A Causal Tree Approach for Personalized Health Care Outcome Analysis

Using patient-level data from 35 hospitals for 6 cardiovascular surgeries in New York, we provide empirical evidence that outcome differences between health care providers are heterogeneous across different groups of patients. We then use a causal tree approach to identify patient groups that exhibit significant differences in outcome. By quantifying these differences, we demonstrate that a large majority of patients can achieve better expected outcomes by selecting providers based on patient-centric outcome information. We also show how patient-centric outcome information can help providers to improve their processes and payers to design effective pay-for-performance programs.http://deepblue.lib.umich.edu/bitstream/2027.42/136093/1/1336_Wang.pd

Big Data and the Precision Medicine Revolution

The big data revolution is making vast amounts of information available in all sectors of the economy including health care. One important type of data that is particularly relevant to medicine is observational data from actual practice. In comparison to experimental data from clinical studies, observational data offers much larger sample sizes and much broader coverage of patient variables. Properly combining observational data with experimental data can facilitate precision medicine by enabling detection of heterogeneity in patient responses to treatments and tailoring of health care to the specific needs of individuals. However, because it is high-dimensional and uncontrolled, observational data presents unique methodological challenges. The modeling and analysis tools of the production and operations management field are well-suited to these challenges and hence POM scholars are critical to the realization of precision medicine with its many benefits to society.https://deepblue.lib.umich.edu/bitstream/2027.42/145441/1/1386_Hopp.pd

Estimating the throughput of an exponential CONWIP assembly system

We consider a production system consisting of several fabrication lines feeding an assembly station where both fabrication and assembly lines consist of multiple machine exponential workstations and the CONWIP (CONstant Work-In-Process) mechanism is used to regulate work releases. We model this system as an assembly-like queue and develop approximations for the throughput and average number of jobs in queue. These approximations use an estimate of the time that jobs from each line spend waiting for jobs from other lines before being assembled. We use our approximations to gain insight into the related problems of capacity allocation, bottleneck placement and WIP setting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47599/1/11134_2005_Article_BF01153531.pd

Cost-Effectiveness of Referring Patients to Centers of Excellence for Mitral Valve Surgery

BACKGROUND The 2014 American Heart Association/American College of Cardiology Valvular Heart Disease Guidelines state that mitral valve diseases should be repaired at a Center of Excellence (CoE). We evaluate the cost-effectiveness of such referrals. METHODS We estimate patients’ life expectancy based on projected survival of patients after mitral valve surgery and develop a cost model to calculate short- and long-term benefits and costs to both patients and payers. Benefits include increased life expectancy and avoidance of medical complications for patients. Short-term costs include all upfront payments by patients and payers at the time of discharge. Long-term costs include all payments associated with the condition that prompted the surgical procedure incurred during the remainder of a patient’s life. We assess cost-effectiveness of treating patients with various ages and major comorbidities at CoEs vs non-CoEs. RESULTS Full implementation of the guidelines would result in an increase in the percentage of patients obtaining mitral valve repair instead of valve replacement from 58% to 72%. Depending on the patient’s age and comorbidities, it would also result in a 6.64% to 12.47% reduction in mortality, 7.85% to 9.97% reduction in reoperation, 9.97% to 17.16% reduction in stroke, and an average gain of 3.77 to 9.88 months of life expectancy. Finally, greater reliance on CoEs results in financial savings to payers, due to avoidance of the costs of future complications. CONCLUSION Patients benefit from mitral valve surgery at a CoE regardless of their age or comorbidities. Payers may incur additional short-term costs when patients are referred to a CoE, but these are fully offset by long-term savings at the current repair rate gap of 24% between CoEs and non-CoEs in New York State. Redesigning co-pay structures and/or refining the set of patients who are referred to CoEs could further align the incentives of patients and payers on a case-by-case basis and achieve an even more desirable social outcome.http://deepblue.lib.umich.edu/bitstream/2027.42/111881/1/1281_Wang.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111881/4/1281_Wang_May2015.pdfDescription of 1281_Wang_May2015.pdf : May 2015 revisio