Application of discrete-event simulation to health services research: analysis of needs and demand for elective

Les tècniques computacionals de simulació han permès la introducció de metodologies de modelització per analitzar sistemes complexes a través d'experimentació virtual, i així avaluar l'impacte d'intervencions sobre els serveis sanitaris. La simulació d'esdeveniments discrets és una tècnica ben coneguda en la investigació operativa que s'ha desenvolupat principalment en l'àmbit de la investigació militar i els sistemes de producció industrial. En l'àmbit mèdic, els models de Markov i els arbres de decisió han estat utilitzats de manera extensa a pesar de les seves limitacions per a reproduir els problemes sanitaris acuradament. La simulació d'esdeveniments discrets està guanyant popularitat degut a la seva flexibilitat per a representar sistemes reals tenint en compte les característiques dels pacients i l'escassedat de recursos present en la provisió de serveis sanitaris. Aquesta tècnica s'ha utilitzat per a analitzar problemes relacionats amb la gestió de recursos sanitaris, però les seves possibilitats per a analitzar problemes més amplis relacionats amb la dinàmica de les poblacions s'han explorat poc. Tradicionalment, les necessitats i la demanda de serveis sanitaris s'han analitzat per separat. En l'aplicació que es presenta es va analitzar la resposta del sistema sanitari tant a la població amb necessitat de cirurgia com als pacients inclosos en llistes d'espera.En aquest sentit, la principal contribució d'aquesta tesi és l'aplicació de la simulació d'esdeveniments discrets a la recerca en serveis sanitaris des d'un punt de vista epidemiològic. A més, el model és complexe a nivell estadístic degut a la diversitat de fonts d'informació i de característiques de les dades que defineixen la informació principal d'entrada; les lleis del sistema modelat van requerir una metodologia ad hoc específica per a recollir i processar aquesta informació per tal de generar les dades d'entrada que necessitava el model de simulació. Per tant, una part important d'aquest treball s'ha dedicat a desenvolupar aquesta metodologia d'anàlisi de les dades d'entrada.Es va construir un model de simulació d'esdeveniments discrets per a analitzar les necessitats i la demanda de cirurgia de cataractes en el sector públic de Catalunya. El model reprodueix el procés de la cirurgia de cataractes, des de la incidència de necessitat de cirurgia, passant per la demanda, la inclusió en una llista d'espera i la cirurgia finalment. Es descriu detalladament la metodologia per a analitzar les dades d'entrada del model. Els paràmetres del model es van estimar utilitzant diferents fonts d'informació, tant bases de dades administratives com de recerca.Es descriu detalladament la implementació del model en el software SIMUL8 i com es pot enllaçar amb Excel per a fer el model més amigable per a usuaris no experts en simulació. Es van realitzar diverses anàlisis de sensibilitat per a avaluar l'impacte de la variabilitat de les estimacions dels paràmetres d'entrada (validació), l'impacte de diferents estratègies de gestió de la llista d'espera segons diferents escenaris de temps mitjà d'espera, i per a avaluar la transferibilitat de la metodologia. Per a avaluar la transferibilitat es va aplicar la metodologia per a calcular els paràmetres d'entrada a diferents àmbits (altres Comunitats Autònomes d'Espanya). Els resultats del model es van utilitzar per a analitzar variacions geogràfiques en l'impacte d'introduir un sistema de priorització de llistes d'espera. A més, es va combinar la informació de les Comunitats Autònomes per a utilitzar el model per a avaluar el volum de necessitat de cirurgia de cataractes a Espanya segons diferents criteris d'indicació de cirurgia. La transferibilitat de la metodologia a d'altres cirurgies electives es va avaluar adaptant el model per a analitzar necessitats i demanda de cirurgia de pròtesi de genoll a Espanya.L'estudi de les necessitats i la demanda de serveis sanitaris és rellevant en la mesura que s'observa un volum important de necessitats no ateses. La diferència entre la necessitat i la provisió de serveis pot ser massa gran per poder-la resoldre, però la utilització de models que avaluïn l'impacte de modificacions en la quantitat de recursos utilitzats o l'impacte de polítiques sanitàries en la gestió de la necessitat i la demanda de serveis és útil en la presa de decisions sanitàries.Computer simulation techniques have allowed the introduction of modeling methodologies that analyze complex systems through virtual experimentation to assess the potential impact of interventions on health services. Discreteevent simulation is a well-known technique in operations research, and has mainly been developed in the context of military research and manufacturing systems. In the medical setting, Markov models and decision trees have been extensively used despite their limitations in reproducing healthcare problems accurately. Discrete-event simulation is gaining popularity because of its flexibility in representing real systems by taking into account patient characteristics and the scarcity of resources present in health services provision. This technique has been used to analyze problems related to healthcare resource management, but its possibilities to analyze larger problems related to population dynamics have been hardly explored. Traditionally, needs and demand for health services have been analyzed separately. In the present application, the response of the health system to both the population with need for surgery and to the patients included on a waiting list was analyzed.In this sense, the main contribution of this thesis is the application of discrete-event simulation to health services research from an epidemiologic point of view. Moreover, the model was statistically complex because the variety of sources and characteristics of data defining the main inputs and rules of the modeled system asked for a specific ad hoc methodology to collect and process them to generate the inputs that the simulation model needs. Therefore a relevant part of this work has been devoted to develop such input data analysis methodology.A discrete-event simulation model was built for needs and demand for cataract surgery in the Catalan public sector.The model reproduced the process of cataract surgery, from incidence of need for surgery, through demand, inclusion on a waiting list and surgery. The input data analysis methodology was described in detail. The model's parameters were estimated from several sources, including administrative and research databases.The implementation of the model in the software SIMUL8 and its link to Excel to make the model user-friendly for nonexpert users were described in detail. Several sensitivity analyses were performed to assess the impact of the variability of the input estimations (validation), the impact of different waiting list management strategies according to different scenarios of mean waiting time, and to assess the transferability of the methodology. Transferability was evaluated by applying the methodology for calculating the input values to different settings (other regions of Spain).Then, results of the model were used to analyze geographical variations of the impact of introducing a waiting list prioritization system. Moreover, information of the different regions was combined to use the model to assess the volume of need for cataract surgery in Spain according to different indication criteria for surgery. Transferability of the methodology to other elective surgeries was assessed by adapting the model to analyze needs and demand for knee replacement in Spain.Study of needs and demand for health services is important since substantial unmet needs are observed. The gap between needs and services provision may be too great to be resolved, but models that assess the impact of changes on the amount of resources used or the impact of health policies on the management of need and demand are useful in healthcare decision-making

Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts

To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution

Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of antimicrobial consumption during this period. Methods : A retrospective quasi-experimental before-after study was conducted in a Spanish tertiary care hospital. The study compared two periods: pre-pandemic, from January 2018 to February 2020, and during the COVID-19 pandemic from March to June 2020. Antimicrobial consumption was analyzed monthly as defined daily doses (DDD)/100 bed-days and overall hospital and ICU consumption were evaluated. Results: An increase in the hospital consumption was noticed. Although only ceftaroline achieved statistical significance (p = 0.014), a rise was observed in most of the studied antimicrobials. A clear temporal pattern was detected. While an increase in ceftriaxone and azithromycin was observed during March, an increment in the consumption of daptomycin, carbapenems, linezolid, ceftaroline, novel cephalosporin/β-lactamase inhibitors or triazoles during April-May was noticed. In the ICU, these findings were more evident, namely ceftriaxone (p = 0.029), carbapenems (p = 0.002), daptomycin (p = 0.002), azithromycin (p = 0.030), and linezolid (p = 0.011) but followed a similar temporal pattern. Conclusion : An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Availability of updated protocols and antimicrobial stewardship programs are essential to optimize these outcomes

Compartir ideas, la universidad va al instituto. Análisis de la primera edición de un proyecto de aprendizaje servicio transversal a la Universidad de Barcelona

Esta comunicación presenta las principales claves de análisis y evaluación de la 1a edición del proyecto Compartir Ideas. La Universidad va al instituto. Este es un proyecto de aprendizaje servicio transversal que consiste en un ciclo de conferencias-taller impartidas por estudiantes de la UB sobre temes de interés general relacionados con sus estudios. El objetivo es compartir conocimientos y conversar sobre un tema que la universidad trabaja y que será relevante para la formación del alumnado de secundaria.El proyecto cuenta con el apoyo del Vicerectorado de Política Docente y Lingüística de la Universitat de Barcelona

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

A new software platform to improve multidisciplinary tumor board workflows and user satisfaction: a pilot study

Workflow and preparation for holding multidisciplinary cancer case reviews (i.e., Tumor Boards) is time-consuming and cumbersome. Use of a software platform might improve this process. This pilot study assessed the impact of a new software platform on tumor board preparation workflow and user satisfaction compared to current methods. Using current methods and the NAVIFY Tumor Board Solution, this study assessed the number of tasks and time to prepare tumor board cases. Participants completed online surveys assessing ease of use and satisfaction with current and new platforms. A total of 41 sessions included two surgeons, two oncologists, two pathologists, and two radiologists preparing tumor board cases with 734 tasks were recorded. Overall, there was no difference in the number of tasks using either preparation method (341 current, 393 NAVIFY Tumor Board solution). There was a significant difference in overall preparation time as a function of specialty (F = 71.74, P < 0.0001), with oncologists, radiologists, and surgeons having reduced times with NAVIFY Tumor Board solution compared to the current platform and pathologists having equivalent times. There was a significant difference (F = 38.98, P < 0.0001) for times as a function of task category. Review of clinical course data and other preparation tasks decreased significantly, but pathology and radiology review did not differ significantly. The new platform received higher ratings than the current methods on all survey questions regarding the ease of use and satisfaction. The study supported the hypothesis that the new software platform can improve Tumor Board preparation. Further study is needed to assess the impact of this platform in different hospitals, different data storage systems, with different observers, and different types of Tumor board cases as well as its impact on the quality of the tumor board discussion

Relación entre el uso de herramientas de trabajo en grupo y la evaluación del trabajo

En la actualidad, en la práctica del trabajo en grupo se usan herramientas asíncronas para compartir información y documentos. Los eventos producidos por los usuarios pueden ser monitorizados y estudiados para hallar relaciones entre el comportamiento del grupo y el resultado obtenido. El objetivo de la comunicación es presentar los resultados obtenidos durante 2 años en asignaturas de proyectos de ingeniería industrial sobre comportamientos que manifiestan una correspondencia con la evaluación final del trabajo. En una primera fase se han creado indicadores susceptibles de ser medidos en los registros de los eventos de las herramientas asíncronas, como el número de lecturas y modificaciones de documentos, el número de eventos de gestión, el número total de sesiones, el número de integrantes del grupo, la desviación típica de la participación de éstos y la desviación típica de la actividad respecto el tiempo. En una segunda fase se han recogido los datos necesarios, y en una última fase se han analizado las relaciones entre los indicadores y los resultados, hallando tendencias que sugieren una mejor práctica del trabajo en grupo.Preprin

Relación entre el uso de herramientas de trabajo en grupo y la evaluación del trabajo

En la actualidad, en la práctica del trabajo en grupo se usan herramientas asíncronas para compartir información y documentos. Los eventos producidos por los usuarios pueden ser monitorizados y estudiados para hallar relaciones entre el comportamiento del grupo y el resultado obtenido. El objetivo de la comunicación es presentar los resultados obtenidos durante 2 años en asignaturas de proyectos de ingeniería industrial sobre comportamientos que manifiestan una correspondencia con la evaluación final del trabajo. En una primera fase se han creado indicadores susceptibles de ser medidos en los registros de los eventos de las herramientas asíncronas, como el número de lecturas y modificaciones de documentos, el número de eventos de gestión, el número total de sesiones, el número de integrantes del grupo, la desviación típica de la participación de éstos y la desviación típica de la actividad respecto el tiempo. En una segunda fase se han recogido los datos necesarios, y en una última fase se han analizado las relaciones entre los indicadores y los resultados, hallando tendencias que sugieren una mejor práctica del trabajo en grupo

Relación entre el uso de herramientas de trabajo en grupo y la evaluación del trabajo

En la actualidad, en la práctica del trabajo en grupo se usan herramientas asíncronas para compartir información y documentos. Los eventos producidos por los usuarios pueden ser monitorizados y estudiados para hallar relaciones entre el comportamiento del grupo y el resultado obtenido. El objetivo de la comunicación es presentar los resultados obtenidos durante 2 años en asignaturas de proyectos de ingeniería industrial sobre comportamientos que manifiestan una correspondencia con la evaluación final del trabajo. En una primera fase se han creado indicadores susceptibles de ser medidos en los registros de los eventos de las herramientas asíncronas, como el número de lecturas y modificaciones de documentos, el número de eventos de gestión, el número total de sesiones, el número de integrantes del grupo, la desviación típica de la participación de éstos y la desviación típica de la actividad respecto el tiempo. En una segunda fase se han recogido los datos necesarios, y en una última fase se han analizado las relaciones entre los indicadores y los resultados, hallando tendencias que sugieren una mejor práctica del trabajo en grupo