Improving the Efficiency of Physical Examination Services

The objective of our project was to improve the efficiency of the physical examination screening service of a large hospital system. We began with a detailed simulation model to explore the relationships between four performance measures and three decision factors. We then attempted to identify the optimal physician inquiry starting time by solving a goal-programming problem, where the objective function includes multiple goals. One of our simulation results shows that the proposed optimal physician inquiry starting time decreased patient wait times by 50% without increasing overall physician utilization

The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

Physician Faculty Scholars Program 2005-2012

Describes the scope, goals, successes, challenges, and lessons of RWJF's career development program which supports physicians' academic careers with three-year research grants. Includes grantee profiles

Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

AI-driven Optimization in Healthcare: the Diagnostic Process

Purpose: Process optimization in healthcare using artificial intelligence (AI) is still in its infancy. In this study, we address the research question "To what extent can an AI-driven chatbot help to optimize the diagnostic process?" Design/ Method/ Approach: First, we developed a mathematical model for the utility (i.e., total satisfaction received from consuming a good or service) resulting from the diagnostic process in primary healthcare. We calculated this model using MS Excel. Second, after identifying the main pain points for optimization (e.g., waiting time in the queue), we ran a small experiment (n=25) in which we looked at time to diagnosis, average waiting time, and their standard deviations. In addition, we used a questionnaire to examine patient perceptions of the interaction with an AI-driven chatbot. Findings: Our results show that scheduling is the main factor causing issues in a physician's work. An AI-driven chatbot may help to optimize waiting time as well as provide data for faster and more accurate diagnosis. We found that patients trust AI-driven solutions primarily when a real (not virtual) physician is also involved in the diagnostic process. Practical Implications: AI-driven chatbots may indeed help to optimize diagnostic processes. Nevertheless, physicians need to remain involved in the process in order to establish patient trust in the diagnosis. Originality/ Value: We analyze the utility to physicians and patients of a diagnostic process and show that, while scheduling may reduce the overall process utility, AI-based solutions may increase the overall process utility. Research Limitations/ Future Research: First, our simulation includes a number of assumptions with regard to the distribution of mean times for encounter and treatment. Second, the data we used for our model were obtained from different papers, and thus from different healthcare systems. Third, our experimental study has a very small sample size and only one test-physician. Paper type: Empirical

Department of Anesthesia. University of Iowa. Spring 2011.

University of Iowa Department of Anesthesia newsletter

Workshop 08. Professional Delivery of Clinical Reasoning in Medicine

Objectives To consider the specific challenges for students in developing clinical reasoning skills in contemporary systems-based curricula. To consider case vignettes portraying specific student cognitive-processing difficulties in diagnostic reasoning and design a teaching approach to address these difficulties. To share best practice with colleagues. To watch and discuss one example of teaching and learning practice demonstrated in the authors’ DVD recording of an innovative teaching session .Workshop Summary A brief presentation will explore recent evidence in current literature regarding clinical teaching in this area. The delegates will work in small groups on real case vignettes bringing these specific student cognitive difficulties to life. This will enable delegates, in collaboration, to generate suitable teaching and learning approaches for consideration by the whole group. Watching the authors’ own demonstration DVD depicting an innovative teaching approach will stimulate further discussion and reflection on incorporating novel approaches in delegates` own teaching. There will be time for Questions/Answers and sharing best practice with other delegates