医疗管理HealthcareManagementSci期刊摘要.docx
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医疗管理HealthcareManagementSci期刊摘要.docx
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医疗管理HealthcareManagementSci期刊摘要
1.Thu-Ba,T,Nguyen,Appa,Iyer,Sivakumar,Stephen,C,Graves.Schedulingrulesto
achievelead-timetargetsinoutpatientappointmentsystems[J].HealthCareManagementScience,2017,20(4):
578-599
Thispaperconsidershowtoscheduleappointmentsforoutpatients,foraclinicthatissubjecttoappointmentlead-timetargetsforbothnewandreturningpatients.Wedevelopheuristicrules,whicharetheexactandrelaxedappointmentschedulingrules,toscheduleeachnewpatientappointment(only)inlightofuncertaintyaboutfuturearrivals.Theschedulingrulesentailtwodecisions.First,therulesneedtodeterminewhetherornotapatient'srequestcanbeaccepted;then,iftherequestisnotrejected,therulesprescribehowtoassignthepatienttoanavailableslot.Theintentoftheschedulingrulesistomaximizetheutilizationoftheplannedresource(i.e.,thephysicianstaff),orequivalentlytomaximizethenumberofpatientsthatareadmitted,whilemaintainingtheservicetargetsonthemedian,the95thpercentile,andthemaximumappointmentlead-times.WetesttheproposedschedulingruleswithnumericalexperimentsusingrealdatafromthechosenclinicofTanTockSenghospitalinSingapore.Theresultsshowtheefficiencyandtheefficacyoftheschedulingrules,intermsoftheservice-targetsatisfactionandtheresourceutilization.Fromthesensitivityanalysis,wefindthattheperformanceoftheproposedschedulingrulesisfairlyrobusttothespecificationoftheestablishedlead-timetargets.
1.Michael,Samudra,Erik,Demeulemeester,Brecht,Cardoen.Duetimedrivensurgery
scheduling[J].HealthCareManagementScience,2017,20(3):
326-352
Inmanyhospitalstherearepatientswhoreceivesurgerylaterthanwhatismedicallyindicated.InoneofEurope?
slargesthospitals,theUniversityHospitalLeuven,thisisthecaseforapproximatelyeverythirdpatient.ServingpatientslatecannotalwaysbeavoidedasahighlyutilizedORdepartmentwillsometimessuffercapacityshortage,occasionallyleadingtounavoidabledelaysinpatientcare.Nevertheless,servingpatientslateisaproblemasitexposesthemtoanincreasedhealthriskandhenceshouldbeavoidedwheneverpossible.Inordertoimprovethecurrentsituation,thedelayinpatientschedulinghadtobequantifiedandtheresponsiblemechanism,theschedulingprocess,hadtobebetterunderstood.Drawingfromthisunderstanding,weimplementedandtestedrealisticpatientschedulingmethodsinadiscreteeventsimulationmodel.Wefoundthatitisimportanttomodelnon-electivearrivalsandtoincludeelectivereschedulingdecisionsmadeonsurgerydayitself.ReschedulingensuresthatORrelatedperformancemeasures,suchasovertime,willonlylooselydependonthechosenpatientschedulingmethod.Wealsofoundthatcapacityconsiderationsshouldguideactionsperformedbeforethesurgery
daysuchaspatientschedulingandpatientreplanning.ThisisthecaseasthoseschedulingstrategiesthatensurethatORcapacityisefficientlyusedwillalsoresultinahighnumberofpatientsservedwithintheirmedicallyindicatedtimelimit.AnefficientuseofORcapacitycanbeachieved,forinstance,byservingpatientsfirstcome,firstserved.Asapplyingfirstcome,firstservedmightnotalwaysbepossibleinarealsetting,wefounditisimportanttoallowforpatientreplanning.
2.Chih-Ching,Yang.Measuringhealthindicatorsandallocatinghealthresources:
a
DEA-basedapproach[J].HealthCareManagementScience,2017,20(3):
365-378
ThispapersuggestsnewempiricalDEAmodelsforthemeasurementofhealthindicatorsandtheallocationofhealthresources.Theproposedmodelsweredevelopedbyfirstsuggestingapopulation-basedhealthindicator.ByintroducingthesuggestedindicatorintoDEAmodels,anewapproachthatsolvestheproblemofhealthresourceallocationhasbeendeveloped.TheproposedmodelsareappliedtoanempiricalstudyofTaiwan?
shealthsystem.Empiricalfindingsshowthatthesuggestedindicatorcansuccessfullyaccommodatethedifferencesinhealthresourcedemandsbetweenpopulations,providingmorereliableperformanceinformationthantraditionalindicatorssuchasphysiciandensity.Usingourmodelsandacommonlyusedallocationmechanism,capitation,toallocatemedicalexpenditures,itisfoundthattheproposedmodelalwaysobtainshigherperformancethanthosederivedfromcapitation,andthesuperiorityincreasesasallocatedexpendituresrise.
3.Lara,Wiesche,Matthias,Schacht,Brigitte,Werners.Strategiesforinterday
appointmentschedulinginprimarycare[J].HealthCareManagementScience,2017,20(3):
403-418
Whenfacedwithamedicalproblem,patientscontacttheirprimarycarephysician(PCP)first.Heremainlytwotypesofpatientrequestsoccur:
non-scheduledpatientswhoarewalk-inswithoutanappointmentandscheduledpatientswithanappointment.Numberandpositionofthescheduledappointmentsinfluencewaitingtimesforpatients,capacityfortreatmentandtheutilizationofPCPs.Asthenumberofpatientrequestsdifferssignificantlybetweenweekdays,thechallengeistomatchcapacitywithpatientrequestsandprovideasfewappointmentslotsasnecessary.Inthisway,capacityforwalk-insismaximizedwhileoverallcapacityrestrictionsaremet.Decisionsastotheoptimalappointmentcapacityperdayonatacticaldecisionlevelhasgainedlittleattentionintheliterature.Amixedintegerlinearmodelisdeveloped,wheretheminimumnumberofappointments
scheduledforaweeklyprofileisdetermined.WearethusabletogivetheanswerastohowmanyappointmentstoofferoneachdayinaweekinordertocreateaschedulethattakespatientpreferencesaswellasPCPpreferencesintoaccount.Appointmentschedulesareofteninfluencedbyuncertaindemandsduetothenumberofurgentpatients,interarrivalsandservicetimes.Basedonanexemplarycasestudy,theadvantagesoftheoptimalappointmentscheduleondifferentperformancecriteriaareshownbydetailedstochasticsimulations.
1.Muge,Capan,Julie,S,Ivy,James,R,Wilson.Astochasticmodelofacute-care
decisionsbasedonpatientandproviderheterogeneity[J].HealthCareManagementScience,2017,20
(2):
187-206
Theprimarycauseofpreventabledeathinmanyhospitalsisthefailuretorecognizeand/orrescuepatientsfromacutephysiologicdeterioration(APD).APDaffectsallhospitalizedpatients,potentiallycausingcardiacarrestanddeath.IdentifyingAPDisdifficult,andresponsetimingiscritical-delaysinresponserepresentasignificantandmodifiablepatientsafetyissue.Hospitalshaveinstitutedrapidresponsesystemsorteams(RRT)toprovidetimelycriticalcareforAPD,withthresholdsthattriggertheinvolvementofcriticalcareexpertise.TheNationalEarlyWarningScore(NEWS)wasdevelopedtodefinethesethresholds.However,currenttriggersareinconsistentandignorepatient-specificfactors.Further,acutecareisdeliveredbyproviderswithdifferentclinicalexperience,resultinginquality-of-carevariation.Thisarticledocumentsasemi-MarkovdecisionprocessmodelofAPDthatincorporatespatientandproviderheterogeneity.Themodelallowsforstochasticallychanginghealthstates,whiledeterminingpatientsubpopulation-specificRRT-activationthresholds.Theobjectivefunctionminimizesthetotaltimeassociatedwithpatientdeteriorationandstabilization;andtherelativevaluesofnursingandRRTtimescanbemodified.AcasestudyfromJanuary2011toDecember2012identifiedsixsubpopulations.RRTactivationwasoptimalforpatientsin“slightlyconcerning”healthstates(NEWS?
>?
0)forallsubpopulations,exceptsurgicalpatientswithlowriskofdeteriorationforwhomRRTwasactivatedin“concerning”states(NEWS?
>?
4).ClusteringmethodsidentifiedproviderclustersconsideringRRT-activationpreferencesandestimationofstabilization-relatedresourceneeds.ProviderswithconservativeresourceestimatespreferredwaitingoveractivatingRRT.Thisstudyprovidessimplepracticalrulesforpersonalizedacutecaredelivery.
2.Sebastian,Hof,Andreas,Fügener,Jan,Schoenfelder.Casemixplanninginhospitals:
areviewandfutureagenda[J].HealthCareManagementScience,2017,20
(2):
207-220
Thecasemixplanningproblemdealswithchoosingtheidealcompositionandvolumeofpatientsinahospital.Withmanycountrieshavingrecentlychangedtosystemswherehospitalsarereimbursedforpatientsaccordingtotheirdiagnosis,casemixplanninghasbecomeanimportanttoolinstrategicandtacticalhospitalplanning.Selectingpatientsinsuchapaymentsystemcanhaveasignificantimpactonahospital?
srevenue.Thecontributionofthisarticleistoprovidethefirstliteraturereviewfocusingonthecasemixplanningproblem.Wedescribetheproblem,distinguishitfromsimilarplanningproblems,andevaluatetheexistingliteraturewithregardtoproblemstructureandmanagerialimpact.Further,weidentifygapsintheliterature.Wehopetofosterresearchinthefieldofcasemixplanning,whichonlylatelyhasreceivedgrowingattentiondespiteitsfundamentaleconomicimpactonhospitals.
3.Jeong,Hoon,Choi,Imsu,Park,Ilyoung,Jung,Asoke,Dey.Complementaryeffectof
patientvolumeandqualityofcareonhospitalcostefficiency[J].HealthCareManagementScience,2017,20
(2):
221-231
ThisstudyexploresthedirecteffectofanincreaseinpatientvolumeinahospitalandthecomplementaryeffectofqualityofcareonthecostefficiencyofU.S.hospitalsintermsofpatientvolume.Thesimultaneousequationmodelwiththree-stageleastsquaresisusedtomeasurethedirecteffectofpatientvolumeandthecomplementaryeffectofqualityofcareandv
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