Management Of Health Care Resources Research Articles

Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore.

SummaryIn December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human‐to‐human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case‐load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri‐operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

Early Identification of Severe COVID-19 in Hospitalised Patients: A Large, French Multicentre Case Series

Background: Early identification of patients at risk for severe coronavirus disease 2019 (COVID-19) is a major issue to help clinicians optimise patient-flow management and allocation of healthcare resources. Methods: This retrospective, observational, multicentre study included all consecutive patients admitted to hospital with COVID-19 across 24 centres in France between February 26 and April 20, 2020. Comprehensive data, including clinical, biological, and imaging variables, were recorded at admission. The primary outcome was a composite of transfer to intensive care unit (ICU) or in-hospital death without transfer to ICU. Findings: Among 2878 patients (57·9% men, 67±17 years), the primary outcome occurred in 838 (29·3%) patients: 19·1% were transferred to ICU and 10·0% died in-hospital without transfer to ICU. Based on the derivation cohort (n=2105), 12 variables were independently associated with the primary outcome in the final model: demographics (age, sex), triage vitals (body temperature, Glasgow coma scale, dyspnoea, respiratory frequency, fraction of inspired oxygen), biological (platelets, C-reactive protein, aspartate aminotransferase, glomerular filtration rate), and imaging (degree of scanographic lesions) data. A risk-stratification score was developed that displayed accurate calibration and discrimination, with C-statistics of 0·80 (95% confidence interval 0·78 to 0·82) in the derivation cohort and 0·79 (95% confidence interval 0·75 to 0·83) in validation cohort. Interpretation: Using data from a multicentre series of patients with COVID-19, we identified independent predictors of severe COVID-19 in hospitalised patients, including clinical, biological, and imaging variables at admission. An accurate integrative risk score was developed and externally validated to optimise early triage of patients. Trial Registration: NCT04344327 Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The CCF study was declared to and authorised by the French data protection committee (Commission Nationale Informatique et Liberte, CNIL, authorisation n°2207326v0), and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

On the issue of creating information base for monitoring medical personnel in health care

The article presents data on the talent pool of dermatovenerologists working in Moscow in state owned healthcare organizations. It is concluded that the availability of complete and reliable monitoring information on the personnel will contribute to the improvement and increase in the efficiency of human resources management in health care.

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management.

BackgroundAppropriate referrals of injured patients could improve clinical outcomes and management of healthcare resources. To gain insights for system development, we interrogated the current situation by assessing burden, patient demography, causes of injury, trauma mortality and the care-process.MethodsWe used an observational, cross-sectional study design and convenience sampling to review patient charts from 3 major hospitals and the death registry in Tanzania.ResultsInjury constitutes 9–13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however, the trauma death registry figures exceeded the ‘inpatient deaths’ and recorded up to 16%. Most patients arrive through a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the trauma admissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%) were the leading causes of injury. The care process revealed a normal primary-survey rate of 73–90%. Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and disability (80%). Most patients had non-operative management (42–57%) or surgery for wound care or skeletal injuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were each performed in 10%.ConclusionThe burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded in the death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process, funding and recording. We found a functional hospital referral-network, transport system, and death registry.

JOB SATISFACTION AMONG PHYSICIANS IN BULGARIAN GENERAL PRACTICE

Research on the professional satisfaction of doctors is especially relevant today, in relation to the crisis with medical staff. The purpose of this article is to study the factors of job satisfaction of general practitioners. An empirical sociological survey was conducted among general practitioners in the Stara Zagora region. The method used is a face-to-face interview. The approved Warr-Cook-Wall (WCW) toolkit is implemented - a questionnaire modified by the research team. The study includes 223 general practitioners, which determines the high responsiveness: 94.9%. The results show that GPs are mostly satisfied with the factors related to the autonomy of the profession. The clinical freedom defined as the ability of general practitioners to choose the method of treatment of their patients is assessed to the greatest extent as satisfactory. Physicians are most dissatisfied with the regulatory framework they have to comply with and with the constant change of activities required in their daily practice. The questionnaire for the assessment of job satisfaction of GPs is applied for the first time among Bulgarian physicians. This assessment is useful for the formation of policies for human resource management in health care, as it identifies adverse trends and leads to certain solutions. Models of professional satisfaction influence the professional behavior, important for staying and leaving certain medical area and the emerging shortage of doctors in some specialties.

The impact of the HEART score on the prevalence of cardiac testing and patient outcomes in a rural emergency department.

This study was conducted to examine the use of the HEART score for risk stratification of chest pain patients presenting to rural Ontario emergency departments (EDs), assessing both its validity in a rural context and its utility in health-care resource management. This study was a retrospective chart review of adult patients presenting to the ED with chest pain. The HEART score was assessed for its ability to risk-stratify patients (high, moderate and low) in terms of the likelihood of a major adverse cardiac event (MACE) within 6 weeks. The prevalence of follow-up testing for each risk category of patients was then determined such that the potential impact on health resource management was estimated based on the number of tests ordered in low-risk patients. Of the 215 charts included, 24 (11.2%) patients experienced a MACE within 6 weeks. None of the patients with a low HEART score experienced a MACE. In comparison, the incidence of MACE in moderate- and high-risk groups was calculated to be 13.9% (95% confidence interval [CI] [5.91% and 21.89%, respectively]) and 66.7% (95% CI [46.54% and 86.86%, respectively]). Eighteen percent of the low-risk patients received follow-up testing with no positive results suggestive of acute coronary syndrome. Our results provide external validation of the predictive value of the HEART score in determining the risk of MACE in patients presenting to a rural ED with chest pain. Our results also suggest that rates of follow-up testing in low-risk patients may be reduced in communities with limited access to resources.

Development and evaluation of NRMIS (Nursing Resources Management Information System) for managing healthcare resources.

Efficient resource management should consider the improvement of internal factors first as the unique task of medical institutions that can perform the medical services for efficient hospital management under the optimum management condition. This study aims to suggest the efficient model for nurse resource management that can estimate optimum nurse resources according to the nursing intensity of the hospitalized patients. The study was performed with four steps including collection and analysis of requirements, system design, system realization, and evaluation, which took 2 years and 10 months. The measurement tool used in the step of system evaluation was a modified version of Questionnaire for User Interaction Satisfaction (QUIS) 5.0. The system was implemented using Oracle database with Power Builder by Sybase. NRS, PCS, and ONMES were realized with developed NRMIS, and the survey was conducted on the usefulness as the system evaluation. The system evaluation results of User Interaction Satisfaction, means scores of ONMES, PCS, and NRS were 7.15 ± 0.52, 6.21 ± 1.11, and 6.03 ± 1.14 out of 9 points, respectively. Demonstrating the positive change in the subjective usefulness of the respondents after using the system compared to the period before using the system (F= 16.551, p= 0.000). It was confirmed that this system contributed to an enhancement of the working process speed, efficiency, and accuracy by simplifying the works which were the purposes of the nursing information system, which changes dynamically, to support decision making on the management of effective and flexible nurse resources.

The Present and Future of the Nurse Profession in Bulgaria

Introduction: The human resources are the most precious capital of any organization: the most significant for achieving its goals and the most difficult to manage. The main issue with human resources management in healthcare for health managers today is the critically low numbers of nurses in the profession. This issue has repercussions for both nurses and patients. Purpose: To study the main reasons for leaving and the conditions for staying in the job from the perspectives of practicing nurses; to advance a possible approach for tackling the issue of nurses` retention in the job; to evaluate the contributions of human resources professionals toward that goal. Methods and Materials: A pilot study was conducted in July-August 2018 with 52 nurses practicing in the city of Varna, Bulgaria. The data were collected through a survey using a questionnaire developed by the first author Findings and Discussion: The main reasons for leaving the profession as stated by the surveyed nurses are the low levels of remuneration, the lack of social recognition for the value of their job, and the systemic work overload. For more than half of respondents it is difficult to strike a balance between personal and professional life due to having to work two or more jobs. Nurses report they would stay in their job provided adequate remuneration for what they see as highly qualified and responsible labor, positive work climate, support and understanding from nurse managers, and flexibility with work hours. Conclusion: At present the functions of human resources management are performed mostly by nurse managers (i.e. chief and senior nurses). The main reasons for leaving the nursing profession concern remuneration, the lack of social recognition for the profession and the systemic work overload. Conditions facilitating staying in the job depend on the attainment of a reasonable balance between the interests of management and practitioners. The professional and career development of nurses depends more on their personality and motivation than contextual factors. The opportunity to exert autonomy on the nursing job would enhance work-related self-esteem and raise the prestige of the profession. The work-life balance has an increasing significance for practicing nurses and is becoming a primary factor for choosing an employer, for work engagement and commitment to the goals of the health organization.

The impact of a simulation-based approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia

Effective communication, team working and human factors are given little attention in traditional medical curricula. However, these skills are fundamentally important during crisis resource management (CRM) in healthcare. These skills can be learnt and can be taught very effectively within a simulated environment. Thus simulation-based training on CRM can positively impact patient safety. One such course which focuses on the management of common neonatal emergencies is the ‘Neonatal Emergencies Simulation Team training’ (NEST) program. This one day multiprofessional educational program, originally designed by the London Neonatal Transfer Service, aims to develop multidisciplinary confidence and competence in the management of common neonatal emergencies. This program has been evaluated positively in India, Nepal, Saudi Arabia and the UK and shows promise for wider implementation in high-, middle- and lowincome countries. Here we give an overview of the program and its implications. Citation: Mohinuddin S, Rajkumar Rajendram R, Swamy S. The impact of a simulationbased approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia. Anaesth Pain & Intensive Care 2018;22(3 Suppl1):S124-S128

Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient's dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking. To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery. Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1, 2006, to January 1, 2017. The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome. Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years; 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% CI, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% CI, 0.19-0.84) and the absence of posterior glottic stenosis (OR, 0.12; 95% CI, 0.04-0.37). These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whether the patient had posterior glottic stenosis. The RDW is a routine laboratory parameter that may provide some insight to the preoperative probability of prosthesis removal, facilitate risk stratification, promote informed patient decision making, and optimize health care resource management.

VP83 Health Economics Distance Learning For Healthcare Workers In Brazil

IntroductionDespite increased healthcare systems costs, limited opportunities for health economics training are available to healthcare professionals. From 2016-2018, with a grant from the Brazilian Ministry of Health, the Federal University of Goias with 7 other universities, implemented the distance learning Postgraduate Certificate in Health Economics for Health Care Professionals (PCHE) aimed at enhancing technical capacity of professionals working in the Brazilian Public Healthcare System (SUS).MethodsThis is a descriptive and qualitative assessment of the PCHE implemented in Brazil 88 healthcare professionals working in SUS and involved in decision making in all levels of managament were enrolled in a health economics training, through long-distance learning strategy. We present course metrics, describe its workload, content, modalities and structure of training.ResultsPCHE was structured with 3-day workshops introducing each of the modules, during which students were also evaluated regarding the previous module content. With a total workload of 360 hours, structured in four modules: Public Health and Epidemiology; Introduction to health economics and healthcare funding; Management of healthcare resources; and Healthcare economic evaluation. The module coordinator was resposible for supervision of course materials development, workshop, distance based tutoring activities, and evaluation. Course material included theorethical content and practical tools for economic evaluation and health technology assessment in the workplace, applying problem-based learning strategies. Certificates were granted to students with 75 percent presence and approved in all modules, and final papers approved by an examination board. Each module was completed in 8 weeks (90 hours/module). Within groups of 20 students, tutors performed communication witn chats twice weekly and discussion forums by topic.. A total of 88 students were enrolled. Drop-out rate was 35.2 percent (n = 31). Additional 10 students did not pass the exams. In total, 47 students completed the training.ConclusionsHealth economics training through distance learning is a more efficient use of resources with good results.

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

Posterior vitreous detachment and incidence of delayed retinal breaks: a retrospective, 2-year study at an academic centre

Posterior vitreous detachment (PVD) is common in older patients, particularly postcataract surgery. Patients are typically followed 4 to 6 weeks after the initial presentation. The study goal was to assess the rate of new retinal tears for patients without new symptoms on routine follow-up. This is a multisite, retrospective cohort study of all patients presenting to the emergency departments at an academic health centre in a 2-year period diagnosed with uncomplicated PVD. Patient demographics, pastocular surgery, retinal findings at the first and second examinations, and the identity of the examiner were recorded. The primary outcome was absence of new retinal tears or pathology on follow-up. One hundred sixty-six patients were identified, and 105 patients were present for both an initial and follow-up examination (median, 6 weeks). No patients had any new pathology on the follow-up examination. Most patients (n = 62) were seen initially by one of 15 residents alone, and most patients (n = 80) were seen at follow-up by one of 10 staff from specialties of comprehensive, uveitis, neuro-ophthalmology, cornea, and retina. The remaining 25 patients were seen in follow-up by residents. To our knowledge, this is the first study on the incidence of delayed retinal breaks with the examination performed by a variety of residents and comprehensive and subspecialist staff. Our results suggest there may be limited benefit to routine follow-up of PVD patients without new symptoms, including when followed by nonretina ophthalmologists. These findings could allow for better health care resources management.

Apoyo con Cariño (support with caring): RCT protocol to improve palliative care outcomes for Latinos with advanced medical illness.

Latinos are more likely to experience uncontrolled pain, and institutional death, and are less likely to engage in advance care planning. Efforts to increase access to palliative care must maximize primary palliative care and community based models to meet the ever-growing need in a culturally sensitive and congruent manner. Patient navigator interventions are community-based, culturally tailored models of care that have been successfully implemented to improve disease prevention, early diagnosis, and treatment. We have developed a patient navigation intervention to improve palliative care outcomes for seriously ill Latinos. We describe the protocol for a National Institute of Nursing Research-funded randomized controlled trial designed to determine the effectiveness of the manualized patient navigator intervention. We aim to enroll 240 Latino adults with non-cancer, advanced medical illness from both urban and rural clinical sites. Participants will be randomized to the intervention group (five palliative care patient navigator visits plus bilingual educational materials) or control group (usual care plus bilingual educational materials). Outcomes include quality of life (Functional Assessment of Chronic Illness Therapy), advance care planning (Advance Care Planning Engagement survey), pain (Brief Pain Inventory), symptom management (Edmonton Symptom Assessment Scale-revised), hospice utilization, and cost and utilization of healthcare resources. This culturally tailored, evidence-based, theory-driven, innovative patient navigation intervention has significant potential to improve palliative care for Latinos, and facilitate health equity in palliative and end-of-life care.

Prediction of the healthcare resource utilization using multi-output regression models

With the rapidly increasing healthcare cost and the scarcity of inpatient resources, it is of paramount importance to accurately predict the healthcare resource utilization. Previous research mainly focuses on predicting the healthcare cost using single-output models. However, the intensity of the healthcare resource utilization is reflected by multiple measures. For example, the Diagnosis Related Group (DRG) system adopted in China measures the healthcare resource utilization using both cost and length of stay (LoS), which motivates us to jointly predict these two measures. Compared to constructing several independent single-output models for each task, using multi-output models can provide unified prediction rules, reduce the training time, and improve the generalization by leveraging the correlations across tasks. We utilize four multi-output machine learning models, including the multi-task Lasso, the decision tree, the random forest, and the neural network. We evaluate their performance based on the Electronic Health Record (EHR) dataset with approximately 750,000 records. Based on extensive numerical experiments, we provide a guideline for model selection and construction. This research has the potential to improve the management of healthcare resources and provide decision support for healthcare payment system.

A smart healthcare reward model for resource allocation in smart city

Today, cities face many significant challenges, and the smart city concept is a promising means to address typical traditional city problems. The wireless e-health technologies is an evolving topic in the area of telemedicine nowadays. Mobile telecommunication and the use of multimedia technologies are the core of providing better access to healthcare personnel on the move. These technologies provide equal access to medical information and expert care leading to a better and a more efficient use of resources. Mobile and Fog computing technologies can also cope with many challenges in smart healthcare resources of mobility, scalability, efficiency, and reliability. Optimal healthcare systems are particularly critical in cities, due to the highly concentrated populations. This high population increases the potential for harm and damage in the case of negligence or improper treatment. This can lead to infections and disease outbreaks, which could become epidemic situations and require containment, which is very costly. Motivated by the need for better usage and management of healthcare resources, which is crucial for reliable healthcare delivery, this paper introduces a model that can provide improved delivery and utilization of resources. The quality reward-based model was developed to study and react to the satisfaction factors of healthcare systems, and proposes an optimization-based algorithm called the Maximum Reward Algorithm (MRA), that enhances the use and delivery of healthcare resources. The algorithm has been tested with multiple experiments and simulations, and has proved that it can provide reliability, efficiency and achieves 50.1% to 77.2% performance improvement.

Perception of cost-consciousness among medical students: an 11-item scale

Introduction: Managing healthcare resources in a cost-conscious way is an important topic in medical education. A validated instrument to measure the perception of cost-conscious attitudes of medical students could be an important tool for university staff to understanding them and to plan and evaluate educational interventions to address them. Objectives: To validate a scale to measure the perception of cost-conscious attitudes among medical students. Method: Thirteen items from a survey to measure cost-conscious attitudes in medical students were used. Semantic validation and psychometric analysis (exploratory factor analysis, Cronbach alpha, and composite reliability test) were carried out. Results: A sample of 275 participants, of which 62% were female, with an average age of 25±3.1 years, completed the questionnaire. The best structure to measure the perceptions is the one-factor solution, with 11 of the 13 items remaining in the final version. Substantial Cronbach's alpha for this questionnaire was obtained 0.66 and composite reliability was 0.77. Conclusion: The results suggest that the questionnaire has a satisfactory psychometric quality and is therefore able to measure the perception of medical students about cost-conscious attitudes.

Systemic Corticosteroid and Antibiotic Use in Hospitalized Patients With Chronic Obstructive Pulmonary Disease Exacerbation.

Effective inpatient chronic obstructive pulmonary disease (COPD) exacerbation management is critical to appropriately manage health care resources. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines provide recommendations on appropriate systemic corticosteroid and antibiotic use, in select patients, for COPD exacerbation. To determine the impact of GOLD guideline-recommended systemic corticosteroid and antibiotic therapy in the hospital setting on clinical outcomes in patients with COPD exacerbation. This was a noninterventional, retrospective, single-center study. Adults admitted to a non-intensive care unit internal medicine service with documented COPD exacerbation were included. Two analyses were conducted evaluating systemic corticosteroid and antibiotic therapy. A total of 220 patients were included in the systemic corticosteroid cohort. No difference in 30-day readmission rates was demonstrated for the standard (⩽200 mg prednisone equivalents [PEs] for exacerbation course) and high-dose groups (>200 mg PEs; 20.5% vs 13.1%, respectively; P = 0.15). Hospital length of stay (LOS) was significantly shorter for patients prescribed standard-dose therapy (3 days [2-4.5] vs 4 days [2-6]; P < 0.001). A total of 174 patients were included in the antibiotic cohort. For the appropriate and inappropriate antibiotic use groups, no significant differences were observed between 30-day readmission rates (15% vs 18.4%, respectively; P = 0.57) and hospital LOS (4 days [2-5] in both groups; P = 0.97). Conclusion and Relevance: Hospital LOS was shorter for patients prescribed standard-dose systemic corticosteroids; however, no differences in other clinical outcomes were found in either cohort. Use of guideline-recommended systemic corticosteroid and antibiotic therapy is recommended for hospitalized patients with COPD exacerbation.

Healthcare resource utilization in the management of hypophosphatasia in three patients displaying a spectrum of manifestations

BackgroundHypophosphatasia (HPP) is a rare, heterogeneous disease caused by low tissue-nonspecific alkaline phosphatase activity and associated with a range of signs and symptoms, including bone mineralization defects, respiratory problems, seizures, premature tooth loss, and fractures. Data from patients with HPP and their healthcare resource utilization are lacking. We evaluated healthcare utilization for 3 patients with differing severities of HPP.ResultsPatient 1 had perinatal HPP (received enzyme replacement therapy asfotase alfa under a compassionate use program), Patient 2 had infantile HPP, and Patient 3 had childhood HPP. Healthcare resources used in the National Health Service, England, were identified from coded activities in the hospital database and detailed medical records. These data showed that healthcare utilization was directly related to disease severity. Patient 1 had respiratory complications necessitating prolonged admission for ventilation from birth. Over 2.5 years, this patient was hospitalized 725 days, with visits from 16 specialists. Patient 2 had HPP-associated signs and symptoms starting in infancy, was treated for craniosynostosis, experienced multiple fractures, and required outpatient management for > 18 years. Patient 3 developed signs and symptoms of HPP in childhood and received outpatient and day case treatment for dental, orthopedic, and cardiovascular problems over 24 years. Healthcare utilization varied with severity and complexity of disease manifestations between these patients.ConclusionsWith the recent approval of asfotase alfa for HPP, data from this analysis may help mobilize multidisciplinary healthcare resources for management of HPP by elucidating healthcare resource needs of patients who show a spectrum of clinical manifestations of HPP.

A system dynamics-based model to implement the Theory of Constraints in a healthcare system

The management of costly and limited healthcare resources, such as operating rooms, doctors, nurses, and beds, is challenged by the uncertainty of arrivals and the service time of different types o...