Economic comparison between Hospital at Home and traditional hospitalization using a simulation-based approach

International audienceHospital at Home (HAH) is a concept slowly expanding over time. At first this type of organization was used to accomplish low-technical tasks. The main objective was to increase bed availability in hospitals for new patients. Nowadays, HAH structures are able to undertake more technical complex care such as (but not limited to) end-of-life care, chemotherapy and rehabilitation. The purpose of this paper is to propose a new methodology to make an unbiased economic comparison between HAH structures and traditional hospitalization. This article accomplishes two main objectives: in the first part the authors propose a comprehensive literature review dealing with the comparison between traditional hospital and home care structures from an economic standpoint, showing that results are highly dependent on initial conditions of the study (patient health state, territory settings, bio-medical parameters); in the second part the authors propose an unbiased economic comparison approach between health care provided in traditional hospital and home care network using formal modelling with Petri nets and discrete event simulation. As an example for the comparison a multi-session treatment is proposed. Various scenarios are tested to ensure that results will be maintained even if initial conditions change. Relevant performance indicators used for comparison are economic costs from the point of view of the insurance and economic costs related to the consumption of resources

Responding to COVID – 19: Insight Into Capability Re-Configuration of Healthcare Service Ecosystems? The Use Case of Hospitalization at Home

An effective Healthcare Service Ecosystem must emphasize the notion of well-being co-creation which entails a dynamic interplay of actors, in face of the challenges, with their ability to use the available resource pools, at the different system levels. An appropriate response, largely avoiding any crisis, depends on a society's resilience and the related response of actors in the reconfiguration of resources. Originally considered luxury and for the fortunate few who could afford the learning curve, Hospitalization-at-Home (HaH) recently approached a new normal with a positive impact to health outcomes. Nowadays, hospitals have had to reconfigure their health services to reduce the workload of caregivers during the COVID-19 outbreak. We show an example of how HaH can be a viable re-configuration of Healthcare Service Ecosystems and a use case for capability reconfiguration. Our use case can be a lesson for the adaptation of technology for patient empowerment allowing patients to interact with their care ecosystem while at their home

Enabling better management of patients: discrete event simulation combined with the STAR approach

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of the Operational Research Society, on 1 May 2017, available online at: https://www.tandfonline.com/doi/full/10.1057/s41274-016-0029-y.Squeezed budgets and funding cuts are expected to become a feature of the healthcare landscape in the future, forcing decision makers such as service managers, clinicians and commissioners to find effective ways of allocating scarce resources. This paper discusses the development of a decision support toolkit (DST) that facilitates the improvement of services by identifying cost savings and efficiencies within the pathway of care. With the help of National Health Service and commercial experts, we developed a discrete event simulation model for Deep Vein Thrombosis (DVT) patients and adapted the socio technical allocation of resources (STAR) approach to answer crucial questions like: what sort of interventions should we spend our money on? Where will we get the most value for our investment? How will we explain the choices we have made? The DST enables users to model their own services by working with the DST interface allowing users to specify local DVT services. They can input local estimates, or data of service demands and capacities, thus creating a baseline discrete event simulation model. The user can then compare the baseline with potential changes in the patient pathway in the safety of a virtual environment. By making such changes key decision makers can easily understand the impact on activity, cost, staffing levels, skill-mix, utilisation of resources and, more importantly, it allows them to find the interventions that have the highest benefit to patients and provide best value for money.Peer reviewe

Benchmarking of health technologies distribution models: an investigation of Lombardy’s local health authorities

Purpose – The purpose of this paper is to develop a benchmarking framework for assessing the performance of the distribution models adopted by the local branches of National Health Services (NHSs) for delivering health technologies to patients at a local level, and to derive prescriptions for enhancing design and optimal management of the distribution models. Design/methodology/approach – The authors focussed the study on the distribution of absorbent devices for incontinence, adopting the analytic hierarchy process as a tool for developing the benchmarking framework. The authors applied the framework to the context of the Italian NHS with respect to the Lombard Local Health Authorities, assessing their performance in terms of operational efficiency and service quality. Findings – The developed framework constitutes a novel contribution, and it allows for generating prescriptions. Through its application to the context studied the authors found that a “one-size-fits-all” distribution model cannot be proposed, as regards both efficiency and effectiveness, since process standardization does not provide benefits or savings in all contexts. Rather, a total landed cost approach in the evaluation of the distribution practices must be adopted. Practical implications – This paper offers to managers and decision makers an innovative approach to the design of distribution models for health technologies. It provides policy makers with prescriptions to develop regulations fostering a comprehensive view of the factors for an optimal health technologies distribution at a local level. Originality/value – Given the dearth of scientific publications focussed on the distribution at the local level of health technologies, this paper significantly contributes to the existing body of knowledge and it offers an innovative framework which can be proficiently replicated in manifold contexts

Plano de negócio: Home Hospital

O presente trabalho consiste na elaboração de um plano de negócios para um projeto de serviços de cuidados de saúde ao domicílio, representado pela marca Home Hospital, na região da Grande Lisboa. Neste plano foi elaborada uma revisão de literatura, que serviu de apoio teórico aos principais temas que, segundo o seu promotor, sustentam os pilares para a construção de um serviço de saúde ao domicílio moderno e de futuro: a perspetiva da família, a integração de cuidados, a hospitalização domiciliária e a inovação. Para estudar a envolvente ao negócio foi feita uma análise macro ambiental e uma análise de Porter, que serviram de principais fontes de informação para a análise SWOT. A estratégia da Home Hospital foi delineada para que permita criar valor, sucesso e vantagem competitiva face à concorrência.This paper is about the creation of a business plan for a home health care service project represented by the Home Hospital brand in the Greater Lisbon area. A literature review was carried out and served as theoretical support for the main topics that the sponsor believes uphold the pillars for the creation of a modern and sustainable home health care service: the family’s perspective, the integration of care, the home hospitalization and the innovation. In order to study the business environment, a macro environmental analysis and a Porter analysis were conducted, both of which served as the main sources of information for the SWOT analysis. The Home Hospital strategy has been designed in such a way to create value, success and a competitive advantage over the competition

Approccio relazionale e co-creazione di valore in sanità: il caso dell’Assistenza Domiciliare Integrata

2014 - 2015Aim – The work aims to analyse the National Heath Care Service (NHCS) in order to trace pathways and evolutions that have produced its actual configuration. It highlights limitations of traditional managerial models in health care in order to define new approaches built on the tradition but oriented to a new vision of health service. The aim is to point out some relevant variable for the survival of National Heath Care Service that, in the last years, have been neglected. The purpose is to propose possible actions to focus the attention on the patient in the perspective of relational approach and value co-creation. In order to achieve this aim, an empirical investigation on the satisfaction produced by Integrated Home Care (IHC) in the Salerno province is proposed. Methodology – The work offers an analysis of the National Heath Care Service’ evolution and of the relationship among providers and users in health context. The increasing dissatisfaction in the health context is analysed through a Systematic Literature Review focused on the topics of knowledge management, information asymmetry and cognitive distance. Evidences of literature are analysed using a conceptual framework based on the Viable Systems Approach and on the Service Dominant Logic. Proposed hypothesis are verified trough an empirical investigation on the satisfaction produced by Integrated Home Care in the Salerno province. Specifically, the pathway of research is based on the collection and elaboration of direct data, through a survey, and indirect data, extracted from medical records of patients and analysed with a structural equation model. The investigation aims to measure the satisfaction of patients produced by IHC in the Salerno province and its evolution along the time in order to verify the validity of the hypothesis on which the work is based. Findings – The work offers an interpretation of National Heath Care Service based on the more recent indications of managerial studies. The adoption of a quali-quantitative pathway of research produces some reflections useful to improve the fitting of NHCS to the emerging context’s needs. Empirical evidences show the relevance of relational approach and value co-creation to face the emerging challenges in the health context. Approccio relazionale e co-creazione di valore in sanità: il caso dell’Assistenza Domiciliare Integrata IV Research limitation – Empirical evidences should be further checked with reference to different pathways of National Heath Care Service and observing a more extensive geographical area. Results, therefore, should be considered only the first step of a research pathways oriented to define the future evolution of NHCS. Research and Managerial implication – The study provides a new interpretative perspective of National Heath Care Service’s dynamics. Building on the existent literature and on the adopted conceptual framework, it traces some guidelines to improve efficiency, effectiveness and sustainability in the management of NHCS acting on the Relational Approach and on the value co-creation logic. Originality – The analysis of dissatisfaction in the health context as result of information asymmetry and cognitive distance among provider and user is an advancement of the existent national and international contributions on the topic. The definition of an interpretative model oriented to explain the relationships among providers and users in order to trace possible actions to improve the satisfaction in the health context opens to new possible research pathways. In the end, the empirical investigation on the satisfaction produced by Integrated Home Care represents the first step of an ambitious long pathway of research to which it is linked the evolution of NHCS. Keywords – National Heath Care Service; Integrated Home Care; Relational Approach; Value co-creation; Viable Systems Approach; Service Dominant Logic; Systematic Literature Review; Information Asymmetry; Cognitive Distance; Structural Equation. [edited by Author]XIV n.s