DEVELOPING AN OPTIMAL MODEL FOR INFANT HOME VISITATION

The United States, Great Britain, Denmark, Canada and many other countries have accepted home visitation (HV) as a promising strategy for interventions for infants after births and for their mothers. Prior HV studies have focused on theoretical foundations, evaluations of programs, cost/benefit analysis and cost estimation by using hospital/payer/insurance data to prove its effectiveness and high cost. As governments and private organizations continue to fund HVs, it is an opportune time to develop and formulate operations research (OR) models of HV coverage, quality and cost so they might be used in program implementation as done for adult home healthcare (HHC) and home care (HC). This dissertation introduces a new modeling approach and proposes a solution methodology which helps to determine the schedules of follow-up nursing care providers (NCP) to visit discharged patients in order to minimize total follow-up cost at the planning and operational level, and to improve the quality of care. The model improves the quality of treatment of infants and mothers during pregnancy, after birth and discharge from the hospital by maximizing the quality of assignment of the right NCP with the right skill, nurse type and years of experience to the right patient with the specific health need. The modeling approach is based on a mixed-interger programming (MIP) formulation that represents the dynamics of the system comprising aspects such as visit schedules and total program’s cost while satisfying a variety of requirements modeled as constraints. The model is tested and validated with real life data. Computational results for the formulation for real life instances of the problem with the Nurse Family Partnership Program (NFP) obtained using IBM CPLEX optimization Studio version 12.6.1 are presented. The intent is to enhance the administrative and deployment process of HV programs, minimize risks, allow planners to explore the best scenarios under different conditions related to cost, treatment and coverage requirements, and highlight the best course of action when assigning NCPs to clients. Results show significant cost savings and enhanced quality treatment in several cases studied and tested. Finally, the study identifies and presents fertile avenues for future research for this field

Development and Flight Test of a Real-Time Energy Management Display

A real-time energy management display is developed and evaluated, and the feasibility and utility of the display in providing real-time guidance and information on the aircraft’s energy state was investigated. Flight simulations were conducted with the UTSI Aviation Systems research flight simulator to validate the display and evaluate its utility for flying along constant specific excess power contours, and directly obtaining specific excess power contours from level acceleration flight test. The display was evaluated for flying optimal paths. This study considered the energy state of the aircraft from the point of view of the relation that exists between specific excess power and the forces in flight. The approach yields as one result a cubic function for the specific excess power, Ps, of the aircraft. We then directly solve for velocity, V as the control parameter for a given Ps, as a function of altitude, H. This technique is then used to build a real-time energy management display that provides guidance and real-time information of the aircraft’s energy state. Flight simulation results proved the display to be successful in obtaining direct Ps contours from level acceleration flight tests and in providing guidance for flights along constant Ps contours at low airspeeds although it was difficult to keep the Ps constant. However flights along zero Ps contours and along constant Ps contours at very high speeds were not successful. The application of the display in flying optimal paths was also not very successful with the current structure of the display. This was due to the fact that the display’s guidance information is provided in a digital format which is very sensitive, and tracking a number for guidance is nearly impossible

Development and flight test of a real-time energy management display / Realaus laiko energijos valdymo monitoriaus kūrimas ir bandymas skrydžio metu

A real-time energy management display is developed and evaluated, and the feasibility and utility of the display in providing real-time guidance and information on an aircraft's energy state is investigated. Flight simulations were conducted with the UTSI's Aviation Systems research flight simulator to validate the display and to evaluate its utility for flying along constant specific excess power (PS) contours and for directly obtaining PS contours from level acceleration flight test. This study considers the energy state of the aircraft from the point of view of the relation that exists between specific excess power, PS, and the forces in flight. The approach yields as one result a cubic function for the PS of the aircraft. We then directly solve for velocity, V, as the control parameter for a given PS as a function of altitude, H. Using LabView software, this technique is used to build a real-time energy management display which provides guidance and real-time information on the aircraft's energy state. Flight simulation results proved the display to be successful in obtaining direct PS contours from level acceleration flight tests and in providing guidance for flights along constant PS contours at low airspeeds, although it was difficult to keep the PS constant. Santrauka Sukurtas ir įvertintas realaus laiko energijos valdymo monitorius, ištirtos jo galimybės ir panaudojimas informacijai apie energijos būklę teikti. Skrydžio simuliacijos rodo, kad monitorius sėkmingai gauna tiesioginį PS kontūrą greitėjančio skrydžio metu ir gali nukreipti skrydžius palei nuolatinį PS kontūrą, esant nedideliam greičiui, nors ir sunku išlaikyti nuolatinį PS. Reikšminiai žodžiai: perteklinė galia, horizontalusis pagreitėjimas, aukštis, greiti

Improving the Hospital Discharge Process Using Lean Approach

Medical services are one of the most important daily practices, so most people demand impeccable service. One of the most important things for hospitals is to provide their patients excellent care, but also to make the patients feel important and unique. For this reason, the discharge process is an important part of the hospital stay because it is the last opportunity to give a good impression. In order to achieve a more efficient discharge process, we have utilized Lean Healthcare at the Fort Sanders Regional Medical Center (FSRMC). Lean Health Care’s importance has emerged and becomes more evident, because in addition to it, resulting in a more efficient process, it emphasizes the importance of customer satisfaction with due consideration towards the staff and not placing difficult, unattainable goals on the hospital staff. This methodology helps hospitals because it reduces the time it takes to complete everyday tasks, while simultaneously eliminating some of the wastes, keeping in mind the quality of care the patients receive and the service the hospital provides. The purpose of Lean Healthcare is to try to reduce the mistakes and improve the process