Efficiency Of Healthcare Services Research Articles

Help Wanted: How to Address Labour Shortages in Healthcare and Improve Patient Access

To address a pandemic, preserving and maintaining the healthcare system’s capacity is critical. This Commentary evaluates factors contributing to healthcare labour shortages and investigates the inter-relationships between access to health services, the number of healthcare providers, compensation rates and migration patterns. Addressing healthcare access challenges likely requires increasing the number of healthcare providers and also addressing inefficiencies in the combination of inputs – the mix of providers, facilities, tools and equipment. Overall, the results suggest a critical and strategic examination of fee schedules for physician services, with the goal of reducing the average cost per service but strategically increasing remuneration for difficult-to-access services. Nurses and other care providers can increase the efficiency of healthcare delivery through expanding scopes of practice or filling gaps when there is a shortage of family or specialist physicians. However, there are, as well, shortages of nurses and other healthcare providers. Another example of increasing the efficiency of healthcare services is the shift toward team-based care. A critical feature of both expanding scopes of practice and team-based care is effective communication and knowledge transfer between supervising specialists and care providers. The time and costs associated with training new physicians make it infeasible to address labour shortages arising from a crisis or an unexpected population need simply through training more of the needed physicians. However, shifting methods and modes of care delivery, or adapting scopes of practice, are tools to address short-term healthcare labour supply gaps. Over the longer term, increasing the efficiency and supply of healthcare labour will require adapting medical education policies, remuneration and entry pathways to practising medical professions, as well as continuing to modernize care delivery methods, coordination and health data accessibility.

From novel to routine: new oral anticoagulants for stroke prevention in primary care in Ireland

New treatments for atrial fibrillation provide promising opportunities to increase the efficiency of healthcare services while optimising the patient experience. However, research shows that current prescribing practice for this patient group is inconsistent and at odds with international guidelines.

Using governance and patient flow strategies to improve healthcare service efficiency.

The aim of this case study was to share lessons learned regarding strategies likely to increase healthcare service efficiency. Following quality assurance review of statewide Hospital in the Home (HITH) average length of stay (ALOS) and readmission data, Queensland's Department of Health observed that for some of the highest volume diagnoses seen in Queensland's HITH services in 2017, services that used a public-private partnership (PPP) model of care achieved a shorter ALOS than services using a traditional public model of care without demonstrably poorer patient outcomes. To understand the reasons for the differences in ALOS, ALOS and readmission data from 2017 for 10 high-volume diagnoses were retrospectively compared for five HITH services. Two of the services used a PPP and three used a public HITH model of care. Additional data were collected to determine similarities and points of difference regarding how the services operated in 2017. Hospitals that used a PPP HITH model of care achieved shorter ALOS for eight of the 10 diagnoses, with the difference ranging from 0.94 to 5.98 days. Differences between how the PPP and public HITH services operated in 2017 were identified. The findings suggest that the use of governance strategies, criteria-led discharge and financial incentives is likely to support safe shorter lengths of stay.

Telehealth and Physical Therapy Clinical Decision Making in a Patient with a Falcine Meningioma.

Telehealth utilizes information technologies and communication networks to deliver healthcare and education with lower costs and improved access, quality, and efficiency of healthcare services. This report describes the application of telehealth for medical screening, clinical decision making, and medical referral in a physical therapy practice. The patient described was a 50-year old man who contacted his physical therapist via telephone for a chief complaint of worsening left sided numbness and tingling that began insidiously 2 days prior. Further questioning revealed that the patient also complained of left ankle weakness, and slight unsteadiness with walking. He had not been feeling well and had been experiencing increasing bouts of unexplained fatigue over the previous two months that were now interfering with his work and recreational activities. The patient was evaluated by his physician the next day. Magnetic resonance imaging of the brain revealed a large (4 cm) falcine meningioma in the right parietal region. The patient was immediately referred to a neurosurgeon and underwent a craniotomy and tumor resection ten days later and subsequent gamma knife radiosurgery of the residual tumor bed two months after craniotomy and tumor resection. Follow-up imaging one year later revealed no evidence of recurrence or residual tumor. This patient case underscores the importance of recognizing signs and symptoms of serious disease, and how referral following telehealth via telephone can inform diagnosis.

Evaluating the efficiency of China’s healthcare service: A weighted DEA-game theory in a competitive environment

In the field of healthcare industries, reasonable and sound resource allocation, as well as its well-balanced distribution do not impose any encumbrance on a society’s healthcare system, preventing negative effects induced by cost-ineffective therapies as well as resource-consuming treatments, upon which the key motivations of our research is constituted.We establish an ingenious and effective model by combining weighted Data Envelopment Analysis (DEA) and game theory to improve the quality and management of the healthcare. First, we aim to divide the decision-making units (DMUs) into group with homogeneity by k-means and canopy algorithm. Then, a model based on the weighted DEA-game theory is built to evaluate the healthcare service efficiency of each cluster. Last but not least, an empirical study is accordingly conducted.Analytical results show that our method outperforms the traditional DEA, throughout which three advantageous findings are therefore summarized as the key contributions of our research in terms of imbalance, healthcare service efficiency and its performance in coastal areas, thereby offering corresponding guidance and suggestions.

The Cost- Saving Role of Blockchain Technology As a Data Integrity Tool: E-health Scenario

The digital economy of health and its global proliferation have led to the use of health information systems in the daily health services delivery to patients. Consequently, there is a development of web-based electronic healthcare aimed at providing electronic health services in real-time. In this way, through the implementation of the concept of electronic health, there is an exchange of health information among all stakeholders of the health organization, all with the aim of monitoring the health status of patients, timely intervention and adequate allocation of medical resources. Processing and sharing a large amount of health data in real time, with the constant need to maintain a high level of interoperability and scalability of network infrastructure, requires the highest possible level of security in accessing data, in order to reduce the misuse of health data. By using blockchain technology, the risk of misusing health information, asymmetry of information and the risk of increasing transaction costs are reduced in a very short time. Blockchain is a robust mathematical algorithm that can provide maximum security of the transaction using cryptographic methods. This type of technology is based on a distributed database that contains encrypted data that can not be changed or disturbed. For this reason, the application of this technology as a data integration tool is increasingly reflected in the electronic business of health organizations - electronic healthcare. Blockchain technology is especially used in information-intensive electronic healthcare records and medical applications, which ultimately results in reduced costs of providing health services, especially when it comes to system maintenance and security costs, interoperability and data redundancy. According to above-mentioned cost-saving role of blockchain technology in processing, sharing and analyzing healthcare data, in this paper, there will be more to say about the positive economic impact of blockchain technology on electronic healthcare, especially in the case of Estonia. This European country is a pioneer in creating, implementing and using the e-Health concept as an integral part of health information system through its healthcare system, in order to increase efficiency of healthcare services.
 Keywords: Blockchain technology, data integrity, e-Health, health economics

Maturity assessment and maturity models in health care: A multivocal literature review.

BackgroundThe maturity of practices and infrastructure in the health care domain directly impacts the quality and efficiency of health care services. Therefore, various health care administrations (e.g. from hospital management to the nationwide health authority) need to assess and improve their operational maturity.ObjectiveThis study aimed to review and classify studies that propose/use maturity assessment or maturity models (MMs) as a vehicle to achieve operational excellence in the health care domain.MethodTo achieve this objective, we performed a multivocal literature review (MLR) – a form of systematic review that includes data from the grey literature (e.g. white papers and online documents) in addition to formal, peer-reviewed literature.ResultsBased on 101 sources, 80 from peer-reviewed literature and 21 from the grey literature, we identified 68 different MMs on, for example, telemedicine, care pathways and digital imaging. We reviewed them with respect to various aspects, including types of research and contribution, list of MMs proposed/used with their subject areas, elements of maturity/capability and application scope or scale. In the synthesis of empirical benefits of using MMs, two were found to be significant: (a) identifying issues and providing guidance for improvement in health care contexts, and (b) improving efficiency, effectiveness, performance and productivity.ConclusionThis MLR provides an overview of the landscape and serves as an index to the vast body of knowledge in this area. Our review creates an opportunity to cope with the challenges in obtaining an overview of the state-of-the-art and practice, choosing the most suitable models or developing new models with further specialties.

Smart Healthcare Systems: The Impact of IoT on Medical Diagnostics and Treatment

AbstractThe rapid advancement of technology has led to the development of the Internet of Things (IoT), which is revolutionizing various sectors, including healthcare. Smart healthcare systems, powered by IoT, have the potential to significantly improve medical diagnostics and treatment, thus enhancing patient outcomes and reducing healthcare costs. This paper aims to analyze the impact of IoT on medical diagnostics and treatment, focusing on three key areas: remote patient monitoring, telemedicine, and artificial intelligence (AI) in diagnostics. Remote patient monitoring allows for real-time data collection and analysis of patient health, enabling healthcare professionals to make informed decisions and provide prompt interventions. IoT devices, such as wearable sensors and smart medical equipment, facilitate the continuous monitoring of vital signs and symptoms, leading to timely detection of abnormalities and improved disease management. Telemedicine, enabled by IoT, allows healthcare providers to virtually consult with patients, reducing the need for in-person visits and expanding access to medical care, especially for individuals in remote or underserved areas. This technology enhances patient-provider communication, fosters a more personalized approach to medicine, and increases the efficiency of healthcare services. Finally, AI-powered diagnostic tools, integrated with IoT devices, can process and analyze large volumes of data to identify patterns and correlations, leading to more accurate and efficient diagnoses. These systems can also aid in treatment planning and decision-making, resulting in improved patient care and outcomes.

Use of the EFQM excellence model to improve hospital pharmacy performance.

Quality management systems are widely used to improve the quality and efficiency of healthcare services. However, evidence regarding the value of the European Foundation for Quality Management (EFQM) model in improving the performance of hospital departments is lacking. To describe the value of the EFQM model as a quality framework for improving the performance of a hospital pharmacy department (PD). A case study describing the development of the Enablers' criteria of the model and the results achieved. PD in a tertiary-care teaching hospital of the Madrid Public Health Service (Spain). Four self-assessments were conducted using the questionnaire "Perfil" during the period 2008-2017. A quality improvement plan was developed on the basis of the results of each self-assessment. A balanced scorecard was used to track progress. Improvement in quality management was externally evaluated by the Spanish Management Excellence Club in 2010, 2013, and 2017. Change in the scores obtained in the external assessments, the quality improvement initiatives implemented for each Enabler's criteria, and the results of key performance indicators. The EFQM was a useful framework for self-assessment and a good system for identifying improvement initiatives. The model progressively improved the services provided for patients, the safety and efficiency of pharmacotherapy, productivity of the PD, and customer and staff satisfaction. The external assessment scores exceeded 300 points in 2010, 400 points in 2013, and 500 points in 2017. Scores for all of the criteria progressively improved, particularly in 'people'. The EFQM was a practical tool for improvement of PD performance, especially in areas such as strategic planning, people management, and innovation. The main difficulties were the lack of decision-making capacity in relevant areas and benchmarking with other PDs.

Advances in Surgical Training Using Simulation.

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.

Salary, financial autonomy and efficiency of healthcare systems in local governments

ABSTRACTThe expansion of financial autonomy increased the interest on the factors that influence the efficiency of local governments (LGs). Although fiscal autonomy and employee’s wages have implications for efficiency, research has ignored their combined effects. This work aims to investigate the relation between salary, financial autonomy and the efficiency of LGs' health systems in Brazil. The sample was composed of 188 LGs in the state of Paraíba from 2011 to 2015. The study consisted of a two-stage analysis: (i) efficiency was measured by means of Data Envelopment Analysis; (ii) and multiple regression on panel data. Results demonstrate that (i) the average salary of doctors affected efficiency negatively, while the salary of non-doctors had a positive impact on efficiency; (ii) salary differences between doctors and non-doctors, as well as differences between members within each group, did not impact efficiency; (iii) LG's financial autonomy presented positive effects on efficiency even if not confirmed by all models. Results show that when an increase in salary affected groups receiving smaller salaries, the effect was positive on efficiency, while for groups with higher salaries, such an increase caused a negative impact. Finally, this study suggests that LGs’ greater financial autonomy is positively correlated to greater efficiency in healthcare services.

Patient-Reported Outcome Measures: Best Is the Enemy of Good (But What if Good Is Not Good Enough?).

Patient-reported outcome measures (PROMs) are increasingly important in research and clinical practice and to monitoring the efficiency of health care services. The selection process of a PROM is fundamental to ensure that what matters to patients is captured in a valid, reliable, responsive, and feasible manner. However, selecting a fit-for-purpose PROM is not always an easy task, as many clinimetric and sociological factors can play a role. In this Viewpoint, 2 different perspectives on PROM selection are presented and debated, and a few key suggestions are provided to improve PROM development and assessment. The measurement of physical functioning in patients with low back pain (LBP) is used as a recurring example. J Orthop Sports Phys Ther 2019;49(2):39-42. doi:10.2519/jospt.2019.0602.

The Use of Smartphone Applications (Apps) for Enhancing Communication With Surgical Patients: A Systematic Review of the Literature.

The widespread use and development of smartphones and mHealth apps has the potential to overcome communication deficiencies in health care. To carry out a literature review of studies that evaluate patients' experience on the use of perioperative mHealth apps. An up-to-date systematic review on studies assessing patients' use of mHealth apps for communicating with the health care team in the perioperative period was performed following the PRISMA statement. Ten studies (in 11 articles) were identified: 8 feasibility studies and 2 randomized controlled trials. Nine studies included apps used for postoperative monitoring while 1 study also provided preoperative guidance. An analysis of barriers and motivations of patients and health care professionals to the use of perioperative mHealth apps was performed. Barriers included patients' lack of confidence when using apps and potential lack of time from health care professionals to monitor information submitted by patients. Motivations included patients' sense of being looked after and potential cost-effectiveness and increased efficiency of health care services. This analysis led to the concept of the "ideal app" that would need to be developed following adequate protocols and security standards. Features of the ideal app include preoperative advice on medications and investigations, information on surgery, and a remote follow-up tool to improve safety and to minimize unnecessary clinic appointments and associated costs. There is an overall positive impression of the use of perioperative mHealth apps. However, further studies are required to assess the impact that they have on patients' care and healthcare professional services.

Privacy-Preserved, Provable Secure, Mutually Authenticated Key Agreement Protocol for Healthcare in a Smart City Environment

Smart home systems can provide health care services for people with special needs in their own homes. Briefly defined, such a smart home has special electronics to enable the remote control of automated devices specifically designed for remote health care to ensure the safety of the patient at home and the supervision of their health status. These sensors are linked to a local intelligence unit responsible for analyzing sensor data, detecting emergency situations, and interfacing between the patient at home and a set of people involved in their health care, such as doctors, nurses, emergency services, and paramedics. Smart homes can improve the patient's quality of life and safety through the innovative use of advanced technologies. Telemedicine and telecare are driving forces behind the adoption of smart homes. The telecare medicine information system (TMIS) has drawn worldwide attention for the past 20 years, as modern technologies have made remote delivery of healthcare a reality. TMIS using multidisciplinary research and application involves advanced technologies in information processing, telecommunications, bio-sensing, and artificial intelligence including smart technologies. TMIS leverages the latest mobile and wireless communication technologies and widely available internet infrastructure to deliver quality services to home patients enabling them to remotely access information about their health and obtain telemedical services. TMIS delivers capabilities to remotely provide $24\times 7$ health care facilities to patients. Its purpose is to provide patients with convenient and expedited remote health care services, greatly improving the quality and efficiency of health care services. However, the open and insecure nature of the internet poses a number of security threats to patient secrecy and privacy. Security design for TMIS is not trivial. Essential security and privacy are provided by mutual authentication and key agreement protocols. This paper proposes an efficient and secure, bilinear pairing-based, unlink-able, mutual authentication and key agreement protocol for TMIS. The proposed protocol adopts a fuzzy extractor for the identification of patients using the biometric data. The security of the proposed protocol is based on the hardness of the elliptic curve discrete logarithm problem (ECDLP) and elliptic curve computational Diffie-Hellman problem (ECCDHP) to preserve the privacy of the user. The detailed security analysis is discussed, and the results of comparison are provided.

"Doctors’ Orders or Patients’ Preferences? Examining the Role of Physicians in Patients’ Privacy Decisions on Health Information Exchange Platforms"

Health information exchange (HIE) platforms could increase the efficiency of health care services by enabling providers to instantly access the medical records of their patients. However, these benefits cannot be realized unless patients disclose their information on HIE platforms. We examine actual privacy decisions made by patients on an HIE platform, study the influence of physicians’ recommendations on patients’ decisions, and explore the process through which this effect takes place. By analyzing a unique data set consisting of the privacy decisions of 12,444 patients, we show that contrary to common belief, patients do not simply follow physician recommendations, but rather carefully consider the risks and benefits of providing consent. We show that competition among medical providers does not hinder patient participation in HIEs, but that providers’ decisions to ask for consent are primarily driven by the potential benefits of HIE for themselves and their patients.

Variations of length of stay: a case study using control charts in the CRISP-DM framework

In-patient length of stay (LOS) at hospitals is considered a critical 'catch-all' metric because it is widely used to measure the overall efficiency of healthcare services. The goal of this paper is to effectively analyse and monitor hospital LOS to help improve healthcare quality. Given the fact that abnormal LOS results in increasing cost for all stakeholders, this study proposes a new framework based on cross-industry standard process for data mining framework (CRISP-DM) and Six Sigma methodology, including control charts for monitoring and improving LOS. The utility of the proposed method is demonstrated through a case study involving 11,722 internal medicine patients at a large hospital in Southwest Virginia. Outcomes of this study have potential to support decision makers at hospitals to detect abnormal LOS by identifying effective and efficient ways to minimise it, thereby reducing costs.

A service evaluation of prescribed only medications (POMs) issued during a 12-month period in a musculoskeletal physiotherapy primary care service

Purpose: Non-medical prescribing was introduced in the United Kingdom (UK) to improve healthcare service efficiency, access to medicines and support service innovation. From 2013, independent prescribing was extended to include physiotherapists. Patients are facing increasingly long waiting times to see their GPs, and delays getting medication to aid their musculoskeletal ailments. This report aims to explore patient satisfaction of this service in a primary care musculoskeletal physiotherapy setting. IPOPS started provision of independent prescribing during physiotherapy sessions by a single physiotherapy practitioner in March 2017.

Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study.

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p<0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p<0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

Managing Healthcare Service Ecosystems: Abstracting a Sustainability-Based View from Hospitalization at Home (HaH) Practices

Sustainability seems to be a hot topic today upon which a paradigmatic transformation is going on; this affects many fields and sectors by revealing the significant implications for actors’ participation, such as in healthcare. Today, healthcare calls for renewing and increasing its own main processes of hospitalization, as inspired by the current new light of sustainability; hospitalization at home (HaH) practices allow for new forms of hospitalizations, which are much more adherent to the real needs of patients and caregivers. Studies in service dominant logic (S-D logic) on service ecosystems help us in understanding which are the dynamics that are shaping actual conditions in healthcare. With the aim of contributing to the challenging debate about the role of “sustainability for healthcare”, this manuscript proposes a conceptual framework for investigating healthcare domains through the interpretative lens provided by the service ecosystems view. Previous managerial contributions are analyzed in an attempt to emphasize the contact points between studies about service ecosystem and sustainability so as to outline the possible roadmaps for sustainability in the healthcare domain. The three dimensions of HaH—efficiency of healthcare service, effectiveness in resource usage, and patients’ satisfaction—have been identified as possible levers on which promoting healthcare processes inspired by sustainability principles and their relations with the three pillars of sustainability science—the economy, society, and environment—have been analyzed. The reflections herein are finally discussed for proposing possible future directions for research interested in promoting a sustainability-based healthcare management.

GIS-based method to delimit spheres of influence for a medical consortium: Experience of a pediatric medical consortium, Shanghai.

To improve the utilization efficiency of health care services, the concept of a "regional medical consortium" has attracted more attention during the most recent round of health care reform in China. Shanghai, a municipality of China, has made many efforts to promote its regional medical consortium project. In this paper, the pediatric medical consortium of Shanghai will serve as an example to introduce the main tasks and groundwork of the Shanghai medical consortium and will underscore Shanghai's exploration of the vertical integration of medical resources. This study delimits the service areas of leading hospitals, which can help determine the spheres of influence of top hospitals geographically. With this information, regional hospitals or community hospitals can find alliance hospitals and leading hospitals more easily. These efforts can be realized using ArcGIS for spatial data analysis. According to the locations of leading hospitals and actual patient distributions at these hospitals, the natural areas of influence of leading hospitals are illustrated. Then, hospitals other than leading hospitals can select allied hospitals in the same area of influence. In this way, connections in a medical consortium will be tighter, and hospitals will be better able to meet the actual demands of patients. In this paper, we introduce a geographic method to delimit the spheres of influence of hospitals based on actual health-seeking behaviors of patients by analyzing the spatial distribution of hospitalization probability. Within the boundaries of a sphere of influence, a geographic connection between the leading hospital and the general hospital is established automatically. Based on this geographic connection, leading hospitals should provide technological support to general hospitals located in their sphere of influence, while the general hospitals should provide spare medical resources in return. Thus, the medical consortium can be formed geographically and operate more smoothly.