Health care management science
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Health Care Manag Sci · Jan 2000
Estimating the "avoidable" burden of disease by Disability Adjusted Life Years (DALYs).
The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the "avoidable" burden of disease. ⋯ The methods of estimating each are explained and we describe how we have applied these methods to seven causes of death and disability in the South and West Region. We discuss the relevance of this work for monitoring the health of populations and deciding how best to use scarce resources to improve health.
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Health Care Manag Sci · Dec 1999
Assessing a team's problem solving ability: evaluation of the Team Problem Solving Assessment Tool (TPSAT).
By employing group consensus development methods, this research identified the variables that experts in team problem solving believe are the most important to a team's problem solving ability. These variables were used to develop a quantitative decision aid to allow health care managers and practitioners to estimate how effective a given problem solving group or team will be at solving a problem. This decision aid can be used to assess a team's problem solving potential before the time and effort is expended to convene the team. This report presents the design and initial evaluations of this decision aid.
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Health Care Manag Sci · Jul 1999
Randomized Controlled Trial Multicenter Study Clinical TrialThe quick response initiative in the emergency department: who benefits?
This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. ⋯ The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total "exclusion" group, 37 refused Home Care services including the QRP. HEALTH CARE PRACTICE IMPLICATIONS: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups.
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Health Care Manag Sci · Oct 1998
A simulation modelling approach to evaluating length of stay, occupancy, emptiness and bed blocking in a hospital geriatric department.
The flow of patients through geriatric hospitals has been previously described in terms of acute (short-stay), rehabilitation (medium-stay), and long-stay states where the bed occupancy at a census point is modelled by a mixed exponential model using BOMPS (Bed Occupancy Modelling and Planning System). In this a patient is initially admitted to acute care. The majority of the patients are discharged within a few days into their own homes or through death. ⋯ The average length of stay in the acute compartment is artificially high if some would-be long-term patients are kept waiting in the short-stay compartment until beds become available in long-stay (residential and nursing homes). In this paper we consider the problem as a queueing system to assess the effect of blockage on the flow of patients in geriatric departments. What-if analysis is used to allow a greater understanding of bed requirements and effective utilisation of resources.
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"Bed crisis" is a buzz word of the 90's in the National Health Services (NHS). Medical emergency admissions keep rising and hospital resources remain limited. Faced with such a dilemma, many hospitals have endeavoured to improve their service efficiencies in order to meet the challenge. This paper describes a real-life hospital process re-engineering project in which computer simulation and optimisation models were applied to provide decision making support in determining the size of the proposed medical assessment unit and the allocation of the available medical beds to minimise hospital bed overflows.