of subclinical hypothyroidism (SH) among children, by using levothyroxine low dosage as disease proxy, and to describe prescription pattern. Design An historical cohort study was performed through administrative databases of 12 Italian Local Health Units covering 3,079,141 inhabitants. A cohort of children (aged 0–13 years) was selected in the period 2001–2014. A subgroup of new users (aged 0–9 years) was identified and followed up for 5 years. Methods The prevalence was provided as mean value of the whole period, as annual trend, by patient gender and age. Demographic details, information on levothyroxine dosage, comorbidities and co-medications were provided. Therapy duration and medication persistence were evaluated among new users. Results 644 children treated with levothyroxine low dosage was selected, with a mean annual prevalence of 0.20 per 1000 children. The temporal trend of prevalence was stable, with a slight reduction in the 2005–2008. Prevalence by age showed an increase after 10 years. Patients were treated with an average annual dose of 4290 µg/year and 66.9% of children were affected by comorbidities. Among 197 new users, 62.9% received therapy only for one year, whereas out of those treated two or more years, 89.0% resulted persistent to the therapy. Conclusions This study provides real-world epidemiology of SH among children, and it depicts the clinical and therapeutic characteristics of these subjects. Its findings showed that the SH treatment of this disorder was widely variable, also due to lack of evidence concerning paediatric population.

Power of big data to improve patient care in gastroenterology

2021 ◽  
pp. flgastro-2019-101239
Author(s):  
Jamie Catlow ◽  
Benjamin Bray ◽  
Eva Morris ◽  
Matt Rutter
Keyword(s):  
Machine Learning ◽  
Big Data ◽  
Real World ◽  
Common Good ◽  
Treatment Effectiveness ◽  
Healthcare Delivery ◽  
Improve Patient Care ◽  
Patient Registries ◽  
General Data Protection Regulation ◽  
Improve Patient

Big data is defined as being large, varied or frequently updated, and usually generated from real-world interaction. With the unprecedented availability of big data, comes an obligation to maximise its potential for healthcare improvements in treatment effectiveness, disease prevention and healthcare delivery. We review the opportunities and challenges that big data brings to gastroenterology. We review its sources for healthcare improvement in gastroenterology, including electronic medical records, patient registries and patient-generated data. Big data can complement traditional research methods in hypothesis generation, supporting studies and disseminating findings; and in some cases holds distinct advantages where traditional trials are unfeasible. There is great potential power in patient-level linkage of datasets to help quantify inequalities, identify best practice and improve patient outcomes. We exemplify this with the UK colorectal cancer repository and the potential of linkage using the National Endoscopy Database, the inflammatory bowel disease registry and the National Health Service bowel cancer screening programme. Artificial intelligence and machine learning are increasingly being used to improve diagnostics in gastroenterology, with image analysis entering clinical practice, and the potential of machine learning to improve outcome prediction and diagnostics in other clinical areas. Big data brings issues with large sample sizes, real-world biases, data curation, keeping clinical context at analysis and General Data Protection Regulation compliance. There is a tension between our obligation to use data for the common good and protecting individual patient’s data. We emphasise the importance of engaging with our patients to enable them to understand their data usage as fully as they wish.

A Review of Digital Health Design Approaches: Challenges Towards Real World Implementation (Preprint)

2021 ◽  
Author(s):  
Anthony Duffy ◽  
Sylvain Moreno ◽  
Greg Christie
Keyword(s):  
Real World ◽  
User Satisfaction ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Health Intervention ◽  
Rapid Expansion ◽  
Stakeholder Group ◽  
Design Approach ◽  
Intervention Design ◽  
Growing Pains

BACKGROUND Digital health represents an important strategy in the future of healthcare delivery. Over the past decade, mHealth has accelerated the agency of healthcare users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability and patience outcome. This challenge is confounded by two industries, DIGITAL and HEALTH, that have vastly different approaches to research, design, testing and implementation. In this regard, there is a need to examine prevailing design approaches, to weigh their benefits and challenges towards implementation, and to recommend a path forward that synthesises the needs of this complex stakeholder group. OBJECTIVE This review studies prominent digital health intervention (DHI) design approaches mediating the digital health space. In doing so, we seek to examine each methodology’s: origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios. METHODS A narrative synthesis approach to literature review was employed to review existing evidence. We searched indexed scientific literature using keywords relative to different digital health intervention designs. Papers selected after screening were those that discussed the design and implementation of digital health design approaches. RESULTS 120 papers on intervention design were selected for full-text review. We selected the 20 most prominent papers on each design approach, synthesizing findings under the categories of origins, advantages, disadvantages, challenges and cases. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented in order to harmonise the needs of a complex stakeholder group. Whether the primary stakeholder is positioned as the end-user/person/human/patient, the challenge to synthesise the constraints and affordances of both digital design and healthcare, built equally around user satisfaction and clinically efficacy remains paramount. Further research that works towards a transdisciplinarity in digital health may help to break down friction in this field. Until digital health is viewed as a hybridised industry with unique requirements rather than competing interests, the nuances that each design approach posits will be difficult to realise in a real world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, in order to create a better digital health culture and design ethos.

Abstract 33: Diagnostic Accuracy, Reperfusion Delay and Triage Scale Comparison: Real-World Paramedic Validation Results From the ACT-FAST Triage Algorithm for Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Henry Zhao ◽  
Karen Smith ◽  
Stephen Bernard ◽  
Michael Stephenson ◽  
Christopher Bladin ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Real World ◽  
False Positive ◽  
Vessel Occlusion ◽  
Time Saving ◽  
Hospital Transfer ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Direct Bypass ◽  
Triage Algorithm

Background: Severity-based selection tools for large vessel occlusion (LVO) are limited by lack of validation in unselected prehospital stroke patients and concerns regarding delayed thrombolysis (tPA) and comprehensive stroke center (CSC) burdening. We examined these issues in a real-world validation of the two exam step (severe arm motor + speech or neglect) ACT-FAST LVO triage algorithm. Methods: The ACT-FAST statewide validation involved 15 metro and 17 rural hospitals in Victoria, Australia from Nov 2017-July 2019 with training of paramedics using an 8 min video. Prehospital paramedic assessments were correlated with hospital imaging to determine presence of LVO. Data were then examined for diagnostic accuracy, time saving for direct bypass to CSC using a validated Google maps model, rates and magnitude of delayed tPA in false-positive non-LVO infarcts, and extra CSC workload. Results: In 517 completed assessments, 58% involving non-EVT centers and including 114 (22%) LVO, ACT-FAST sensitivity was 81% (92/114) and specificity was 81% (325/403; 89% if ICH are not regarded as false-positive) for LVO. Figure compares to other LVO scales. Bypass to CSC was modelled to save median 71 min for analysis of 29 thrombectomy patients requiring inter-hospital transfer. Of 27 non-LVO infarcts with false positive ACT-FAST, only 4 (15%) received tPA at a non-CSC center, and bypass would have only added median 10 mins in these cases. The increase in CSC presentation using ACT-FAST triage was estimated to be 2-3.3 patients/week using estimated 7,200 suspected stroke cases/year across entire metro Victoria. Conclusion: In comprehensive real-world validation, the simple ACT-FAST algorithm detected LVO or ICH in almost 80% of positive assessments with highly favorable comparison to other scales. Prehospital bypass to CSC substantially reduces thrombectomy delay, and appears to strongly outweigh negatives of bypassing false positive cases on tPA delay and CSC overburdening.

scholarly journals Severe symptomatic hyponatraemia secondary to bowel preparation

2019 ◽  
Vol 12 (10) ◽  
pp. e230385 ◽  
Author(s):  
Krishan Pratap ◽  
Manasi Jiwrajka ◽  
Liam Weber ◽  
Alan Richardson
Keyword(s):  
Bowel Preparation ◽  
Rare Complication ◽  
Limited Resources ◽  
Tertiary Level ◽  
Upper Endoscopy ◽  
Hospital Transfer ◽  
To Receive ◽  
Level Hospital ◽  
Australian Hospital

​A 62-year-old woman presented to a rural Australian hospital for a planned admission to receive bowel preparation 1 day prior to an upper endoscopy and colonoscopy. This admission was complicated by seizures and reduced levels of consciousness in the setting of hyponatraemia secondary to bowel preparation. Given the limited resources in a remote/rural Australian hospital, transfer to a tertiary level hospital was required for review and management of this rare complication of bowel preparation.

Optimizing Bundling Policy of Single-Period Products

2014 ◽  
Vol 5 (4) ◽  
pp. 1-25
Author(s):  
Gregory Gurevich ◽  
Yuval Cohen ◽  
Baruch Keren
Keyword(s):  
Sensitivity Analysis ◽  
Real World ◽  
The Other ◽  
Order Quantity ◽  
End User ◽  
Demand Distribution ◽  
Common Strategy ◽  
User Demand ◽  
Coordination Tool

Combining different product types into standard discount bundles is a common strategy used by producers and wholesalers to increase overall sales profitability. While markets consist of many producers and retailers, a deal is typically made between a single producer and a single retailer. This paper deals with a producer who sells items separately, and considers setting and selling standard discount bundles. The purchased wholesale bundles are unpacked by the retailer and the items are sold to the end-users one by one. Thus, the end-user demand distribution is unchanged, but the retailer's order quantity grows with the magnitude of the discount. The paper explores the effect of bundle price and content on the profits of both the producer/wholesaler and the retailer, and derives a general objective function composed of a linear combination of these profits. Moreover, the paper establishes the conditions for bundling profitability and presents a way to optimize the profit of each party (producer, or retailer) without reducing the other party's profit. A real-world case study and sensitivity analysis demonstrate the solution's applicability. The results indicate that bundling can be a coordination tool for increasing expected profit for both the producer and the retailer.

scholarly journals Critical care transfer in an English critical care network: Analysis of 1124 transfers delivered by an ad-hoc system

2019 ◽  
Vol 21 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Scott Grier ◽  
Graham Brant ◽  
Timothy H Gould ◽  
Johannes von Vopelius-Feldt ◽  
Julian Thompson
Keyword(s):  
Critical Care ◽  
Ad Hoc ◽  
Published Data ◽  
National Guidelines ◽  
Care Network ◽  
National Conversation ◽  
Hospital Transfer ◽  
Specialist Treatment ◽  
Transfer Services ◽  
Time Critical

Background Critical care transfers between hospitals are time critical high-risk episodes for unstable patients who often require urgent lifesaving intervention. This study aimed to establish the scale, nature and safety of current transfer practice in the South West Critical Care Network (SWCCN) in England. Methods The SWCCN database contains prospectively collected data in accordance with national guidelines. It was interrogated for all adult (>15 years of age) patients from January 2012 to November 2017. Results A total of 1124 inter-hospital transfers were recorded, with the majority (935, 83.2%) made for specialist treatment. The transferring team included a doctor in 998 (88.8%) and nurse in 935 (93.7%) transfers. In 204 (18.1%) transfers, delays occurred, with the commonest cause being availability of transport. Critical incidents occurred in 77 (6.9%). Conclusions This is the first published data on the transfer activity of a UK adult critical care network. It demonstrates that current ad-hoc provision is not meeting the longstanding expectations of national guidelines in terms of training, clinical experience and timeliness. The authors hope that this study may inform national conversation regarding the development of National Health Service commissioned inter-hospital transfer services for adult patients in England.

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