Assignment Of Patients Research Articles

Visit Data and Telehealth in a Clinic for Trafficked Persons: Virtual Care and Human Trafficking During the COVID-19 Pandemic

Abstract: Background. Human trafficking involves coerced labor or sex. THRIVE, a multidisciplinary University of Miami clinic for trafficked persons, transitioned to a hybrid telehealth model during the COVID-19 pandemic. Th is paper presents appointment data across THRIVE clinic services during this transition. Methods. A review of appointments for THRIVE patients (n=156) was conducted to compare pre-pandemic (February 2019 to February 2020) and pandemic (March 2020 to December 2021) appointment trends. Results. There were 15% more scheduled (n=51.1 versus n=44) and 8% more completed (n=30.2 versus n=27.9) appointments per month early in the pandemic period with telehealth use compared to the pre-pandemic period. Telehealth was most used within psychiatry. Rescheduled and no-show appointments per month significantly increased during the pandemic period (p=0.010 in pandemic period 1 and and p=0.028 in pandemic period 2). There were few significant differences in appointment trends according to demographic variables. Conclusion. Telehealth succeeded in connecting THRIVE patients during the pandemic, highlighting its potential for long-term use amongst trafficked persons.

Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program.

Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.

The Impact of Online Self-Scheduling Platform Optimization on Patient Directed Access to Screening Mammography Appointments During the COVID-19 Pandemic | A Single Institution Experience

Objective: During the COVID-19 pandemic, screening mammography utilization declined nationally by nearly 65% compared to pre-pandemic volumes. This study assessed the impact of online screening mammography self-scheduling platform optimization on patient scheduling, rescheduling and cancellation rates during the COVID-19 pandemic. Methods: A retrospective review of online SM scheduling utilization between October 1, 2019, and December 31, 2022 was performed. The electronic health record (EHR) was queried to extract the total number of SMs performed, online scheduling, rescheduling and cancellation rates during the busiest screening mammography months of October through December in 2019 and 2022. Results: October to December online SM scheduling patient activity rose from 57 to 1481 patients when comparing 2019 and 2022 performance, representing a 26-fold increase in online platform utilization after EHR-tethered scheduling integration (p=0.013). This resulted in a concurrent 16x fold reduction in patient access specialist SM scheduling engagement. Concurrently, SM scheduling automation resulted in increases in appointment rescheduling and cancellation rates, from 14% to 22% (p=0.005) and 18% to 38% (p=0.000), respectively. Discussion: Optimization of our online self-scheduling platform with EHR integration resulted in a 26-fold increase in online self-scheduling patient utilization and a 16x fold reduction in DI-PAS hands on SM scheduling engagement. The rates of OSS patient appointment rescheduling and cancellation also increased but the overall net gain in self-scheduling automation should not deter continued use and implementation of this program.

Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture.

This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.

Scheduling coupled tasks on parallel identical machines

In many applications in the context of patient appointment scheduling there are recurring tasks with fixed delays between them. These tasks are commonly referred to as coupled-task jobs. In the coupled-task settings, each job consists of two tasks whereby the second task must start processing after an exact time lag following the completion of the first task. In this paper, we introduce the problem of scheduling a set of coupled-task jobs on parallel identical machines with the objective function of minimizing the makespan. We study the computational complexity of the general problem, as well as its special cases. We prove that the majority of these problems are (strongly) NP-hard. Nonetheless, we provide the optimal scheduling policy for two settings consisting of identical jobs. An important result of our work includes showing that the existence of a (2-ε)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(2-\\varepsilon )$$\\end{document}-approximation algorithm for the problem implies P=NP\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=NP$$\\end{document}. The latter result improves a recently proposed bound for the open-shop counterpart as well.

From the Editors.

From the Editors.

Patient assignment optimization in cloud healthcare systems: a distributed genetic algorithm

Integrating Internet technologies with traditional healthcare systems has enabled the emergence of cloud healthcare systems. These systems aim to optimize the balance between online diagnosis and offline treatment to effectively reduce patients’ waiting times and improve the utilization of idle medical resources. In this paper, a distributed genetic algorithm (DGA) is proposed as a means to optimize the balance of patient assignment (PA) in cloud healthcare systems. The proposed DGA utilizes individuals as solutions for the PA optimization problem and generates better solutions through the execution of crossover, mutation, and selection operators. Besides, the distributed framework in the DGA is proposed to improve its population diversity and scalability. Experimental results demonstrate the effectiveness of the proposed DGA in optimizing the PA problem within the cloud healthcare systems.

P27 An innovative multidisciplinary approach to optimizing the dermatology service for patients with chronic spontaneous urticaria, psoriasis and atopic dermatitis

Abstract The aim of this work was to optimize multidisciplinary practice in the dermatology department of our teaching hospital and to integrate pharmacist independent prescribers (PIPs) into the dermatology team, establish multidisciplinary patient pathways and evaluate patient satisfaction with pharmacist-led clinics. One dermatology lead pharmacist and three specialist pharmacists completed training in dermatologist-led clinics, and multidisciplinary patient pathways were developed. A pharmacist-led clinic for patients with chronic spontaneous urticaria (CSU) was established and delivered under the indirect supervision of a dermatologist. Pharmacist-led eczema and psoriasis clinics were then established, in which care is delivered by PIPs working alongside dermatologists to facilitate medical input when required. Patient satisfaction with the PIP service was evaluated by the administration of anonymized questionnaires sent to patients seen by PIPs over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. Over an 18-month period, dermatologists referred 53 of their 63 patients (84%) with CSU to the pharmacist-led clinic and PIPs delivered 150 CSU appointments. In the 12 months since establishing eczema and psoriasis multidisciplinary pathways, PIPs have delivered 279 eczema and 342 psoriasis appointments. PIPs have 30-min appointments for patients to discuss medication-related issues, assess response to treatments and demonstrate a holistic approach to patient care, including cardiovascular risk assessments. An estimated 400 h of dermatologist time was released over an 18-month period of gradual rollout of clinics as PIPs reviewed return patients, managed repeat prescribing for approximately 550 patients with CSU, psoriasis and eczema (homecare), and supported drug protocol development. In turn, PIPs reported increased job satisfaction. PIP consultations were rated excellent by 85% of eczema responders [85% response rate; 43% female, median age 38 years (range 19–84)] and 89% of psoriasis responders [90% response rate; 44% female, median age 50 years (range 15–77)]. All free-text comments (n = 34) were positive, with two suggestions for improvement (better explanation of pharmacist appointment, online appointments). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 20), ‘multidisciplinary team service delivery’ (n = 15), ‘ensuring patient understanding’ (n = 17), ‘pharmacist knowledge’ (n = 13), ‘professionalism’ (n = 8) and ‘medical team input’ (n = 4). There have been no patient complaints or adverse outcomes related to pharmacist-led clinics since the clinics were launched. Dermatology PIPs have successfully integrated into the dermatology multidisciplinary team, receiving support to develop their clinical roles. Pharmacist-led clinics substantially increase the overall capacity of the dermatology service, while patients report high satisfaction and appreciation of PIP consultation skills and the quality of the service.

PA06 Impact of clinical pharmacist-led isotretinoin management and acne care education at a multispecialty clinic

Abstract Isotretinoin, an oral retinoid derived from vitamin A, is one of the most effective medications in the treatment of severe acne vulgaris. However, it carries serious risks due to the teratogenic nature of the drug. The iPledge national programme in the USA has been founded to reduce and prevent adverse isotretinoin reactions and complications by ensuring its safe use by patients. Owing to the strict monitoring parameters of isotretinoin, an increased workload is placed on prescribing physicians for accurate and timely iPledge authorization, comprehensive counselling, laboratory testing and many patient follow-up visits. The most commonly reported reasons for delay were iPledge-related, including issues navigating the iPledge website, missed pick-up windows, and missed or delayed doctor appointments or laboratory tests. To remedy the difficulties with isotretinoin monitoring, physicians can look to clinical pharmacists as a valuable asset to their practice. Because clinical pharmacists are well trained in isotretinoin dispensing and iPledge regulation and consultation, they can play a crucial role in the management and education of patients with severe acne vulgaris. This retrospective, longitudinal case study takes place at a multispeciality clinic with internal medicine, rheumatology and dermatology. At this multispecialty clinic, a clinical pharmacist will be integrated into the practice with complete patient appointments and isotretinoin follow-ups under the training and direction of a dermatological specialist. The initial evaluation, diagnosis and prescribing of isotretinoin will be completed by the physician. The clinical pharmacist will follow-up the patients in subsequent visits in conjunction with the physician. The study population is approximately 50 patients with existing diagnoses of severe acne vulgaris. The inclusion criteria will include patients with acne who complete a clinical pharmacist visit for isotretinoin acne treatment from September 2022 to March 2023. At each follow-up clinical pharmacist visit, patients receive management and counselling on medications, a review of laboratory values, iPledge verification, and monitoring of symptoms and quality of life. Primary outcomes are patient symptoms and quality of life, acne grade and severity and side-effects; secondary outcomes are navigation of the iPledge website, number of misses in pick-up windows and doctor appointment adherence. The preliminary results showed significant improvement in primary and secondary outcomes. Patient acne grade decreased, while satisfaction increased; there was also a decreased risk of missed pick-up windows and improved doctor appointment adherence compared with the national standard. In addition, a clinical pharmacist-led iPledge programme can substantially reduce the time required for administrative work on managing isotretinoin while maintaining the same quality of care for patients with severe acne.

The impact of COVID-19 on primary care accessibility and the role of telehealth for patients with chronic conditions

ObjectivesThe objective of this study is to quantify how long patients took to complete their rescheduled primary care appointment pre-pandemic (2019) and during an initial pandemic period (2020). In doing so, the study evaluates telehealth's role in helping primary care patients – particularly in patients with chronic conditions – withstand COVID's significant disruption in care. MethodsCancelled and completed primary care appointments for adult patients were extracted from the beginning of the pandemic (March 1 to July 31, 2020) and a similar period pre-pandemic (March 1 to July 31, 2019). Days to the subsequent completed visit after cancellation (through June 30, 2021) and appointment modality (in-person, phone, video) were examined. Statistical testing was done to determine statistical significance, and a linear regression was run to control for effects of other study variables. ResultsPre-pandemic patients with chronic conditions needed 52.3 days on average to reschedule their cancelled in-person appointment. During the early pandemic period, chronic condition patients who saw their provider in-person took on average 78.8 days. During the same pre-pandemic period, patients with chronic conditions had their average wait time decrease to 51.5 days when rescheduling via telehealth. These differences were similar for patients without chronic conditions. ConclusionsThis analysis shows that telehealth created return to care timelines comparable to the pre-pandemic period which is especially important for patients with chronic conditions. Public interest summaryTelehealth visits (i.e., talking with a physician via phone or video call) help patients continue to receive the medical care they need – especially during disruptive periods such as the COVID pandemic. Access to telehealth is the strongest predictor in determining how soon a patient will complete their reschedule primary care appointment. Because telehealth is so important, health care providers and systems need to continue to offer patients the ability to talk with their physician via phone or video call.

Emergency department patient navigators successfully connect patients to care within a rapidly evolving healthcare system

In the United States, adherence to follow up medical appointments among patients discharged from the emergency department varies between 26% and 56%, depending on the population. It is well known that patients face significant barriers to care within an increasingly complicated system of care. In an effort to better support patients, in 2020, NewYork-Presbyterian Queens implemented a Patient Navigator Program with 7 bilingual Patient Navigators who were trained to deliver culturally sensitive education and support, and to schedule follow up appointments for patients experiencing barriers to care. Between February 2020 and December 2022, 30,164 patients were supported by the 7 Patient Navigators. Ninety-four percent of patients without a primary care provider had a new provider and appointment upon discharge, and 81% of patients attended the appointment scheduled by the Patient Navigator. This study demonstrates that Patient Navigators can work alongside clinical colleagues, and as members of emergency department health care teams, to support patients to connect to care and to attend follow up appointments. It also highlights that Patient Navigators are uniquely qualified to build trust and to support patients to achieve appropriate, continuous care within a rapidly evolving health care system.

155-LB: Econsults—An Innovative Model for Diabetes Specialty Care Delivery

Background: More than 10% of the US population has diabetes. However, a national shortage of endocrinologists limits access to diabetes specialty care, creating a delay of several weeks to months for a new patient appointment in endocrine clinic. Econsults, which are asynchronous provider-to-provider communications embedded in the electronic medical record, are a relatively new pathway to seek consultation from specialists. The most common reason for endocrine econsult is uncontrolled diabetes. However, there is little evidence on effectiveness of econsults in improving diabetes control. Methods: We completed a retrospective chart review of all endocrine econsults that were completed for adults with diabetes within a large integrated health system in 2022. We compared HbA1c values before and 3, 6, 12 months after econsult to assess glycemic change. We also analyzed how many econsults were followed by an endocrinology office visit. Results: Of 212 diabetes econsults completed in 2022, 8% (16/212) were for type 1 DM, and 92% (196/212) were for type 2 DM management. Follow-up HbA1c values were available in 189 patients. Eighty-eight percent (166/189) of patients had improvement in HbA1c 12 months following econsult. Only 15% (32/212) of all econsults were followed by a video or in-person visit with an endocrinologist, while 85% (180/212) did not require a follow-up endocrine appointment. Of the patients who only received econsult, mean HbA1c improved from 9.9% at baseline to 7.4% at 12 months (p<0.05). Of the 31 patients with type 2 DM who required a follow-up appointment with endocrinologist, mean HbA1c improved from 10.4% at baseline to 7.1% post-visit (p<0.05). Of note, 6 patients were diagnosed with new-onset type 1 DM during econsult process and were triaged to an immediate video visit to start appropriate insulin treatment and prevent DKA. Conclusion: Econsult is an efficient and effective model which can expand access to diabetes specialty care for patients with uncontrolled diabetes. Disclosure E. Karslioglu-French: Research Support; Abbott. M. Zupa: None. J. Quaytman: None. Funding Pittsburgh Foundation Grant (MR2022-128717)

Proliferative Diabetic Retinopathy Requiring Vitrectomy Over Clinic Management During COVID-19: Impact of Delayed Care.

This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy. The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate. Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact. Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.

Lens-induced Glaucoma, a Collateral Damage during COVID-19 Pandemic

Cataract if left untreated, can lead to complications such as lens induced glaucoma and permanent visual loss. The COVID-19 outbreak resulted in movement control orders causing closure and reduction of non-COVID hospital services resulting delayed appointment dates. This study described the side effects of delayed patient appointments due to COVID-19 pandemic. A 70-year-old man presented with right eye (RE) pain and redness. There was gradual reduction in RE vision over the last year but treatment was delayed due to pandemic. In examination, visual acuity on his RE was hand movement and left eye (LE) was 6/12 (ph6/12) and near vision of N5. The right pupil was mid-dilated, reacting sluggishly with presence of relative afferent pupillary defect. Intraocular pressure (IOP) on the RE was 54 mmHg and LE was 16 mmHg. Circumciliary injection of right conjunctiva with central corneal haziness was seen. The anterior chamber was deep with the presence of 3+ cells with whitish lens material at the pupillary axis. A Morgagnian cataract with phacodonesis was present. A diagnosis of lens induced glaucoma was made. Immediate reduction of IOP included topical and systemic medication and pain relief were instituted. Intracapsular cataract extraction with anterior vitrectomy and surgical peripheral iridectomy was performed. This highlights the late presentation of a patient with mature cataract during the COVID-19 pandemic. Patient awareness and education are essential in recognising the complications of mature cataract if it is presented later. A reminder of signs and symptoms of lens induced glaucoma should be conveyed to patient when appointment is delayed.

Understanding user experiences and expectations toward patient appointment systems

Patient appointment systems are automated reservation systems which allow people to book healthcare services, such as doctor appointments or outpatient appointments online or in apps. In many cases, patient appointment systems are attached as a function in the websites of hospitals. As a kind of direct-to-user healthcare technology which build interactions with patients, the experiences the systems created can affect patients emotion status and health conditions. Therefore, to investigate how user experience could be improved and how positive experience could be created through Human Computer Interaction (HCI) and user experience design, Clincare, a prototype healthcare website making users feel supportive was designed. To characterize users experience and expectations towards patient appointment systems, user experience study was then conducted using the prototype. The results revealed 4 aspects which could significantly influence participants experience and emotions: Information Display, Aesthetics, Workflow, and Context of Use. Based on the result, 4 design implications were proposed to inform future design works of patient appointment systems.

Development of the Escalation of Therapy or Intervention (ETI) Calculator for Patients with Ulcerative Colitis Using ePROMs.

Digital collection of patient-reported outcome measures [PROMs] is largely unexplored as a basis for follow-up for patients with ulcerative colitis [UC]. Our aim was to develop a model to predict the likelihood of escalation of therapy or intervention at an outpatient appointment that may be used to rationalize follow-up. TrueColours-IBD is a web-based, real-time, remote monitoring software that allows longitudinal collection of ePROMs. Data for prediction modelling were derived from a Development Cohort, guided by the TRIPOD statement. Logistic regression modelling used ten candidate items to predict escalation of therapy or intervention. An Escalation of Therapy or Intervention [ETI] calculator was developed, and applied in a Validation Cohort at the same centre. The Development Cohort [n = 66] was recruited in 2016 and followed for 6 months [208 appointments]. From ten items, four significant predictors of ETI were identified: SCCAI, IBD Control-8, faecal calprotectin, and platelets. For practicality, a model with only SCCAI and IBD Control-8, both entered remotely by the patient, without the need for faecal calprotectin or blood tests was selected. Between 2018 and 2020, a Validation Cohort of 538 patients [1188 appointments] was examined. A 5% threshold on the ETI calculator correctly identified 343/388 [88%] escalations and 274/484 [57%] non-escalations. A calculator based on digital, patient-entered data on symptoms and quality of life can predict whether a patient with UC requires escalation of therapy or intervention at an outpatient appointment. This may be used to streamline outpatient appointments for patients with UC.

Efficacy Evaluation of Smartphone-based Stent Tracking Application in Follow-up Patients with Ureteral Stents: A Prospective Study

Objective: Our objective was to determine how effectively our smartphone app improved follow-up compliance in ureteral stent patients. Materials and Methods: Two groups of patients who underwent double-j stent placement were compared. For the traditional program (i), retrospective data from January 2021 to June 2021 was collected. We randomly selected 72 patients from the overall 121 patient data. For the smartphone-based stent tracking program (ii), a smartphone application was used from July 2022 to January 2023 to track 72 patients. Result: The rate of poor compliance in group (ii) (4.2%), was significantly lower (p=0.004) than the rate of poor compliance in group (i) (19.4%). Differences in diagnosis between the two groups were not found to be related to the compliance rates. Surprisingly, kidney transplant patients in both groups had perfect compliance. Conclusion: Smartphone-based stent tracking application increased patient compliance to appointments in patients who underwent double-j stent placement. This study is a demonstration of how technology can assist patients to better health care and can prevent complications.

Virtual nutrition services in oncology.

e13504 Background: In 2016, the National Academy of Sciences, Engineering and Medicine convened a workshop to examine challenges patients experience accessing specialized nutrition care in outpatient cancer treatment settings. Inadequate Registered Dietitian Nutritionist (RDN) staffing and reimbursement were identified as barriers to timely care. Staffing challenges at our three destination community cancer centers led to a backlogged queue of nutrition consults resulting in a ≥ 4-week wait time for an appointment. A quality improvement project to address delays in care for patients at risk for malnutrition, resulted in implementation of a hybrid model utilizing remote RDNs to provide virtual Medical Nutrition Therapy (MNT) to supplement onsite RDNs. Methods: After approved in June 2022, two remote RDNs were hired to provide virtual patient care. Nationwide recruitment allowed for hiring rare talent. A project team was created to assure we followed all regulatory guidelines related to licensing and billing. RDNs were individually licensed in 14 states to cover where ≥ 70% of our patients reside. System-wide criteria and licensure alerts for appointments were established between scheduling and nutrition leaders. The first patients were seen virtually on October 14, 2022, with units of service (uos) logged in 15-minute increments. Results: Appointments were tracked from October 14, 2022, through February 3, 2023. 69.2% of 302 scheduled appointments were successfully delivered virtually via telehealth platform with a mean of 1.7 uos. The main reasons for nonuse of the platform were no shows (52.7%) and the need to convert to a phone call (32.3%). The mean uos was significantly higher in new patients compared to returning patients (2.23 versus 1.53; p<0.001). Conclusions: A hybrid model of onsite and virtual care RDNs has potential to improve access to nutrition care. New patient appointments averaged > 30 minutes, and follow-ups averaged < 30 minutes. This may help inform future scheduling of virtual MNT appointments. This model may allow for recruitment from a wider pool of RDNs. It may also help avoid delays in care for patients at risk for malnutrition and gaps in their cancer treatment. [Table: see text]

A New Scenario-Based Simulation Model for Cost Management of Healthcare Services through Improving the Efficiency of the Health Centers

There is a need for an appropriate decision-making approach and a precise costing method in order to make appropriate decisions that result in managing the resource utilization, improving the efficiency of healthcare systems and processes, increasing the patient consent, and reducing the costs of healthcare services. Therefore, this study is to develop a new method for estimating and reducing the services’ costs by assessing the scenarios intended for the improvement of departments using time-driven activity-based costing (TDABC) and simulation model with conditions of uncertainty. To investigate the application of this method, the lithotripsy department of a kidney center has been studied and attempted to investigate the effects of different scenarios of scheduling the technicians’ presence and scheduling patients’ appointments, alongside the effects of controlling the factors of patient cancellation in different stages of the treatment process on lowering the healthcare costs and waiting time and on improving the hospital efficiency. The results showed that significant improvements in costs, waiting time, human resource utilization, and overall system efficiency were emerged. The impact of patient appointment scheduling scenarios on the abovementioned indexes was found to be far more than other scenarios. Furthermore, the results from the costs determined indicate a difference of 0.60, 0.61, 0.67, 0.67, and 0.63 percent between these costs and the costs determined by the traditional approaches. Such differences among the costs determined by these two approaches mainly occur due to different methods of allocating indirect costs and existence of uncertainty in the costs and time of therapeutic activities.

To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic

Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.