Data Mining for Enhanced Operations Management Decision Making: Applications in Health Care

Data Mining involves the extraction of new knowledge from large data sets. Despite the growing research interest in data mining, however, integrating this extra knowledge into the subsequent decision making processes has received little attention. Within the context of operations management, this integration can occur in two different ways: by providing inputs for an optimization procedure and by analyzing the output of an optimization procedure. In this dissertation, I will begin by introducing a database exploration technique, which is used to improve the drug discovery process of a pharmaceutical company (Samorani et al., 2011). The same procedure is also applied to a mental health clinic\u27s database to predict whether patients will show up at their scheduled appointments. The knowledge obtained with this procedure is then used to improve patient scheduling procedures (Samorani and LaGanga, 2011). I will finally discuss how data mining can be used to learn useful information about the structure of a problem (Samorani and Laguna, 2012)

The Impact of Probabilistic Classifiers on Appointment Scheduling with No-Shows

Appointment no-shows are common in outpatient clinics and increase clinic costs and patients’ dissatisfaction. We develop a framework to predict the no-show probabilities of a given set of patients, and to subsequently employ these predictions to find the optimal appointment schedule. Some existing work assumes that all patients have the same no-show probability (1-class approach); other work assumes that patients have either a low or a high no-show probability (2-class approach). In contrast, we utilize probabilistic classifiers to obtain the individual patients’ no-show probabilities (N-class approach). Our approach results in better-quality schedules, as measured by a weighted average of patient waiting time and provider overtime. We also find that a small increase in the prediction performance (measured by the Brier score) translates into a large decrease in the schedule cost. Our results are obtained through a large-scale computational study and validated on a real-world data set from an outpatient clinic

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

The Evolutionary Trajectories of Peer-Produced Artifacts: Group Composition, the Trajectories’ Exploration, and the Quality of Artifacts

Members of an online community peer-produce digital artifacts by negotiating different perspectives and personal knowledge bases. These negotiations are manifested in the temporal evolution of the peer-produced artifact. In this study, we conceptualize the evolution of a digital artifact as a trajectory in a feature space. Our theoretical frame suggests that, through negotiations, contributors’ actions “pull” the trajectory and shape its movement in the feature space. We hypothesize that the type of contributors that work on a focal article influences the extent to which that article’s trajectory explores alternative positions within that space, and that the trajectory’s exploration is, in turn, associated with the artifact’s quality. To test these hypotheses, we analyzed the trajectories of wiki articles drawn from two peer-production communities, Wikipedia and Wikia, tracking the evolution of 242 paired articles for over a decade during which the articles went through 536,745 revisions. We found that the contributors who are the most likely to increase the trajectory’s exploration are those that (1) return to work on the focal artifact and (2) are unregistered members in the broader online community. Further, our results show that the trajectory’s exploration has a curvilinear association with article quality, indicating that exploration contributes positively to quality, but that the effect is reversed when exploration exceeds a certain level. The insights derived from this study highlight the value of an artifact-centric approach to increasing our understanding of the dynamics underlying peer-production

Stochastic Workflow Authorizations with Queueing Constraints

Cloud-based workflow architecture has been widely used in e-science, e-business, smart city, and others, to automate business processes and improve their flexibility and maintainability. Online workflow executes in a collaborative and distributed environment and is prone to fraud and information leakage. Workflow authorization models are implemented to ensure that tasks are performed by authorized subjects with compliance of security/privacy polices. However, existing workflow authorization models have some limitations. First, most of the existing research focuses on static workflows, where an order arriving at a workflow traverses tasks in a fixed sequence. In many real applications, however, task routing is not deterministic, having a probability distribution or pattern that may be estimated from historical data. Second, existing research ignores practical resource constraints, like user utilization, order waiting time, etc. To address the limitations, this article studies the workflow authorization model under the more realistic dynamic settings. We formulate a workflow as a queueing system, so business constraints can be analytically represented, under reasonable assumptions. We model the studied problems as pseudo-Boolean satisfiaiblity problems and investigate their theoretical properties. We also develop algorithms and carry out computational studies. The experimental results show the effectiveness and efficiency of our developed solutions. Our research results are useful for production and process design in many real-life settings such as health care, online banking and electronic payment systems

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care