Demand, Selection and Patient Outcomes in German Acute Care Hospitals

In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically.We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days without excess demand.We find that when this variation is ignored in the regression framework, the effect of demand on outcomes is biased upwards. The reason is that when demand is high more patients with a higher unobservable frailty are admitted to the hospitals. After having controlled for this selection of patients, excess demand does not negatively affect patient outcomes.Hospital staffing, inpatient outcomes

Data science of stroke imaging and enlightenment of the penumbra.

Imaging protocols of acute ischemic stroke continue to hold significant uncertainties regarding patient selection for reperfusion therapy with thrombolysis and mechanical thrombectomy. Given that patient inclusion criteria can easily introduce biases that may be unaccounted for, the reproducibility and reliability of the patient screening method is of utmost importance in clinical trial design. The optimal imaging screening protocol for selection in targeted populations remains uncertain. Acute neuroimaging provides a snapshot in time of the brain parenchyma and vasculature. By identifying the at-risk but still viable penumbral tissue, imaging can help estimate the potential benefit of a reperfusion therapy in these patients. This paper provides a perspective about the assessment of the penumbral tissue in the context of acute stroke and reviews several neuroimaging models that have recently been developed to assess the penumbra in a more reliable fashion. The complexity and variability of imaging features and techniques used in stroke will ultimately require advanced data driven software tools to provide quantitative measures of risk/benefit of recanalization therapy and help aid in making the most favorable clinical decisions

Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning.

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection

Evaluating candidate reactions to selection practices using organisational justice theory

Objectives: This study aimed to examine candidate reactions to selection practices in postgraduate medical training using organisational justice theory. Methods: We carried out three independent cross-sectional studies using samples from three consecutive annual recruitment rounds. Data were gathered from candidates applying for entry into UK general practice (GP) training during 2007, 2008 and 2009. Participants completed an evaluation questionnaire immediately after the short-listing stage and after the selection centre (interview) stage. Participants were doctors applying for GP training in the UK. Main outcome measures were participants’ evaluations of the selection methods and perceptions of the overall fairness of each selection stage (short-listing and selection centre). Results: A total of 23 855 evaluation questionnaires were completed (6893 in 2007, 10 497 in 2008 and 6465 in 2009). Absolute levels of perceptions of fairness of all the selection methods at both the short-listing and selection centre stages were consistently high over the 3 years. Similarly, all selection methods were considered to be job-related by candidates. However, in general, candidates considered the selection centre stage to be significantly fairer than the short-listing stage. Of all the selection methods, the simulated patient consultation completed at the selection centre stage was rated as the most job-relevant. Conclusions: This is the first study to use a model of organisational justice theory to evaluate candidate reactions during selection into postgraduate specialty training. The high-fidelity selection methods are consistently viewed as more job-relevant and fairer by candidates. This has important implications for the design of recruitment systems for all specialties and, potentially, for medical school admissions. Using this approach, recruiters can systematically compare perceptions of the fairness and job relevance of various selection methods

The optimal treatment of multivessel coronary artery disease

The practice of percutaneous coronary intervention has overtaken coronary bypass surgery in the treatment of ischaemic heart disease. Several randomized controlled as well as registry and observational trials have addressed the issue of patient selection and outcomes in order to provide the cardiologist with data enabling optimal treatment selection. This article reviews the major trials performed over the past 25 years, underscoring their strengths and limitations and draws on lessons and guidelines that are relevant to our local practice.peer-reviewe

Pharmacogenomic testing and its future in community pharmacy

Although it is common to see pharmacogenomic testing used North America and Australia, it is not yet part of practice in the UK. With the promise of genomic screening becoming part of the NHS, pharmacists must equip themselves with a knowledge of how the process works. Source: Shutterstock.com In January 2019, the UK government unveiled its ten-year plan for NHS England and emphasised the role pharmacists can play in promoting patient self-care[1]. There was also a focus on delivering value from medicines and reducing avoidable medicines related-harm, which costs the NHS a minimum of £98.5m per year[2]. This coincides with the NHS Genomic Medicine Service, which will be rolled out across England from April 2020, meaning that the routine use of genomic screening and personalised treatments will be the new normal in the NHS[3],[4]. Pharmacists’ advice currently relies on knowledge of observable patient characteristics, such as age, weight, comorbidities and concurrent medicines, while largely disregarding genetics. However, it is estimated that genetic factors could contribute to between 25–50% of inappropriate drug responses[5]. Knowing exactly which medicine to use for a patient and which to avoid can be a challenging task in clinical practice. However, pharmacogenomics can provide the prescriber with additional information on some of the unobserved patient characteristics that affect drug response — this can assist with both drug selection and safety. Therefore, the combination of this pharmacogenomic information along with other factors influencing pharmaceutical care may provide an opportunity to deliver more ‘personalised’ medicine, facilitating better selection and reducing the need for ‘trial and error’ prescribing

On the role of patience in an insurance market with asymmetric information

We analyse a 2-period competitive insurance market which is characterized by the simultaneous presence of standard moral hazard and adverse selection with regard to consumer time preferences. It is shown that there exists an equilibrium in which patient consumers use high effort and buy a profit-making insurance contract with high coverage, whereas impatient consumers use low effort and buy a contract with low coverage or even remain uninsured. This finding may help to explain why positive profits and the opposite of adverse selection with regard to risk types can sometimes be observed empirically. JEL Classification: D82, G2

Physiology-Aware Rural Ambulance Routing

In emergency patient transport from rural medical facility to center tertiary hospital, real-time monitoring of the patient in the ambulance by a physician expert at the tertiary center is crucial. While telemetry healthcare services using mobile networks may enable remote real-time monitoring of transported patients, physiologic measures and tracking are at least as important and requires the existence of high-fidelity communication coverage. However, the wireless networks along the roads especially in rural areas can range from 4G to low-speed 2G, some parts with communication breakage. From a patient care perspective, transport during critical illness can make route selection patient state dependent. Prompt decisions with the relative advantage of a longer more secure bandwidth route versus a shorter, more rapid transport route but with less secure bandwidth must be made. The trade-off between route selection and the quality of wireless communication is an important optimization problem which unfortunately has remained unaddressed by prior work. In this paper, we propose a novel physiology-aware route scheduling approach for emergency ambulance transport of rural patients with acute, high risk diseases in need of continuous remote monitoring. We mathematically model the problem into an NP-hard graph theory problem, and approximate a solution based on a trade-off between communication coverage and shortest path. We profile communication along two major routes in a large rural hospital settings in Illinois, and use the traces to manifest the concept. Further, we design our algorithms and run preliminary experiments for scalability analysis. We believe that our scheduling techniques can become a compelling aid that enables an always-connected remote monitoring system in emergency patient transfer scenarios aimed to prevent morbidity and mortality with early diagnosis treatment.Comment: 6 pages, The Fifth IEEE International Conference on Healthcare Informatics (ICHI 2017), Park City, Utah, 201

Selection Effects in Regulated Markets

This paper analyzes dynamic selection effects that arise in a regulated market where price structures are determined by a regulator or central management. Consumers come in different types where each type requires a different service or treatment. We show that for a large class of price structures some group of customers is refused the service. Equilibria with selection are welfare inferior to equilibria without selection. We also characterize the class of price structures for which selection does not arise. As the number of customers increases or agents become more patient the class of selection-free price structures shrinks and in the limit it is unique. Moreover, all other price structures induce selection. The general model can be applied to a variety of markets, including health care and taxi markets.

Waiting lists and patient selection

We develop a model of waiting lists for public hospitals when physicians deliver both private and public treatment. Public treatment is free but rationed, i.e., only cases meeting some medical criteria area admitted for treatment. Private treatment has no waiting time but entails payment of a fee. Both physicians and patients take into account that each patient treated in the private practice schedule reduces the waiting list for public treatment. We show that physicians do not necessarily select the mildest cases from the waiting list. We provide sufficient conditions on the rationing policy under which cream skimming is always partial. We show that, to a large extent, one can bypass the analysis of doctors' behavior in the characterization of patient selection