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Exploratory analysis using discrete event simulation modelling of the wait times and service costs associated with the maximum wait time guarantee policy applied in a rheumatology central intake clinic 探索性分析使用离散事件模拟建模的等待时间和服务成本与最大等待时间保证政策应用于风湿病中心门诊
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-06-01 DOI: 10.1080/20476965.2023.2219293
T. Tagimacruz, Monica Cepoiu-Martin, D. Marshall
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引用次数: 1
Assessment of implementation barriers of blockchain technology in public healthcare: evidences from developing countries. 区块链技术在公共医疗领域的实施障碍评估:来自发展中国家的证据。
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-05-23 eCollection Date: 2023-01-01 DOI: 10.1080/20476965.2023.2206446
Sudhanshu Joshi, Manu Sharma

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.

区块链技术在发展中国家的广泛使用仍处于早期阶段,因此需要使用高效和适应性强的方法进行更全面的评估。医疗保健行业对数字化以提高运营效率的需求正在增长。尽管英国电信有潜力成为医疗保健行业的竞争选择,但研究不足阻碍了它的充分利用。本研究旨在确定发展中国家公共卫生系统采用BT的主要社会学、经济和基础设施障碍。为了实现这一目标,本研究采用混合方法对区块链障碍进行了多层次分析。该研究的发现为决策者提供了如何进行的指导,以及对实施挑战的见解。
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引用次数: 0
Long term simulation analysis of deceased donor initiated chains in kidney exchange programs. 肾脏交换计划中已故供者启动链的长期模拟分析
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-04-04 eCollection Date: 2024-01-01 DOI: 10.1080/20476965.2023.2197023
Utkarsh Verma, Nayaran Rangaraj, Viswanath Billa, Deepa Usulumarty

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.

肾脏交换项目已经发展起来,为有不相容供体的受者寻找相容的肾脏。另一方面,没有活体捐赠者的患者依靠已故捐赠者(DD)的捐赠来获得肾脏移植。目前,在印度,已故捐赠者直接将肾脏捐赠给等待捐赠的已故捐赠者。在一些文章中提出了从已故捐赠者的肾脏开始启动交换链的想法(最近在意大利实施),但没有给出这种合并的数学公式。我们引入了一个整数规划公式,该公式可以创建已故捐赠者发起的链,同时考虑配对交换注册和已故捐赠者分配。配对交换登记和已故捐赠者等候名单登记数据之间可能存在重叠,因为接受者可以独立地为这两个登记进行登记。本文也对此进行了论述。我们进行了长期的模拟研究,以分析这些DD启动链随时间的增益。这表明,即使只有少量的已故捐献者,这些器官链也能显著增加潜在的移植数量。此外,合并注册表中的等待时间和退出率也大大降低。
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引用次数: 0
A new vision and direction for Health Systems. 卫生系统的新愿景和新方向。
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-03-08 eCollection Date: 2023-01-01 DOI: 10.1080/20476965.2023.2180173
Samir Chatterjee, Kathy Kotiadis, Daniel Gartner
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引用次数: 0
A genetic algorithm-based strategic planning framework for optimising accessibility and costs of general practices in Northland, New Zealand. 基于遗传算法的战略规划框架,用于优化新西兰Northland的一般做法的可及性和成本
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-02-16 eCollection Date: 2023-01-01 DOI: 10.1080/20476965.2023.2174454
Fulvio D Lopane, Melanie Reuter-Oppermann, Andrea Raith, Daniel J Exeter, Ilze Ziedins, Richard Dawson

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.

全科医生(GP)短缺是全世界面临的一项挑战,不仅在欧洲如此,在新西兰等国也是如此。在农村地区提供初级医疗服务尤其具有挑战性。为了向决策者提供支持,有必要首先评估当前全科医生的覆盖率,然后确定未来的不同方案和计划。在本文中,我们首先全面概述了有关全科医生诊所选址的相关文献。其次,我们提出了一种基于遗传算法框架评估全科医生覆盖率和确定未来全科医生位置的方法。我们选择了新西兰北地农村地区作为使用案例。我们还对主要输入参数进行了敏感性分析。
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引用次数: 0
Using stochastic simulation modelling to study occupancy levels of decentralised admission avoidance units in Norway 使用随机模拟模型研究挪威分散式免入单元的入住率
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-02-15 DOI: 10.1080/20476965.2023.2174453
Meetali Kakad, M. Utley, F. A. Dahl
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.
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引用次数: 0
Assessing the impact of software quality models in healthcare software systems. 评估软件质量模型对医疗保健软件系统的影响。
IF 1.2 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-01-08 eCollection Date: 2023-01-01 DOI: 10.1080/20476965.2022.2162445
Elisabetta Ronchieri, Marco Canaparo

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.

卫生和医疗保健是安全至关重要的环境。开发安全可靠的医疗软件系统是最重要的过程之一,它可能会影响临床决策的准确性,并对疾病诊断和治疗产生影响。本研究旨在评估 McCall 等软件质量模型能否对医疗软件质量产生影响,从而减少软件故障。我们根据现有文献、软件质量模型和编程语言标准确定了医疗保健软件系统的主要关键性;我们将这些关键性与软件特性联系起来;我们分析了医疗保健软件系统的主要关键性与其软件特性之间的关系。以下关键点--更改硬编码软件的风险和开发可维护软件的重要性--必须在软件开发过程的一开始就加以解决。
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引用次数: 0
Strategic planning of operating room session allocation using stability analysis. 基于稳定性分析的手术室会期分配策略规划。
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-01-01 DOI: 10.1080/20476965.2021.1997651
Shiva Faeghi, Kunibert Lennerts, Stefan Nickel

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.

手术室(OR)资源有限,因此外科医生之间通常会竞争以赢得资源。然而,用于分配手术室时段的方法大多基于优化方法,这些方法补偿了外科医生或外科专业的偏好,从而有利于整个手术室部门的生产力。这导致了外科医生之间的冲突和不满。为了克服这一问题,本文提出了一种基于博弈论解的方法,将分配问题表述为一个简单的博弈。作为球员的外科医生或专家共同追求实现整体稳定的目标。稳定性是用一种叫做功率指数的方法来定义和测量的。然后将该方法与蒙特卡罗技术相结合来处理不确定性。为了证明建议的程序的能力,将它们应用于文献中的一个案例研究和一组假设的场景。
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引用次数: 2
Mind the gap: a review of optimisation in mental healthcare service delivery. 注意差距:精神卫生保健服务提供的优化审查。
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-01-01 DOI: 10.1080/20476965.2022.2035260
Sheema Noorain, Maria Paola Scaparra, Kathy Kotiadis

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.

精心规划的护理安排和现有资源的有效分配,有可能解决精神卫生服务效率低下的问题。我们首先探索与心理健康相关的复杂性,并描述这些如何影响服务提供。然后,我们对采用优化技术解决精神保健服务提供问题的研究进行了范围文献综述。研究是根据诸如规划决策类型、研究目的和护理环境等标准进行分类的。我们分析使用的建模方法、目标、约束和模型解决方案。我们发现,与其他医疗保健相比,优化精神保健的应用尚处于早期阶段。讨论了精神卫生保健服务提供与其他服务之间的共性,并概述了未来的研究议程。我们发现,在特定的医疗环境优化现有的应用程序可以转移到精神卫生保健。还强调了解决精神保健服务所面临的具体问题的机会。
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引用次数: 6
Multi-criteria decision-making methods applied in health-insurance underwriting. 多准则决策方法在健康保险承保中的应用。
IF 1.8 Q4 HEALTH POLICY & SERVICES Pub Date : 2023-01-01 DOI: 10.1080/20476965.2022.2085190
John Mourmouris, Thomas Poufinas
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.
本研究试图运用多准则决策(MCDM)分析方法,建构健康保险核保过程。这是通过给每个健康保险申请人分配一个分数来完成的,这个分数可以用来确定他或她是被接受、拒绝还是有特殊条款和条件(如排除、额外的等待期和/或附加费)被接受。在健康保险承保中引入MCDM方法,可以量化选择标准,提高流程的标准化和自动化程度,并通过量化指标与保险公司的风险承受能力/风险偏好保持一致,这是本研究的新颖之处。建议的方法可以很容易地由保险公司实施,在承保、风险管理和分销(销售和营销)职能以及公司的盈利能力或被保险人支付的保费水平方面具有附加值。
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引用次数: 2
期刊
Health Systems
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