1
|
van Staalduinen DJ, van den Bekerom PE, Groeneveld SM, Stiggelbout AM, van den Akker-van Marle ME. Relational coordination in value-based health care. Health Care Manage Rev 2023; 48:334-341. [PMID: 37615943 PMCID: PMC10476589 DOI: 10.1097/hmr.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.
Collapse
|
2
|
Jayakumar P, Mills Z, Triana B, Moxham J, Olmstead T, Wallace S, Bozic K, Koenig K. A Model for Evaluating Total Costs of Care and Cost Savings of Specialty Condition-Based Care for Hip and Knee Osteoarthritis in an Integrated Practice Unit. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1363-1371. [PMID: 37236394 DOI: 10.1016/j.jval.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The viability of specialty condition-based care via integrated practice units (IPUs) requires a comprehensive understanding of total costs of care. Our primary objective was to introduce a model to evaluate costs and potential costs savings using time-driven activity-based costing comparing IPU-based nonoperative management with traditional nonoperative management and IPU-based operative management with traditional operative management for hip and knee osteoarthritis (OA). Secondarily, we assess drivers of incremental cost differences between IPU-based care and traditional care. Finally, we model potential cost savings through diverting patients from traditional operative management to IPU-based nonoperative management. METHODS We developed a model to evaluate costs using time-driven activity-based costing for hip and knee OA care pathways within a musculoskeletal IPU compared with traditional care. We identified differences in costs and drivers of cost differences and developed a model to demonstrate potential cost savings through diverting patients from operative intervention. RESULTS Weighted average costs of IPU-based nonoperative management were lower than traditional nonoperative management and lower in IPU-based operative management than traditional operative management. Key drivers of incremental cost savings included care led by surgeons in partnership with associate providers, modified physical therapy programs with self-management, and judicious use of intra-articular injections. Substantial savings were modeled by diverting patients toward IPU-based nonoperative management. CONCLUSIONS Costing models involving musculoskeletal IPUs demonstrate favorable costs and cost savings compared with traditional management of hip or knee OA. More effective team-based care and utilization of evidence-based nonoperative strategies can drive the financial viability of these innovative care models.
Collapse
Affiliation(s)
- Prakash Jayakumar
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA.
| | - Zachary Mills
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
| | | | - Jamie Moxham
- Department of Analytics and Health Economics. Ascension Seton. Austin, TX, USA
| | - Todd Olmstead
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - Scott Wallace
- Value Institute for Health and Care. University of Texas at Austin, Austin, TX, USA
| | - Kevin Bozic
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
| |
Collapse
|
3
|
Schouten AM, Flipse SM, van Nieuwenhuizen KE, Jansen FW, van der Eijk AC, van den Dobbelsteen JJ. Operating Room Performance Optimization Metrics: a Systematic Review. J Med Syst 2023; 47:19. [PMID: 36738376 PMCID: PMC9899172 DOI: 10.1007/s10916-023-01912-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/26/2022] [Indexed: 02/05/2023]
Abstract
Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.
Collapse
Affiliation(s)
- Anne M Schouten
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands.
| | - Steven M Flipse
- Science Education and Communication Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
| | - Kim E van Nieuwenhuizen
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Frank Willem Jansen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Anne C van der Eijk
- Operation Room Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - John J van den Dobbelsteen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| |
Collapse
|
4
|
Paluch J, Kohr J, Squires A, Loving V. Patient-centered Care and Integrated Practice Units: Embracing the Breast Care Continuum. JOURNAL OF BREAST IMAGING 2022; 4:413-422. [PMID: 38416987 DOI: 10.1093/jbi/wbac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 03/01/2024]
Abstract
Patient-centered care is a health care approach optimized for the needs of the patient. As patients have sought more autonomy in recent years, this model has been more frequently adopted. Breast radiologists aspiring to advance patient-centered care should seek greater ownership of the breast diagnostic imaging and intervention workflows, helping their patients navigate the complex breast care landscape with patients' preferences taken into account. Applying this approach to breast radiology will increase patient satisfaction and compliance while also limiting wasted health care dollars, unnecessary diagnostic delays, and overall confusion. Herein, the benefits of patient-centered breast radiology are discussed, and numerous suggestions and case examples are provided to help readers reshape their practice toward the priorities of their patients.
Collapse
Affiliation(s)
- Jeremy Paluch
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Jennifer Kohr
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | | | - Vilert Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, AZ, USA
| |
Collapse
|
5
|
Mondal PK, Norman BA. Enhancing staffing methods and improving the admission process of a psychiatric hospital using simulation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pritom Kumar Mondal
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
| | - Bryan A. Norman
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
| |
Collapse
|
6
|
Jain U, Jain B, Dee EC, Jain P, Palakodeti S. Integrated practice units present an opportunity over siloed survivorship care settings. Support Care Cancer 2022; 30:6375-6379. [PMID: 35290514 DOI: 10.1007/s00520-022-06964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Given the rapidly rising cancer burden in the USA, the need to innovate survivorship care for oncology patients is rising rapidly. The current body of empirical evidence in survivorship care has focused on care provided by general practitioners (GP) and specialists/surgeons (SS). In particular, current evaluations address cost of care, cancer recurrence, quality of life, and overall survival of patients, with results indicating no statistically significant differences in GP- and SS-led care models and little emphasis on the broader characteristics of care settings. We fill this gap in survivorship care by introducing a perspective on the potential for holistic care delivery with a multidisciplinary team approach at integrated practice units (IPUs). Additionally, we propose a comprehensive examination of survivorship care across GP-, SS-, and IPU-led settings to provide researchers and practitioners with solid ground to determine the optimal survivorship care model, considering four key characteristics: (1) operating mode and skills, (2) cost and accountability of care, (3) health outcome measurement, and (4) workflow and scheduling.
Collapse
Affiliation(s)
- Urvish Jain
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pankaj Jain
- Indiana University of Pennsylvania, Indiana, PA, USA.,Highmark Health, Pittsburgh, PA, USA
| | - Sandeep Palakodeti
- Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA.
| |
Collapse
|
7
|
Appointment Scheduling Problem in Complexity Systems of the Healthcare Services: A Comprehensive Review. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5819813. [PMID: 35281532 PMCID: PMC8913063 DOI: 10.1155/2022/5819813] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 12/29/2022]
Abstract
This paper provides a comprehensive review of Appointment Scheduling (AS) in healthcare service while we propose appointment scheduling problems and various applications and solution approaches in healthcare systems. For this purpose, more than 150 scientific papers are critically reviewed. The literature and the articles are categorized based on several problem specifications, i.e., the flow of patients, patient preferences, and random arrival time and service. Several methods have been proposed to shorten the patient waiting time resulting in the shortest idle times in healthcare centers. Among existing modeling such as simulation models, mathematical optimization techniques, Markov chain, and artificial intelligence are the most practical approaches to optimizing or improving patient satisfaction in healthcare centers. In this study, various criteria are selected for structuring the recent literature dealing with outpatient scheduling problems at the strategic, tactical, or operational levels. Based on the review papers, some new overviews, problem settings, and hybrid modeling approaches are highlighted.
Collapse
|
8
|
Bauer J, Kösel E, Henkel AG, Spinner CD, Kolisch R. [Integrated care concepts and multidisciplinary process chains in a radiological context]. Radiologe 2022; 62:331-342. [PMID: 35201396 DOI: 10.1007/s00117-022-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Modern patient-centered and cost-efficient care concepts in hospitals require the mapping of multidisciplinary process chains into clinical pathways. Clinical decision support systems and operations research methods use algorithms to classify patients into homogeneous groups and to model a complete clinical pathway for scheduling individual procedures. An improvement of the economic situation of the care facility can be achieved through improved resource utilization, reduced patient waiting times and a shortening of the length of stay. The interdisciplinary use of centrally stored interoperable information and comprehensive care management via information technology (IT) services lay the foundation for the dissolution of traditional IT system architectures in medicine and the development of flexibly integrable modern system platforms. New IT approaches such as the semantically standardized definition of procedures and resource properties, the use of clinical decision support systems and the use of service-oriented system architectures form the basis for the deep integration of radiology services into comprehensive interdisciplinary care concepts.
Collapse
Affiliation(s)
- J Bauer
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - E Kösel
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A G Henkel
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C D Spinner
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - R Kolisch
- Lehrstuhl für Operations Management, Fakultät für Wirtschaftswissenschaften, Technische Universität München, München, Deutschland
| |
Collapse
|
9
|
Applying Discrete Event Simulation to Reduce Patient Wait Times and Crowding: The Case of a Specialist Outpatient Clinic with Dual Practice System. Healthcare (Basel) 2022; 10:healthcare10020189. [PMID: 35206804 PMCID: PMC8871892 DOI: 10.3390/healthcare10020189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital’s information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study’s dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10–21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.
Collapse
|
10
|
Sharif F, Rahman A, Tonner E, Ahmed H, Haq I, Abbass R, Asinger S, Sbai M. Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study. Perioper Med (Lond) 2020; 9:33. [PMID: 33292556 PMCID: PMC7667783 DOI: 10.1186/s13741-020-00166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/03/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.
Collapse
Affiliation(s)
- Faraz Sharif
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Ammar Rahman
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | | | | | - Iqraa Haq
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Rami Abbass
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Shad Asinger
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Magda Sbai
- Guy’s and St Thomas NHS Trust, London, UK
| |
Collapse
|