Health care management science
-
We investigate the issue of patient readmission at a large academic hospital in the U. S. ⋯ Each additional bed utilized at time of discharge increases the odds of readmission on average by 0.35% (Odds Ratio = 1.008, 95% CI [1.003, 1.012]). We propose that this effect is due to an increased discharge rate when the unit is highly utilized.
-
Health Care Manag Sci · Dec 2011
Multicenter StudyHow do strategic decisions and operative practices affect operating room productivity?
Surgical operating rooms are cost-intensive parts of health service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. Previous research about operating room management has focused on studying the effect of management practices and decisions on efficiency by utilizing mainly modeling approach or before-after analysis in single hospital case. ⋯ The results indicate that operative practices, such as personnel management, case scheduling and performance measurement, affect productivity more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. Units with different strategic positions should apply different operative practices: Focused hospital units benefit most from sophisticated case scheduling and parallel processing whereas central and ambulatory units should apply flexible working hours, incentives and multi-skilled personnel. Operating units should be more active in applying management practices which are adequate for their strategic orientation.
-
Health Care Manag Sci · Mar 2011
A model for allocating CDC's HIV prevention resources in the United States.
The Division of HIV/AIDS Prevention (DHAP) at the Centers for Disease Control and Prevention has an annual budget of approximately $325 million for funding HIV prevention programs in the U. S. The purpose of this paper is to thoroughly describe the methods used to develop a national HIV resource allocation model intended to inform DHAP on allocation strategies that might improve the overall effectiveness of HIV prevention efforts. ⋯ Incorporating future epidemic trends in the decision-making process informs the selection of populations and interventions that should be targeted. Improving the use of funds by targeting the interventions and population subgroups at greatest risk may lead to improved HIV outcomes. These models can also direct research by pointing to areas where the development of cost-effective interventions can have the most impact on the epidemic.
-
Health Care Manag Sci · Dec 2010
Using simulation-optimization to construct screening strategies for cervical cancer.
Cervical cancer is the second most common cancer in women worldwide. Cervical screening is critical for preventing this type of cancer. Traditionally, screening strategies are evaluated from an economic point of view through cost-effectiveness analysis. ⋯ Our dynamic screening strategies provide approximately the same health benefits as this but with four to six fewer scheduled screenings, depending on the performance measure considered. Our dynamic strategies also provide approximately the same health benefits as screening every 2 years, but with six to nine fewer scheduled screenings. The results suggest that dynamic, age-based cervical cancer screening policies offer substantial economic savings in order to offer the same health benefits as equally spaced screening strategies.
-
Health Care Manag Sci · Jun 2009
What is the best workflow for an operating room? A simulation study of five scenarios.
Parallel induction of anesthesia improves operating room (OR) efficiency. To support decision-making as to optimal facilities and optimal use of resources, we compared the cost-efficiency of several workflow models of parallel induction to that of the traditional model, using discrete-event simulation. For each scenario, average number of procedures performed, surgery time, daily over- and underutilized time, and staffing costs per operation were assessed. ⋯ All parallel work-flow models demonstrated better cost-efficiency than the traditionally sequenced working pattern. Staffing costs per procedure were 7% lower in the best induction model than in the traditional model. When short procedures were scheduled separately, differences between induction models were small.