Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level

We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis is novel in that it focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between outpatient visits, inpatient admissions, daycase treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply

The Influence of Public Policy on Health, Wealth and Mortality

In this project we extend an augmented lifecycle model, incorporating a Grossman-style model of health capital, to enhance understanding of factors influencing consumption, wealth and health. We develop three primary results when using the model to explore the effects of stylized versions of Medicare and Social Security on wealth and longevity. First, our model calibration implies consumption and health are complements. As health depreciates with age, households will get less utility from consumption than would be in the case of a lifecycle model that does not endogenize health. Second, it appears that forward-looking households, when confronted by a substantially reduced safety net, will respond by reducing consumption and by reducing their health investment and therefore longevity. Third, there is a potentially important difference between short- and long- run responses to policy.

Improving Patients Experience in an Emergency Department using Systems Engineering Approach

Indiana University-Purdue University Indianapolis (IUPUI)Healthcare industry in United States of America is facing a big paradox. Although US is a leader in the industry of medical devices, medical practices and medical researches, however there isnt enough satisfaction and quality in performance of US healthcare operations. Despite the big investments and budgets associated with US healthcare, there are big threats to US healthcare operational side, that reduces the quality of care. In this research study, a step by step Systems Engineering approach is applied to improve healthcare delivery process in an Emergency Department of a hospital located in Indianapolis, Indiana. In this study, different type of systems engineering tools and techniques are used to improve the quality of care and patients satisfaction in ED of Eskenazi hospital. Having a simulation model will help to have a better understanding of the ED process and learn more about the bottlenecks of the process. Simulation model is verified and validated using different techniques like applying extreme and moderate conditions and comparing model results with historical data. 4 different what if scenarios are proposed and tested to find out about possible LOS improvements. Additionally, those scenarios are tested in both regular and an increased patient arrival rate. The optimal selected what-if scenario can reduce the LOS by 37 minutes compared to current ED setting. Additionally, by increasing the patient arrival rate patients may stay in the ED up to 6 hours. However, with the proposed ED setting, patients will only spend an additional 106 minutes compared to the regular patient arrival rate

AN EMPIRICAL SURVEY OF FRONTIER EFFICIENCY MEASUREMENT TECHNIQUES IN HEALTHCARE SERVICES

Healthcare institutions worldwide are increasingly the subject of analyses aimed at defining, measuring and improving organisational efficiency. However, despite the importance of efficiency measurement in healthcare services, it is only relatively recently that the more advanced econometric and mathematical frontier techniques have been applied to hospitals, nursing homes, health management organisations and physician practices. This paper attempts to provide a synoptic survey of the comparatively few empirical analyses of frontier efficiency measurement in healthcare services. Both the measurement of inefficiency in healthcare services and the determinants of healthcare efficiency are examined.data envelopment analysis; stochastic frontiers; technical, allocative and productive efficiency

ORGANIZATION OF INFORMATION FOR REVERSIBLE CAUSES OF PULSELESS IN-HOSPITAL CARDIAC ARREST: A RANDOMIZED CONTROL TRIAL USING A COGNITIVE AID

More than 200,000 in-hospital cardiac arrests are treated each year in the US with 21% survival rate. According to American Heart Association (AHA) guidelines, many causes for these arrests could be successfully treated if identified early. Such causes can be generalized as \u27reversible causes\u27. Medical doctors identify the reversible causes associated with an arrest by recalling them from memory, using a mnemonic. In this study, using a cognitive aid such as an iPad application, the mnemonic was modified and causes were displayed alphabetically, and tested along with a new method that rank-ordered the reversible causes based on the patient context, known as the context-sensitive scheme. Both methods were implemented electronically in an iPad application and presented in a counterbalanced order to 11 anesthesia medical residents using simulated scenarios. Performance and usability measures were recorded and analyzed. It took significantly longer for the participants to identify the reversible causes using the context-sensitive scheme. However, the scheme resulted in significantly lesser number of unnecessary keystrokes when compared to the alphabetical scheme. Some of these unnecessary keystrokes could affect the patient\u27s outcome. Both the schemes agreed in terms of usability. The above results indicate the potential of the context-sensitive scheme of the reversible causes to be useful when applied during an emergency scenario when refined further. A combination of both methods is suggested