Modeling emergency departments using discrete event simulation techniques

This paper discusses the application of Discrete Event Simulation (DES) for modeling the operations of an Emer-gency Department (ED). The model was developed to help the ED managers understand the behavior of the system with regards to the hidden causes of excessive waiting times. It served as a tool for assessing the impact of major departmental resources on Key Performance Indicators (KPIs), and was also used as a cost effective method for testing various what-if scenarios for possible system im-provement. The study greatly enhanced managers’ under-standing of the system and how patient flow is influenced by process changes and resource availability. The results of this work also helped managers to either reverse or modify some proposed changes to the system that were previously being considered. The results also show a possible reduc-tion of more than 20% in patients waiting times

A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism

Purpose: This randomized controlled trial evaluated the effectiveness of a play-based pragmatic language intervention for children with autism. Methods: A sample of 71 children with autism were randomized to an intervention-first group (n = 28 analyzed) or waitlist-first (n = 34 analyzed) group. Children attended 10, weekly clinic play-sessions with a typically developing peer, and parents mediated practice components at home. The Pragmatics Observational Measure (POM-2) and the Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention. Results: POM-2 gains were greatest for intervention-first participants (p = 0.031, d = 0.57). Treatment effects were maintained at 3-month follow-up (p < 0.001–0.05, d = 0.49–0.64). POM-2 scores were not significantly different in the clinic and home settings at follow-up. Conclusion: Findings support the combination of play, peer-mediation, video-feedback and parent training to enhance pragmatic language in children with autism

Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. In this paper we examine service and patient group characteristics to study the conditions where a centralized model is more efficient, and conversely, where a decentralized model is more efficient. This relationship is examined analytically with a queuing model to determine themost influential factors and then with simulation to fine-tune the results. The tradeoffs between economies of scale and economies of focus measured by these models are used to derive general management guidelines

CareOregon: Transforming the Role of a Medicaid Health Plan From Payer to Partner

Details Triple Aim pilot programs designed to offer patient-centered medical homes and multidisciplinary case management in an effort to improve population health, enhance patients' experience, and slow cost growth

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients.

Study designA longitudinal cohort study.ObjectiveTo define a set of objective biomechanical metrics that are representative of adult spinal deformity (ASD) post-surgical outcomes and that may forecast post-surgical mechanical complications. Current outcomes for ASD surgical planning and post-surgical assessment are limited to static radiographic alignment and patient-reported questionnaires. Little is known about the compensatory biomechanical strategies for stabilizing sagittal balance during functional movements in ASD patients.MethodsWe collected in-clinic motion data from 15 ASD patients and 10 controls during an unassisted sit-to-stand (STS) functional maneuver. Joint motions were measured using noninvasive 3D depth mapping sensor technology. Mathematical methods were used to attain high-fidelity joint-position tracking for biomechanical modeling. This approach provided reliable measurements for biomechanical behaviors at the spine, hip, and knee. These included peak sagittal vertical axis (SVA) over the course of the STS, as well as forces and muscular moments at various joints. We compared changes in dynamic sagittal balance (DSB) metrics between pre- and post-surgery and then separately compared pre- and post-surgical data to controls.ResultsStandard radiographic and patient-reported outcomes significantly improved following realignment surgery. From the DSB biomechanical metrics, peak SVA and biomechanical loads and muscular forces on the lower lumbar spine significantly reduced following surgery (- 19 to - 30%, all p &lt; 0.05). In addition, as SVA improved, hip moments decreased (- 28 to - 65%, all p &lt; 0.05) and knee moments increased (+ 7 to + 28%, p &lt; 0.05), indicating changes in lower limb compensatory strategies. After surgery, DSB data approached values from the controls, with some post-surgical metrics becoming statistically equivalent to controls.ConclusionsLongitudinal changes in DSB following successful multi-level spinal realignment indicate reduced forces on the lower lumbar spine along with altered lower limb dynamics matching that of controls. Inadequate improvement in DSB may indicate increased risk of post-surgical mechanical failure. These slides can be retrieved under Electronic Supplementary Material

Behavior patterns in hormonal treatments using fuzzy logic models

Assisted reproductive technologies are a combination of medical strategies designed to treat infertility patients. Ideal stimulation treatment has to be individualized, but one of the main challenges which clinicians face in the everyday clinic is how to select the best medical protocol for a patient. This work aims to look for behavior patterns in this kind of treatments, using fuzzy logic models with the objective of helping gynecologists and embryologists to make decisions that could improve the process of in vitro fertilization. For this purpose, a real-world dataset composed of one hundred and twenty-three (123) patients and five hundred and fifty-nine (559) treatments applied in relation to such patients provided by an assisted reproduction clinic, has been used to obtain the fuzzy models. As conclusion, this work corroborates some known clinic experiences, provides some new ones and proposes a set of questions to be solved in future experiments.Ministerio de Economía y Competitividad TIN2013-46928-C3-3-RMinisterio de Economía y Competitividad TIN2016-76956- C3-2-RMinisterio de Economía y Competitividad TIN2015-71938-RED