Probability Models for Health Care Operations with Application to Emergency Medicine

This thesis consists of four contributing chapters; two of which are inspired by practical problems related to emergency department (ED) operations management and the remaining two are motivated by the theoretical problem related to the time-dependent priority queue. Unlike classical priority queue, priorities in the time-dependent priority queue depends on the amount of time an arrival waits for service in addition to the priority class they belong. The mismatch between the demand for ED services and the available resources have direct and indirect negative consequences. Moreover, ED physician pay in some jurisdictions reflects pay-for-performance contracts based on operational benchmarks. To assist in capacity planning and meeting these benchmarks, in chapter 4, I built a forecasting model to produce short-term forecasts of ED arrivals. In chapter 5, I empirically investigated the effect of workload on the productivity of ED services. Specifically, under discretionary work setting, different statistical models were fitted to identify the effect of workload and census on four measures of ED service processes, namely, number discharged, length of stay, service time, and waiting time. The time-dependent priority model was first proposed by Kleinrock (1964), and, more recently, naming it accumulating priority queue (APQ), Stanford et al. (2014) derived the waiting time distributions for the various priority classes when the queue has a single server. In chapter 6, I derived expressions for the waiting time distributions for a multi-server APQ with Poisson arrivals for each class, and a common exponential service time distribution. In chapter 7, I worked with a KPI based service system where there are specific time targets by which each class of customers should commence their service and a compliance probability indicating the proportion of customers from that class meeting the target. Recognizing the fact that customer who misses their KPI target is of greater, not lesser importance, I seek to minimize a weighted sum of the expected amount of excess waiting for each class. When minimizing the total expected excess, our numerical examples lead to an easily-implemented rule of thumb for the optimal priority accumulation rates, which can have an immediate impact on health care delivery

Perceived barriers to maintain physical activity and its association to mental health status of Bangladeshi adults: a quantile regression approach

Abstract Insufficient physical activity and unhealthy lifestyle preferences have been significant concerns for decades. This study aimed to determine the perceived barriers to maintaining physical activity among adults in three major cities of Bangladesh and their association with mental health status. This is a cross-sectional study where 400 participants were selected using a multistage sampling technique. Twenty municipal wards were randomly selected from three cities, followed by a convenient selection of the study participants from each ward. Questionnaires about perceived physical activity barriers were developed based on previously published literature. The DASS-21 scale assessed the mental health status of the study participants. Descriptive statistics were applied to narrate the baseline characteristics of the respondents. The Shapiro–Wilk test was used to check the normality of the perceived physical activity scores. Quantile regression analysis was applied to model the physical activity barrier scores depending on several covariates. Five quantiles were used: the 10th, 25th, 50th, 75th, and 90th. A p-value less than 0.05 was considered significant for hypothesis testing. Among the respondents, 68.50% were male, half of them were married, 68.0% belonged to nuclear families, 48.0% completed graduate level education, 34.25% were service holders, one-third of the respondent's working hours were 6–8 h, and 19.50% belongs to the overweight and obese groups. Poor traffic and construction work near the road (60.30%) was seen as the most significant barrier to physical activity. Over half of the respondents stated that lack of time, facilities, and expenses hinder physical activity. Mental health status reported mild to extremely severe levels of depression (32%), anxiety (47%), and stress (42.50%), respectively. Significant associations between the perceived physical activity scores and gender, family type, occupation, income, BMI, anxiety, and depression were obtained. Ensuring a safe environment, facilitating accessibility and availability of low-cost exercise facilities, improving road and traffic conditions, and providing appropriate mental health counseling may help to mitigate physical activity barriers

Background characteristics of the infertile patients (n = 300).

Background characteristics of the infertile patients (n = 300).</p

Factors affecting MCS-12, and PCS-12 scores among the infertile women receiving fertility treatment in Bangladesh.

Factors affecting MCS-12, and PCS-12 scores among the infertile women receiving fertility treatment in Bangladesh.</p

Comparison of MCS-12, and PCS-12 scores with the different background variables (<i>n = 300)</i>.

Comparison of MCS-12, and PCS-12 scores with the different background variables (n = 300).</p

S1 Questionnaire -

Infertility poses significant physical and psychological challenges for women of reproductive age. In low- and middle-income countries, the prevalence of depression among infertile women is alarmingly high, reaching 44.32%. Additionally, over 50% of infertile women worldwide experience varying degrees of decline in their quality of life. Therefore, this study aimed to assess the effects of infertility on the mental health status and quality of life of infertile women in Bangladesh. Between December 2022 and March 2023, 375 infertile women in Dhaka, Bangladesh were selected using simple random sampling for this cross-sectional study. The participants’ mental health status was assessed using the Depression Anxiety and Stress Scale (DASS-21), while their quality of life was evaluated by the Short Form-12 (SF-12) scale. The prevalence of depression, anxiety, and stress were 59.7%, 55.0%, and 48.7%, respectively. Multiple logistic regression showed that infertile homemakers had 2.98 (95% CI: 1.30 to 6.80) times the odds of depression than government service holders. Aborted infertile women had 1.8 (95% CI: 1.10 to 3.26) times the odds of depression. Infertile women who married between 20 and 24 years old were 49% (95% CI: 0.27 to 0.98) less anxious than those who married earlier. Low-income infertile women (60,000 BDT). Multiple linear regression analysis suggests that education and infertility diagnosis status significantly affect the Mental Component Summary (MCS-12) scores of the Short Form-12 (SF-12). In contrast, age, occupation, and Body Mass Index (BMI) were the significant predictors for the Physical Component Summary (PCS-12). Policymakers may use lessons learned from this study to incorporate appropriate counseling techniques, social awareness campaigns, and media involvement to control the added burden of infertility on women’s psychological health and quality of life.</div

Adjusted effects of explanatory factors on depression, anxiety, and stress.

Adjusted effects of explanatory factors on depression, anxiety, and stress.</p

S1 Data -

Infertility poses significant physical and psychological challenges for women of reproductive age. In low- and middle-income countries, the prevalence of depression among infertile women is alarmingly high, reaching 44.32%. Additionally, over 50% of infertile women worldwide experience varying degrees of decline in their quality of life. Therefore, this study aimed to assess the effects of infertility on the mental health status and quality of life of infertile women in Bangladesh. Between December 2022 and March 2023, 375 infertile women in Dhaka, Bangladesh were selected using simple random sampling for this cross-sectional study. The participants’ mental health status was assessed using the Depression Anxiety and Stress Scale (DASS-21), while their quality of life was evaluated by the Short Form-12 (SF-12) scale. The prevalence of depression, anxiety, and stress were 59.7%, 55.0%, and 48.7%, respectively. Multiple logistic regression showed that infertile homemakers had 2.98 (95% CI: 1.30 to 6.80) times the odds of depression than government service holders. Aborted infertile women had 1.8 (95% CI: 1.10 to 3.26) times the odds of depression. Infertile women who married between 20 and 24 years old were 49% (95% CI: 0.27 to 0.98) less anxious than those who married earlier. Low-income infertile women (60,000 BDT). Multiple linear regression analysis suggests that education and infertility diagnosis status significantly affect the Mental Component Summary (MCS-12) scores of the Short Form-12 (SF-12). In contrast, age, occupation, and Body Mass Index (BMI) were the significant predictors for the Physical Component Summary (PCS-12). Policymakers may use lessons learned from this study to incorporate appropriate counseling techniques, social awareness campaigns, and media involvement to control the added burden of infertility on women’s psychological health and quality of life.</div

Mental health status among the infertile women receiving fertility treatment in Bangladesh(n = 300).

Mental health status among the infertile women receiving fertility treatment in Bangladesh(n = 300).</p

Recommended cut-off for Depression Anxiety and Stress Scale (DASS-21).

Recommended cut-off for Depression Anxiety and Stress Scale (DASS-21).</p