首页 > 最新文献

Operations Research for Health Care最新文献

英文 中文
Optimizing interventions across the HIV care continuum: A case study using process improvement analysis 优化艾滋病毒护理连续体的干预措施:使用过程改进分析的案例研究
IF 2.1 Q1 Health Professions Pub Date : 2020-06-01 DOI: 10.1016/j.orhc.2020.100258
Geoffrey J. Barrow , Michael Fairley , Margaret L. Brandeau

UNAIDS’ 90–90–90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).

联合国艾滋病规划署2020年的“90-90-90”目标是使90%的艾滋病毒感染者了解自己的状况,90%的感染者接受抗逆转录病毒治疗,90%接受抗逆转录病毒治疗的人实现病毒抑制。为了实现这些雄心勃勃的目标,需要有效的医疗服务规划。在本文中,我们提出了一个案例研究,展示了如何通过将患者护理过程视为生产过程并应用过程改进分析方法来改善艾滋病毒护理。我们在牙买加金斯敦的一家医院艾滋病毒诊所检查了艾滋病毒护理的连续性。我们执行定性分析,以确定关键的程序、人员和临床领域的过程改进。然后进行定量分析。我们开发了一个护理过程的随机模型,我们用它来评估潜在的过程改进对接受抗逆转录病毒治疗的患者数量和实现病毒抑制的患者数量的影响。我们还开发了一个模型,用于在旨在改善护理级联的干预措施中进行固定预算的最佳投资,我们使用该模型来确定诊所可以投资的三种干预措施中的最佳投资。通过将患者护理过程视为生产过程并应用定性和定量过程改进分析,我们的案例研究说明了诊所如何确定最大化临床结果的最佳方法。我们的方法可推广到其他HIV护理诊所以及提供其他慢性疾病护理的诊所(例如,糖尿病,乙型肝炎或阿片类药物使用障碍)。
{"title":"Optimizing interventions across the HIV care continuum: A case study using process improvement analysis","authors":"Geoffrey J. Barrow ,&nbsp;Michael Fairley ,&nbsp;Margaret L. Brandeau","doi":"10.1016/j.orhc.2020.100258","DOIUrl":"10.1016/j.orhc.2020.100258","url":null,"abstract":"<div><p>UNAIDS’ 90–90–90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2020.100258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38453921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
An optimization framework to determine an optimal local sharing variance for organ allocation 确定器官分配最优局部共享方差的优化框架
IF 2.1 Q1 Health Professions Pub Date : 2020-03-01 DOI: 10.1016/j.orhc.2019.100242
Mohsen Mohammadi , Vikram Koli , Monica Gentili , Shanthi Muthuswamy

One of the main elements affecting the performance of the organ transplantation system is the set of organ allocation boundaries that limits the number of organs shared among regions. To overcome these boundary limits, members of the Organ Procurement Transplant Network - OPTN - (including, transplant hospitals, Organ Procurement Organizations (OPO), medical/scientific members, among others) can propose a variance to the current allocation system to allocate organs differently than the OPTN policies. Over the years, several variances have been enacted by different members for various organs. In this study, we focus on the analysis of sharing variances which allow allocating organs within participating members before offering them at other levels. This type of variance has been successfully implemented in the past. For example, Florida and Tennessee created the Statewide Sharing program whereby kidneys are made available within-state donor service areas before they are made available for regional or national allocation. This program removed geographic disparities within those two states and resulted in better performance of the system in the states. Given these success stories, we propose a multi-period optimization model that can be used to determine the best policy for a local sharing program for any given OPO. We use liver allocation for the GALL OPO (i.e., LifeLink of Georgia) in the state of Georgia (USA) as a test case; however, our approach could be used for a variety of organs in any OPO.

影响器官移植系统性能的主要因素之一是器官分配边界,它限制了区域间共享器官的数量。为了克服这些边界限制,器官获取移植网络(OPTN)的成员(包括移植医院、器官获取组织(OPO)、医疗/科学成员等)可以对目前的分配制度提出不同于OPTN政策的器官分配方案。多年来,不同的成员为不同的机构制定了一些差异。在本研究中,我们重点分析了允许在其他级别提供器官之前在参与成员内部分配器官的共享差异。这种类型的变化在过去已经成功地实现了。例如,佛罗里达州和田纳西州创建了全州共享计划,根据该计划,肾脏在提供给地区或全国分配之前,先在州内的捐赠服务区提供。这个项目消除了这两个州之间的地理差异,提高了这两个州的系统性能。鉴于这些成功案例,我们提出了一个多周期优化模型,该模型可用于确定任何给定OPO的本地共享计划的最佳策略。我们使用佐治亚州(美国)的GALL OPO(即佐治亚州LifeLink)的肝脏分配作为测试案例;然而,我们的方法可以用于任何OPO的各种器官。
{"title":"An optimization framework to determine an optimal local sharing variance for organ allocation","authors":"Mohsen Mohammadi ,&nbsp;Vikram Koli ,&nbsp;Monica Gentili ,&nbsp;Shanthi Muthuswamy","doi":"10.1016/j.orhc.2019.100242","DOIUrl":"10.1016/j.orhc.2019.100242","url":null,"abstract":"<div><p><span>One of the main elements affecting the performance of the organ transplantation system is the set of organ allocation boundaries that limits the number of organs shared among regions. To overcome these boundary limits, members of the Organ Procurement Transplant Network - OPTN - (including, transplant hospitals, Organ Procurement Organizations (OPO), medical/scientific members, among others) can propose a variance to the current allocation system to allocate organs differently than the OPTN policies. Over the years, several variances have been enacted by different members for various organs. In this study, we focus on the analysis of sharing variances which allow allocating organs within participating members before offering them at other levels. This type of variance has been successfully implemented in the past. For example, Florida and Tennessee created the Statewide Sharing program whereby kidneys are made available within-state donor service areas before they are made available for regional or national allocation. This program removed geographic </span>disparities within those two states and resulted in better performance of the system in the states. Given these success stories, we propose a multi-period optimization model that can be used to determine the best policy for a local sharing program for any given OPO. We use liver allocation for the GALL OPO (i.e., LifeLink of Georgia) in the state of Georgia (USA) as a test case; however, our approach could be used for a variety of organs in any OPO.</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48022359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Optimal inventory system for pharmaceutical products incorporating quality degradation with expiration date: A game theory approach 包含质量退化和有效期的药品库存优化系统:一种博弈论方法
IF 2.1 Q1 Health Professions Pub Date : 2020-03-01 DOI: 10.1016/j.orhc.2020.100245
S. Priyan , P. Mala

Healthcare supply chain systems around the world face an immediate pressure to transform in the face of unprecedented demand and high Customer Service Level (CSL). And the expiration date of a pharmaceutical product is also a widespread issue in a customer’s purchase decision. In view of this, studies are essential to understand operations in healthcare systems and to offer decision support tools that improve public health, patient safety and strategic decision-making in the healthcare systems. This paper proposes a game theory approach for addressing inventory strategies for managing the flow of a pharmaceutical raw-material incorporating different quality characteristics in a two echelon hospital and pharmaceutical company supply chain. This research also considers a more realistic situation where the deteriorating rate of a finished product gradually increases as the expiration date approaches. We design a procedure for deciding an optimal strategy to achieve the target CSL of the hospital with the help of game theory payoff matrix. Numerical example is presented to illustrate the solution procedure and the sensitivity analysis of some key parameters is provided to demonstrate the proposed model.

面对前所未有的需求和高客户服务水平(CSL),全球医疗保健供应链系统面临着转型的直接压力。药品的有效期也是消费者购买决策中普遍存在的问题。鉴于此,研究对于了解医疗系统的运作,并提供决策支持工具,以改善公共卫生,患者安全和医疗系统的战略决策至关重要。本文提出了一种博弈论方法,用于解决二级医院和制药公司供应链中具有不同质量特征的药品原料的库存管理策略。本研究还考虑了一种更为现实的情况,即随着保质期的临近,成品的变质率逐渐增加。本文运用博弈论的收益矩阵,设计了一套优化策略的决策程序,以实现医院社会服务价值的目标。通过数值算例说明了模型的求解过程,并对关键参数进行了敏感性分析。
{"title":"Optimal inventory system for pharmaceutical products incorporating quality degradation with expiration date: A game theory approach","authors":"S. Priyan ,&nbsp;P. Mala","doi":"10.1016/j.orhc.2020.100245","DOIUrl":"10.1016/j.orhc.2020.100245","url":null,"abstract":"<div><p>Healthcare supply chain systems around the world face an immediate pressure to transform in the face of unprecedented demand and high Customer Service Level (CSL). And the expiration date of a pharmaceutical product is also a widespread issue in a customer’s purchase decision. In view of this, studies are essential to understand operations in healthcare systems and to offer decision support tools that improve public health<span>, patient safety and strategic decision-making in the healthcare systems. This paper proposes a game theory approach for addressing inventory strategies for managing the flow of a pharmaceutical raw-material incorporating different quality characteristics in a two echelon hospital and pharmaceutical company supply chain. This research also considers a more realistic situation where the deteriorating rate of a finished product gradually increases as the expiration date approaches. We design a procedure for deciding an optimal strategy to achieve the target CSL of the hospital with the help of game theory payoff matrix. Numerical example is presented to illustrate the solution procedure and the sensitivity analysis of some key parameters is provided to demonstrate the proposed model.</span></p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2020.100245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44151269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 24
EURO 2018 — Innovative methods and uses of operations research in health and care applications 2018年欧洲杯-运筹学在健康和护理应用中的创新方法和应用
IF 2.1 Q1 Health Professions Pub Date : 2020-03-01 DOI: 10.1016/j.orhc.2019.100243
Inês Marques, Derya Demirtas, Sebastian Rachuba, Christos Vasilakis
{"title":"EURO 2018 — Innovative methods and uses of operations research in health and care applications","authors":"Inês Marques,&nbsp;Derya Demirtas,&nbsp;Sebastian Rachuba,&nbsp;Christos Vasilakis","doi":"10.1016/j.orhc.2019.100243","DOIUrl":"10.1016/j.orhc.2019.100243","url":null,"abstract":"","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48336090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing the impact of patient prioritization on operating room schedules 评估病人优先次序对手术室安排的影响
IF 2.1 Q1 Health Professions Pub Date : 2020-03-01 DOI: 10.1016/j.orhc.2019.100232
Mariana Oliveira , Valérie Bélanger , Inês Marques , Angel Ruiz

This paper proposes an integrated approach to merge patient prioritization and patient scheduling to improve access to services in an elective (i.e., non-urgent) context. In particular, we assume that patients are included on a waiting list for a given surgery, and that every patient on the list has received a “utility score”, which is a proxy for the relative urgency with regards to the other patients on the list. A mathematical model is formulated to solve the patient scheduling problem, i.e., the simultaneous assignment of surgery sessions to surgeons and patients to surgeons, in such a way that the total utility is maximized along with other practical requirements. The model has been applied to a testbed of randomly generated instances, inspired by the context of the Urology Department at a University Hospital in Quebec City. Experiments have been conducted to analyze both the short- and medium-term behaviors of the proposed approach. The numerical results confirm that the use of an objective function designed to maximize utility does not deteriorate the efficiency of the resulting schedules in terms of the number of surgeries performed. They also show that, as expected, higher utility patients are scheduled first, and their waiting time before surgery are shorter than those of lower utility. However, this approach may lead to longer, and even unacceptable waiting times for low utility patients. To mitigate such an undesirable effect, a dynamic utility updating approach is proposed to progressively increase the utility of patients according to their time spent on the waiting list. This approach seems to adequately balance the advantages of scheduling patients based on their utility and the risk of causing too much delay for low priority patients.

本文提出了一种整合的方法来合并患者优先级和患者调度,以改善在可选(即非紧急)环境中获得服务的机会。具体地说,我们假设患者被列在等待某一手术的名单上,并且名单上的每个患者都得到了一个“效用评分”,这是与名单上其他患者相比的相对紧迫性的代理。建立了患者调度问题的数学模型,即同时将手术时段分配给外科医生,同时将患者分配给外科医生,以使总效用最大化并满足其他实际需求。受魁北克市一家大学医院泌尿科的启发,该模型已应用于随机生成实例的测试平台。实验分析了该方法的短期和中期行为。数值结果证实,使用旨在使效用最大化的目标函数不会降低所产生的手术数量方面的效率。他们还表明,正如预期的那样,高效用患者首先被安排,他们的手术前等待时间比低效用患者短。然而,这种方法可能会导致低效用患者等待时间更长,甚至无法接受。为了减轻这种不良影响,提出了一种动态效用更新方法,根据患者在等待名单上花费的时间逐步增加患者的效用。这种方法似乎充分平衡了基于效用安排患者的优势和对低优先级患者造成过多延迟的风险。
{"title":"Assessing the impact of patient prioritization on operating room schedules","authors":"Mariana Oliveira ,&nbsp;Valérie Bélanger ,&nbsp;Inês Marques ,&nbsp;Angel Ruiz","doi":"10.1016/j.orhc.2019.100232","DOIUrl":"10.1016/j.orhc.2019.100232","url":null,"abstract":"<div><p>This paper proposes an integrated approach to merge patient prioritization and patient scheduling to improve access to services in an elective (i.e., non-urgent) context. In particular, we assume that patients are included on a waiting list for a given surgery, and that every patient on the list has received a “utility score”, which is a <em>proxy</em><span> for the relative urgency with regards to the other patients on the list. A mathematical model is formulated to solve the patient scheduling problem, i.e., the simultaneous assignment of surgery sessions to surgeons and patients to surgeons, in such a way that the total utility is maximized along with other practical requirements. The model has been applied to a testbed of randomly generated instances, inspired by the context of the Urology Department at a University Hospital in Quebec City. Experiments have been conducted to analyze both the short- and medium-term behaviors of the proposed approach. The numerical results confirm that the use of an objective function designed to maximize utility does not deteriorate the efficiency of the resulting schedules in terms of the number of surgeries performed. They also show that, as expected, higher utility patients are scheduled first, and their waiting time before surgery are shorter than those of lower utility. However, this approach may lead to longer, and even unacceptable waiting times for low utility patients. To mitigate such an undesirable effect, a dynamic utility updating approach is proposed to progressively increase the utility of patients according to their time spent on the waiting list. This approach seems to adequately balance the advantages of scheduling patients based on their utility and the risk of causing too much delay for low priority patients.</span></p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42836102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 17
A stochastic location model for designing primary healthcare networks integrated with workforce cross-training 结合劳动力交叉培训设计初级卫生保健网络的随机定位模型
IF 2.1 Q1 Health Professions Pub Date : 2020-03-01 DOI: 10.1016/j.orhc.2019.100226
Amir Ahmadi-Javid, Nasrin Ramshe

Health posts aim to elevate the level of public health by providing primary health services. The effectiveness of a health post network depends on factors such as the number and location of health posts. The service quality in such networks can be improved by controlling the amount of congestion at the facilities. An important policy for decreasing operational cost of these networks is to consider a workforce mix of flexible and dedicated servers. This paper integrates the network design with workforce cross-training in the presence of congestion, where the queuing system at each health post is modeled by a set of multi-class M/G/m queues offering multiple service types. The problem is formulated as an integer nonlinear programming model, and a linearization method is used to solve it. A hypothetical case study illustrates how the model can be used, and interesting managerial insights are presented.

保健站旨在通过提供初级保健服务来提高公共卫生水平。卫生站网络的有效性取决于卫生站的数量和位置等因素。这种网络的服务质量可以通过控制设施的拥塞量来提高。降低这些网络运营成本的一个重要策略是考虑灵活和专用服务器的劳动力组合。本文将网络设计与拥挤情况下的人员交叉培训相结合,其中每个卫生站的排队系统由一组提供多种服务类型的多类M/G/ M队列建模。将该问题表述为一个整数非线性规划模型,并采用线性化方法求解。一个假设的案例研究说明了如何使用该模型,并提出了有趣的管理见解。
{"title":"A stochastic location model for designing primary healthcare networks integrated with workforce cross-training","authors":"Amir Ahmadi-Javid,&nbsp;Nasrin Ramshe","doi":"10.1016/j.orhc.2019.100226","DOIUrl":"10.1016/j.orhc.2019.100226","url":null,"abstract":"<div><p><span>Health posts aim to elevate the level of public health by providing primary health services. The effectiveness of a health post network depends on factors such as the number and location of health posts. The service quality in such networks can be improved by controlling the amount of congestion at the facilities. An important policy for decreasing operational cost of these networks is to consider a workforce mix of flexible and dedicated servers. This paper integrates the network design with workforce cross-training in the presence of congestion, where the queuing system at each health post is modeled by a set of multi-class M/G/</span><span><math><mi>m</mi></math></span> queues offering multiple service types. The problem is formulated as an integer nonlinear programming model, and a linearization method is used to solve it. A hypothetical case study illustrates how the model can be used, and interesting managerial insights are presented.</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47058857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 13
Understanding provider-level properties that influence the transmission of healthcare associated infections using network analysis 使用网络分析了解影响医疗保健相关感染传播的提供者级别属性
IF 2.1 Q1 Health Professions Pub Date : 2019-12-01 DOI: 10.1016/j.orhc.2019.100223
Hyojung Kang , Marika E. Waselewski , Jennifer M. Lobo

The goal of this study is to determine which provider-level properties (e.g., provider types, patient contact factors) of healthcare workers (HCW) have the greatest impact on the transmission of healthcare associated infections (HAIs). This study focused on Carbapenem-resistant Enterobacteriaceae (CRE) acquisition for patients who stayed in a long-term acute care hospital (LTACH) in central Virginia during July and August 2014. We used both patient data (e.g., bed movement, screening results for CRE) and provider activity data documented through the electronic medical record. We created a network of patients for each HCW and performed Poisson regression analysis including the network measures. A total of 204 providers saw at least one of the nine positive patients who stayed in the LTACH over the study period. From the Poisson regression, provider types, total number of patients each provider saw, LTACH workdays, average number of patients per day during LTACH workdays, and the provider’s network were associated with the frequency of case contact. Our study demonstrated that in addition to patient data, provider activity logs that show provider-level properties can be used to assess the role of healthcare workers in transmitting HAIs and highlight risk mitigation opportunities.

本研究的目的是确定卫生保健工作者(HCW)的哪些提供者级别属性(例如,提供者类型,患者接触因素)对卫生保健相关感染(HAIs)的传播影响最大。本研究的重点是2014年7月至8月在弗吉尼亚州中部一家长期急性护理医院(LTACH)住院的患者的碳青霉烯耐药肠杆菌科(CRE)获得情况。我们使用了通过电子病历记录的患者数据(例如,床位移动、CRE筛查结果)和提供者活动数据。我们为每个HCW创建了一个患者网络,并进行了包括网络测量在内的泊松回归分析。在研究期间,共有204家医疗机构在LTACH中至少接待了9名阳性患者中的1名。从泊松回归中,提供者类型、每个提供者所见的患者总数、LTACH工作日、LTACH工作日内每天平均患者人数以及提供者网络与病例接触频率相关。我们的研究表明,除了患者数据之外,显示提供者级别属性的提供者活动日志可用于评估医疗工作者在传播HAIs中的作用,并突出风险缓解机会。
{"title":"Understanding provider-level properties that influence the transmission of healthcare associated infections using network analysis","authors":"Hyojung Kang ,&nbsp;Marika E. Waselewski ,&nbsp;Jennifer M. Lobo","doi":"10.1016/j.orhc.2019.100223","DOIUrl":"10.1016/j.orhc.2019.100223","url":null,"abstract":"<div><p><span>The goal of this study is to determine which provider-level properties (e.g., provider types, patient contact factors) of healthcare workers (HCW) have the greatest impact on the transmission of healthcare associated infections (HAIs). This study focused on Carbapenem-resistant Enterobacteriaceae (CRE) acquisition for patients who stayed in a long-term acute care hospital (LTACH) in central Virginia during July and August 2014. We used both patient data (e.g., bed movement, screening results for CRE) and provider activity data documented through the </span>electronic medical record. We created a network of patients for each HCW and performed Poisson regression analysis including the network measures. A total of 204 providers saw at least one of the nine positive patients who stayed in the LTACH over the study period. From the Poisson regression, provider types, total number of patients each provider saw, LTACH workdays, average number of patients per day during LTACH workdays, and the provider’s network were associated with the frequency of case contact. Our study demonstrated that in addition to patient data, provider activity logs that show provider-level properties can be used to assess the role of healthcare workers in transmitting HAIs and highlight risk mitigation opportunities.</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45732572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Improving patient transportation in hospitals using a mixed-integer programming model 利用混合整数规划模型改进医院的病人运输
IF 2.1 Q1 Health Professions Pub Date : 2019-12-01 DOI: 10.1016/j.orhc.2019.100202
Sara Séguin , Yoan Villeneuve , Charles-Hubert Blouin-Delisle

This paper investigates the current patient transportation between care units in a large hospital to determine possible solutions to reduce total completion times of demands. The goal is to avoid major changes in the current staff schedules. Historical data of the service calls is available and an in-depth analysis is conducted to identify popular routes and current assignment of demands to patient transport employees. We present a mixed-integer model to determine the best distribution of the employees throughout the most popular routes of the hospital to minimize costs. Experiments are conducted on real data from CHU de Québec-Université Laval, HEJ, in the province of Québec, Canada. Results obtained from assigning specific employees to routes instead of the current method, which consists at assigning employees to all of the hospital are compared and show that there is a gain in doing so.

本文调查了目前在一家大型医院的护理单位之间的病人运输,以确定可能的解决方案,以减少总完成时间的需求。其目标是避免对当前的工作人员时间表进行重大更改。服务电话的历史数据是可用的,并进行了深入的分析,以确定热门路线和当前分配给病人运输员工的需求。我们提出了一个混合整数模型来确定员工在医院最受欢迎的路线上的最佳分配,以最大限度地降低成本。实验是在加拿大曲梅省的曲梅-拉瓦尔大学的真实数据上进行的。通过将特定员工分配到路线而不是将员工分配到所有医院的现行方法所获得的结果进行了比较,并表明这样做有好处。
{"title":"Improving patient transportation in hospitals using a mixed-integer programming model","authors":"Sara Séguin ,&nbsp;Yoan Villeneuve ,&nbsp;Charles-Hubert Blouin-Delisle","doi":"10.1016/j.orhc.2019.100202","DOIUrl":"10.1016/j.orhc.2019.100202","url":null,"abstract":"<div><p>This paper investigates the current patient transportation between care units in a large hospital to determine possible solutions to reduce total completion times of demands. The goal is to avoid major changes in the current staff schedules. Historical data of the service calls is available and an in-depth analysis is conducted to identify popular routes and current assignment of demands to patient transport employees. We present a mixed-integer model to determine the best distribution of the employees throughout the most popular routes of the hospital to minimize costs. Experiments are conducted on real data from CHU de Québec-Université Laval, HEJ, in the province of Québec, Canada. Results obtained from assigning specific employees to routes instead of the current method, which consists at assigning employees to all of the hospital are compared and show that there is a gain in doing so.</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48800563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Multi-criteria decision making in health care 卫生保健中的多标准决策
IF 2.1 Q1 Health Professions Pub Date : 2019-12-01 DOI: 10.1016/j.orhc.2019.100234
Melanie Reuter-Oppermann, Sebastian Rachuba, Andrea Raith
{"title":"Multi-criteria decision making in health care","authors":"Melanie Reuter-Oppermann,&nbsp;Sebastian Rachuba,&nbsp;Andrea Raith","doi":"10.1016/j.orhc.2019.100234","DOIUrl":"10.1016/j.orhc.2019.100234","url":null,"abstract":"","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2019.100234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42400959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multi-criteria decision analysis for the assessment of non-clinical hospital services: Methodology and case study 非临床医院服务评估的多标准决策分析:方法和案例研究
IF 2.1 Q1 Health Professions Pub Date : 2019-12-01 DOI: 10.1016/j.orhc.2018.08.002
Irene Lasorsa , Elio Padoano , Sara Marceglia , Agostino Accardo

Non-clinical hospital services to support clinical activities, such as the sterilization service and clinical engineering, are an important technology asset in healthcare, and require constant improvement aimed to reduce economic burden and increase quality. The selection of the most effective healthcare service to adopt in a healthcare facility is a multi-criteria decision problem that classical Health Technology Assessment, being mostly focused on medicines, vaccines and medical devices, cannot easily address.

Here we present a methodology based on Multi-Criteria Decision Analysis allowing a full assessment of non-clinical hospital services and supporting the selection of the most suitable solution in a certain environment.

The methodology involves two different panels of experts: the first one includes international professionals and is aimed at selecting the assessment criteria that are relevant to the target service; the second one is a local panel whose members know the needs and peculiarities of the specific healthcare facility. This approach allows the final decision makers to take into account changes and constraints of their environment, but examining criteria that are internationally recognized as of interest. The proposed methodology, tested in a real context of an Italian Local Health Authority, is versatile and can be applied in any context, even out of the healthcare domain, especially if data in the literature are not sufficient to allow comparisons with similar services in different settings.

支持临床活动的非临床医院服务,如消毒服务和临床工程,是医疗保健领域的一项重要技术资产,需要不断改进,以减轻经济负担和提高质量。在医疗保健设施中选择最有效的医疗保健服务是一个多标准决策问题,经典的卫生技术评估主要关注药物、疫苗和医疗设备,无法轻易解决。在这里,我们提出了一种基于多标准决策分析的方法,允许对非临床医院服务进行全面评估,并支持在特定环境中选择最合适的解决方案。该方法涉及两个不同的专家小组:第一个小组包括国际专业人员,目的是选择与目标服务有关的评价标准;第二个小组是一个当地小组,其成员了解特定医疗机构的需求和特点。这种方法使最后的决策者能够考虑到环境的变化和限制,但审查国际公认的标准是有意义的。拟议的方法在意大利地方卫生当局的实际情况下进行了测试,是通用的,可以应用于任何情况,甚至在医疗保健领域之外,特别是如果文献中的数据不足以与不同环境中的类似服务进行比较。
{"title":"Multi-criteria decision analysis for the assessment of non-clinical hospital services: Methodology and case study","authors":"Irene Lasorsa ,&nbsp;Elio Padoano ,&nbsp;Sara Marceglia ,&nbsp;Agostino Accardo","doi":"10.1016/j.orhc.2018.08.002","DOIUrl":"10.1016/j.orhc.2018.08.002","url":null,"abstract":"<div><p><span>Non-clinical hospital services to support clinical activities, such as the sterilization service and clinical engineering, are an important technology asset in healthcare, and require constant improvement aimed to reduce economic burden and increase quality. The selection of the most effective healthcare service to adopt in a healthcare facility is a multi-criteria decision problem that classical </span>Health Technology<span> Assessment, being mostly focused on medicines, vaccines and medical devices, cannot easily address.</span></p><p>Here we present a methodology based on Multi-Criteria Decision Analysis allowing a full assessment of non-clinical hospital services and supporting the selection of the most suitable solution in a certain environment.</p><p>The methodology involves two different panels of experts: the first one includes international professionals and is aimed at selecting the assessment criteria that are relevant to the target service; the second one is a local panel whose members know the needs and peculiarities of the specific healthcare facility. This approach allows the final decision makers to take into account changes and constraints of their environment, but examining criteria that are internationally recognized as of interest. The proposed methodology, tested in a real context of an Italian Local Health Authority, is versatile and can be applied in any context, even out of the healthcare domain, especially if data in the literature are not sufficient to allow comparisons with similar services in different settings.</p></div>","PeriodicalId":46320,"journal":{"name":"Operations Research for Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.orhc.2018.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48188573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
期刊
Operations Research for Health Care
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1