Mixed Service Research Articles

The effect of delivery structure on costs, screening and health promotional services in state level National Breast and Cervical Cancer Early Detection Programs.

We estimated the costs and effectiveness of state programs in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) based on the type of delivery structure. Programs were classified into three delivery structures: (1) centralized, (2) decentralized, and (3) mixed. Centralized programs offer clinical services in satellite offices, but all other program activities are performed centrally. Decentralized programs contract with other entities to fully manage and provide screening and diagnostic services and other program activities. Programs with mixed service delivery structures have both centralized and decentralized features. Programmatic costs were averaged over a 3year period (2006-2007, 2008-2009, and 2009-2010). Effectiveness was defined in terms of the average number of women served over the 3years. We report costs per woman served by program activity and delivery structure and incremental cost effectiveness by program structure and by breast/cervical services. Average costs per woman served were lowest for mixed program structures (breast = $225, cervical = $216) compared to decentralized (breast = cervical = $276) and centralized program structures (breast = $259, cervical = $251). Compared with decentralized programs, for each additional woman served, centralized programs saved costs of $281 (breast) and $284 (cervical). Compared with decentralized programs, for each additional woman served, mixed programs added an additional $109 cost for breast but saved $1,777 for cervical cancer. Mixed program structures were associated with the lowest screening and diagnostic costs per woman served and had generally favorable incremental costs relative to the other program structures.

A truck scheduling problem at a cross-docking facility with mixed service mode dock doors

PurposeThe purpose of this study is truck scheduling and assignment of trucks to the doors simultaneously since these issues were considered mainly separately in the previous research. Also, the door service time and its impact on truck scheduling were not taken into account, so this research endeavors to cover this gap.Design/methodology/approachIn this research, a novel model has been presented for simultaneous truck scheduling and assignment problem with time window constraints for the arrival and departure of trucks, mixed service mode dock doors and truck queuing. To resolve the developed model, two meta-heuristic algorithms, namely, genetic and imperialist competitive algorithms, are presented.FindingsThe computational results indicate that the proposed framework leads to increased total costs, although it has a more accurate planning; moreover, these indicate that the proposed algorithms have different performances based on the criteria considered for the comparison.Research limitations/implicationsThere are some limitations in this research, which can be considered by other researchers to expand the current study, among them the specifications of uncertainty about arrival times of inbound and outbound trucks, number of merchandises which has been loaded on inbound trucks are the main factors. If so, by considering this situation, a realistic scheme about planning of cross docking system would be acquired. Moreover, the capacity of temporary storage has been considered unlimited, so relaxing this limitation can prepare a real and suitable situation for further study. Examining the capacity in the front of each type of doors of cross-dock and executive servers are the other aspects, which could be expanded in the future.Originality/valueIn this study, a mathematical programing model proposed for truck scheduling to minimize total costs including holding, truck tardiness and waiting time for queue of trucks caused by the interference of each carrier’s movement. At the operational levels, this research considered a multi-door cross-docking problem with mixed service mode dock doors and time window constraints for arrival and departure time of trucks. Moreover, M/G/C queue system was developed for truck arrival and servicing of carriers to trucks.

Improving the profit by using a mixed after-sales service as a market segmentation

PurposeThis paper aims to study the mixed after-sales service which simultaneously offers return and replacement services. The authors develop a model to propose what kind of after-sales service the firm should choose and how to make the after-sales service policy to improve the profit. The study aims to extend the literature on the mixed after-sales service and give some support to the managers to make decisions.Design/methodology/approachIn this paper, the authors use the optimization modeling method to describe the situations of a firm offering two exclusive after-sales service policies and a mixed after-sales service policy, respectively. They compare the results in different cases and analyze the impact of different parameters on the boundary values and other results. Finally, the authors include three numerical examples to illustrate the major results.FindingsThe authors find that the mixed after-sales service can successfully segment the market, meet various customers’ distinct needs and differentiate the service prices to improve the total profit. Moreover, the authors find the boundary values which indicate the optimal interval for each service. Then, for a certain situation, they can clearly tell which after-sales service dominates and provides the optimal selling price, order quantity and total profit. Besides, the authors show the impact of different parameters on the boundary values and other results.Originality/valueThis paper combines after-sales service into traditional models and provides a new mixed service to segment the market and improve total revenue. It provides some managerial implications for the decision-makers.

Integrated scheduling and assignment of trucks at unit-load cross-dock terminals with mixed service mode dock doors

Scheduling trucks and assigning them to dock doors are two major operational decisions at cross-dock facilities. Including flexibility by operating (part of) the dock doors in a mixed service mode is known to make cross-dock operations more efficient (i.e., when both inbound and outbound trucks can be processed at these mixed-mode doors). However, the literature and practice often consider the truck scheduling and dock-door assignment problem sequentially, or only for either inbound or outbound operations. When combined with mixed-mode dock doors, such a sequential approach results in suboptimal or even infeasible solutions. In this paper, we study an integrated approach to solve the two problems simultaneously for cross-dock terminals where dock doors can operate in a mixed service mode. We propose an adaptive large neighborhood search algorithm to solve the integrated problem and find good solutions within a reasonable amount of computational effort. Extensive computational experiments demonstrate that the operational costs at a cross-dock terminal reduce on average 12% compared to the best solution with a sequential approach (and even 20–30% compared to the results of the metaheuristics from the literature). Moreover, with the integrated approach, we study what percentage of dock doors to operate in a mixed service mode and where to position these flexible doors in U-shaped cross-dock terminals. Numerical results indicate an average cost savings of 9.7% when 60% of the dock doors are used flexibly, and the savings increase to 12.3% when these doors are centrally located in the cross-dock facility.

Demand and supply-side carbon linkages of Turkish economy using hypothetical extraction method

Inter-industrial carbon linkage analysis tells us about the transfer of CO2 amongst sectors of a nation. Hypothetical extraction model which removes a target sector and compares the difference between actual and theoretical economies is a popular model for linkage analysis. Regardless of mounting evidence favoring simultaneous application of both Ghosh supply and Leontief demand for forward and backward linkages. Related studies have mostly calculated both upstream and downstream carbon linkages using only demand-driven Leontief inverse model. This research estimates inter-sectoral carbon linkages of Turkey from both demand and supply. Electricity, gas, and water had the highest total demand and supply carbon linkage. Extraction of backward and forward linkages of mixed services have the highest demand pull and supply push impact on rest of the blocks. It also had the highest amount of net pulled and pushed emissions. Production block had the highest intra-sectoral purchase emissions while electricity, gas, and water had the highest internal sales emissions. Wind and Solar PV are the cleanest energy sources for Electricity, gas, and water supply. A carbon demand and supply based policy diversifies emission responsibility and encourages mitigation of a block's entire upstream, downstream and intra-sectoral carbon chain.

The Mental Health Act Assessment Process and Risk Factors for Compulsory Admission to Psychiatric Hospital: A Mixed Methods Study

Abstract Background Compulsory admission rates under the Mental Health Act (MHA) have been on the rise for many years despite representing a costly and coercive approach to psychiatric care. There is therefore an urgent need to minimise compulsory admission rates using interventions based on known risk factors for detention. However, risk factors in the MHA assessment process have been under-researched. Methods A mixed methods service evaluation was conducted in one inner London NHS Trust. A retrospective cohort study used routinely collected assessment records to model potential risk factors for detention. Local assessors were interviewed to explore factors that might help or hinder detention minimisation. Main findings Assessments were less likely to result in detention when professionals other than the assessing team were in attendance, although this association weakened after adjusting for potential confounders. Interviewed assessors identified factors that could contribute to detention minimisation in the assessment process, in general service provision, and in wider society. Conclusion Some local assessment processes could contribute to minimising detention rates, such as community team participation in assessments. Challenges posed by limited resources and community and inpatient care were particularly evident. Consideration of these might also help reduce detentions.

QoE-aware user association and resource allocation for mixed services in heterogeneous networks

In heterogeneous networks (HetNets), user association and resource allocation (UARA) is a great challenge for radio resource management (RRM). In this paper, a novel QoE-aware UARA scheme is proposed. The delay factor is introduced to QoE metric to weight delays’ effect on service transmitting. Then the UARA scheme based on QoE is formulated as an optimization problem which is a mixed integer nonlinear programming (MINLP) problem. To solve the problem, we adopt the genetic algorithm (GA) and associate the user association and the resource with population and fitness respectively. Through the evolutions of genetic algorithm, the optimal UARA scheme can be worked out. The simulation results indicate that the proposed scheme can reduce packet loss rate, and improve the system load balancing performance.

Integrated Millimeter Wave and Sub-6 GHz Wireless Networks: A Roadmap for Joint Mobile Broadband and Ultra-Reliable Low-Latency Communications

Next-generation wireless networks must enable emerging technologies such as augmented reality and connected autonomous vehicles via a wide range of wireless services that span enhanced mobile broadband (eMBB) and ultra-reliable low-latency communication (URLLC). Existing wireless systems that solely rely on the scarce sub-6 GHz, mW frequency bands will be unable to meet such stringent and mixed service requirements for future wireless services due to spectrum scarcity. Meanwhile, operating at high-frequency mmWave bands is seen as an attractive solution, primarily due to the bandwidth availability and possibility of large-scale multi-antenna communication. However, even though leveraging the large bandwidth at mmWave frequencies can potentially boost the wireless capacity for eMBB services and reduce the transmission delay for low-latency applications, mmWave communication is inherently unreliable due to its susceptibility to blockage, high path loss, and channel uncertainty. Hence, to provide URLLC and high-speed wireless access, it is desirable to seamlessly integrate the reliability of mW networks with the high capacity of mmWave networks. To this end, in this article, the first comprehensive tutorial for integrated mmWave-mW communications is introduced. This envisioned integrated design will enable wireless networks to achieve URLLC along with eMBB by leveraging the best of two worlds: reliable, long-range communications at the mW bands and directional high-speed communications at the mmWave frequencies. To achieve this goal, key solution concepts are discussed that include new architectures for the radio interface, URLLC-aware frame structure and resource allocation methods along with mobility management, to realize the potential of integrated mmWave-mW communications. The opportunities and challenges of each proposed scheme are discussed and key results are presented to show the merits of t

Аналітичні моделі багатопріоритетних хмарних дата-ценрів зі змішаною дисципліною надання послуг з урахуванням особливостей функціонування та можливих відмов

One of the main indicators of the effectiveness of cloud data centers are indicators based on the assessment of temporal characteristics. Violation of permissible time constraints, for example, the response time of cloud data centers, has a negative impact on the efficiency of solving user target tasks. This is of particular importance for real-time systems and, above all, for special information systems built using private clouds. Analytical models of cloud data centers are developed as queuing systems with a mixed discipline of resource allocation. The models take into account failures and various features of functioning and have arbitrary distribution laws for some stochastic processes. For each model, analytical expressions for computing time characteristics have been obtained. Such models for the cloud data centers are used for the first time. General description of the models is as follows. At the input of the cloud date - center, which implements a mixed service discipline (with relative and absolute priorities), receives N Poisson flows of requests for resources with corresponding N priorities. Duration of service for applications of various flows have their own arbitrary distribution laws. An application with relative priority, whose service is interrupted by applications with absolute priority, returns to the queue. Two disciplines for the renewal of service A and B are considered. Within the same priority, applications are serviced in the order of receipt. Cloud the date-center refuses to provide resources (for example, fails) under the Poisson law, and is restored under an arbitrary law. During the recovery period, elements of adaptation to failures are used: applications of some flows to the queue are accepted and accumulated, while others are not accepted (the discipline of the queue replenishment, I and II, respectively). The denial of service device can occur both during its free state and during the application processing. Two disciplines of resumption of service after restoration C and D have been considered. An interrupted application is processed from the point of its interruption. The combination of disciplines — resumption of service and queue replenishment — allows us to consider independent models of various types of systems that have the respective designation. Different features of functioning consist of various combinations of disciplines A, B, C, D, I and II, for which analytical formulas for calculating time characteristics of different types of systems have been obtained.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Chantal HoussetChantal HoussetChantal Housset was trained as a Hepatologist in René Descartes University Paris 05, France. She was Visiting Scientist and NIH grant recipient in 1992, at University of California, San Francisco, California, USA. She obtained a PhD degree from Denis Diderot University Paris 07, France, in 1993 and Research Direction Habilitation from Sorbonne University Paris 06, France, in 1998. She was appointed fulltime Researcher at INSERM (National Institute of Health and Medical Research) in 1994, and full-time Professor in Cell Biology at Sorbonne University Paris 06, in 2000. She is Course Director of molecular and cellular biology at Sorbonne University Medical School & Life Science Department. She is Member of the Executive Committees of the Reference Center for Inflammatory Biliary Diseases and Auto-immune Hepatitis, Saint-Antoine Hospital, of the Rare Liver Disease National Network (FILFOIE), and of the Institute of Cardiometabolism and Nutrition (ICAN). She is Director of an INSERM- Sorbonne University Research Laboratory in Saint-Antoine Research Center (CRSA). The expertise of the Laboratory relates to the mechanisms responsible for metabolic and biliary diseases of the liver and their progression towards fibrosis. Dr Housset is currently Director of an INSERM-UPMC mixed service unit (UMS) of imaging and cytometry (LUMIC). She is member of the University National Council (CNU) in Cell Biology. She has been recipient of a reward from the Ministry of Education and Research (MESR) since 2007. She published 150 articles. Her main scientific contributions relate to the mechanisms of bile secretion, the pathobiology of biliary diseases, the origins and functions of liver myofibroblasts. Eamonn M.M. QuigleyEamonn M.M. QuigleyEamonn M.M. Quigley is Chief of Gastroenterology and Hepatology at Houston Methodist Hospital in Houston, Texas, USA, Professor of Medicine at Weill Cornell Medical College and David M Underwood Chair of Medicine in Digestive Disorders. A graduate of University College Cork, Ireland, Dr Quigley trained in internal medicine in Glasgow and Manchester, and in gastroenterology in Glasgow, the Mayo Clinic, USA, Rochester, Minnesota and Manchester. In 1986, he joined the faculty at the University of Nebraska Medical Center in Omaha, Nebraska, USA, where he ultimately served as Chief of Gastroenterology and Hepatology. Returning to Cork in 1998, he served as Dean of the Medical School at UCC for 7 years and was a principal investigator at its Alimentary Pharmabiotic Center from its inception. He served as president of both the American College of Gastroenterology and the World Gastroenterology Organization and is a past editor-in-chief of the American Journal of Gastroenterology. Clinical and research interests include irritable bowel syndrome, gastrointestinal motility and the role of the gut microbiota in health and in gastrointestinal and metabolic disorders.

152Empowering patients through educating and counselling for lifestyle changes using the web-based intervention “care information exchange”: a mixed method service evaluation

152Empowering patients through educating and counselling for lifestyle changes using the web-based intervention “care information exchange”: a mixed method service evaluation

Bandwidth estimation for aggregate traffic under delay QoS constraint based on supermartingale theory

Bandwidth estimation for network traffic plays an important role in various communication network applications. Due to the diversity presented by the network services, exploring theory and methods to measure bandwidth of superposition of traffic flows has great practical significance. In this paper, we propose a supermartingale approach to calculate bandwidth for aggregate traffic under delay Quality of Service (QoS) constraint. The concept of supermartingale bandwidth is put forward to define the required bandwidth of traffic, which measures bandwidth more accurately. The communication network carrying mixed services is modeled as a queuing system with aggregate arrival traffic. Supermartingale method enables the complex queuing system analysis. Based on the stopping time theory of supermartingale, remarkably tight bound of delay-violation probability for aggregate traffic is derived. Subsequently, we estimate the bandwidth according to delay QoS requirement and traffic characteristics. Searching program for bandwidth estimation is designed. Simulation results show that the estimated bandwidth through supermartingale model is more accurate and smaller than effective bandwidth, especially when arrival traffic has bursty feature. Although this approach is presented for the analysis of two typical arrivals, the proposed model is applicable to general aggregate traffic.

The Controversy of Views About Health Service Quality Between Health Provider and Patients With Bpjs Insurance:A Case Study in Mamami Hospital – Kupang

BACKGROUND: The latest challenge of hospital service system in Indonesia now adays is the controversy of views about health service quality between health provider with patients andfamilies. Patients as the ultimate assessors measure the quality from medical care started up to the patients get cured without any physical defect. Mean while, the health providers as the health suppliers see the quality of health service from the using of medical scientific standard up to the curing of sickness.PURPOSE: The paper analyzes the controversy of health service quality between the Providers and patients in Mamami Hospitaluse BPJS (Badan Penyelenggara JaminanSosial) as a Social Insurance Administration Bureau in Indonesia.METHODS: Observational survey with cross sectional. Independent variables: sympathy and empathy, interaction, environment quality. Dependent variable: health service quality. Variables measurement: Likert scale. Population and sample: BPJS inpatient for 3 days in Mamami hospital. Sample number: 200 respondents taken with purposive sampling.RESULT: The three independent variables effect health service quality. Significant point of sympathy and empathy (β = 490; α = 0.00); environment quality (β = 180; α = 0.48); interaction with patients (β = 233; α = 0.18).CONCLUSION: Controversy of viewseliminated in modern health service system. Mixed service between medical care and cognitive service is the answer. The providers come in and get inpatient service in the room for patients with psychological deficiency. The mixed of service have impacts in the change of patients’ status: from consumers to customers. The resultant for health service institutions is profitability.

A trial engagement? Innovative free and other service trials

PurposeThis paper aims to discover how consumers process an innovative set of systematically varied service trial offers and how this affects their learning and interaction as precursors to customer engagement.Design/methodology/approachThe research uses experiments that manipulate pricing, type of service and delivery method. A repeated-measures design was used with a sample of 396 participants.FindingsFree (as opposed to cost or full price) service trials were more likely to be accepted, with perceived truthfulness of the trial offer and perceived obligation mediating the relationship. Credence service trials generate higher levels of perceived obligation than experience service trial offers, while personal services are more likely to lead to trial adoption.Research limitations/implicationsThe research can be extended to well-recognized brands and further mixed service contexts.Practical implicationsTrial offers of new services are best targeted at buyers who are in the likely buyer group. The trial offer may accelerate time to purchase and relieve perceived risks. The trials of credence services need further signals of quality in the trial itself for consumers to adopt the full service. With personal service trials, skeptical consumers need assurance as to what will happen after the trial experience. Free trials may actually devalue a service, threatening engagement.Originality/valueUniquely, service trial offers are systematically manipulated using experience versus credence and personal versus impersonal trials to determine their effect on acceptance of the trial offer and the full service. Additionally, the study compares free, cost price and full price trial offers.

Spectral‐efficient resource allocation for mixed services in OFDMA‐based 5G heterogeneous networks

AbstractOne of the principal thrusts of proposed fifth‐generation networks is the provisioning of mixed services or heterogeneous quality of service, which includes delay‐sensitive and delay‐tolerant services. Guaranteeing the fairness in data rate among end users in such a complex network brings many challenges. In this paper, we consider heterogeneous quality of service and fairness in the problem of spectrally efficient resource allocation in orthogonal frequency‐division multiple access (OFDMA)‐based fifth‐generation heterogeneous networks with femtocells. We aim to maximize the total capacity of all femtocells while satisfying the following: fairness constraint for delay‐tolerant users, minimum throughput for delay‐sensitive users, cross‐tier interference threshold of femtocell heterogeneous networks, and exclusive property of OFDMA subchannels. The formulated problem is combinatorial and nonconvex due to the integer constraint of OFDMA subchannels and the nonaffine equality constraint of the fairness. To make the problem more tractable, we propose to maximize the overall throughput over instantaneous data rate instead of power and subchannel. By doing this, the fairness equality becomes affine on instantaneous data rate. The feasible domain of the problem is redefined with the constraints of subchannels readily included. The transformed problem takes the standard convex form, which is much simpler and is easily solved using the Lagrangian dual method. The proposed algorithm has a low complexity and provides a higher spectral efficiency compared with existing algorithms.

The misleading choice for safer births in Brazilian’s most developed region: a cross-sectional study

Purpose: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery.Materials and methods: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery.Results: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity.Conclusions: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.

A quasi-birth-and-death process approach for integrated capacity and reliability modeling of railway systems

A railway system's capacity is an important performance indicator allowing to assess different infrastructure variants and to devise market-compliant schedules. Existing approaches in capacity analysis assume the unrestricted availability and peak performance of all system components. Disruptions leading to infrastructure unavailability and reduced system performance are not considered in long- and medium term tactical planning of capacity.We present a quasi-birth-and-death process approach for the integrated modelling of capacity and reliability. By allowing for phase-type distributed arrival, service and repair processes the model permits to describe a wide range of schedule and operational characteristics. At the same time, the solvability of Markovian processes and the information on the queue length distribution are preserved. The model is solved using a Krylov-subspace method, which allows to effectively deal with large state spaces and transition matrices.The approach is compatible to existing queueing-based models in the capacity analysis of railway lines and junctions. The functionality of the method is demonstrated in a case study of a mixed service railway line with infrastructure unavailability.

혼합 현실 서비스의 GUI(Graphic User Interface) 디자인 스타일 연구 : 현실 세계와 가상 Object 간의 구분 방법에 대한 분석을 중심으로

혼합 현실 서비스의 GUI(Graphic User Interface) 디자인 스타일 연구 : 현실 세계와 가상 Object 간의 구분 방법에 대한 분석을 중심으로

Load Balancing Scheme with PTM Mode for Multicast Services Between MBSFN

In long term evolution (LTE) networks, the multicast services can be transmitted by single frequency network (SFN) mode or point-to-multipoint (PTM) mode, and the unicast services are delivered with point-to-point (PTP) mode. To avoid the network congestion in the LTE networks with the multicast and unicast mixed services, a load balancing (LB) scheme with PTM mode is proposed to minimize the demanded radio resources of the maximum load cell. The system model of the demanded radio resources is based on the signal to interference noise ratio (SINR) of multicast services with SFN mode and PTM mode. Then the minimization problem is solved by means of simulated annealing (SA) heuristics. It selects the optimal transmission mode between SFN and PTM for multicast services. Simulation results show that the proposed LB needs less demanded radio resources of the maximum load cell than SFN mode for all the multicast services.

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is widely used in most developed countries, providing considerable opportunities for improved cost savings. However, it is implemented only partially in the UK, using a variety of service models.ObjectivesThe aims of this research were to (1) establish the extent of OPAT service models in England and identify their development; (2) evaluate patients’ preferences for different OPAT service delivery models; (3) assess the cost-effectiveness of different OPAT service delivery models; and (4) convene a consensus panel to consider our evidence and make recommendations.MethodsThis mixed-methods study included seven centres providing OPAT using four main service models: (1) hospital outpatient (HO) attendance; (2) specialist nurse (SN) visiting at home; (3) general nurse (GN) visiting at home; and (4) self-administration (SA) or carer administration. Health-care providers were surveyed and interviewed to explore the implementation of OPAT services in England. OPAT patients were interviewed to determine key service attributes to develop a discrete choice experiment (DCE). This was used to perform a quantitative analysis of their preferences and attitudes. Anonymised OPAT case data were used to model cost-effectiveness with both Markov and simulation modelling methods. An expert panel reviewed the evidence and made recommendations for future service provision and further research.ResultsThe systematic review revealed limited robust literature but suggested that HO is least effective and SN is most effective. Qualitative study participants felt that different models of care were suited to different types of patient and they also identified key service attributes. The DCE indicated that type of service was the most important factor, with SN being strongly preferred to HO and SA. Preferences were influenced by attitudes to health care. The results from both Markov and simulation models suggest that a SN model is the optimal service for short treatment courses (up to 7 days). Net monetary benefit (NMB) values for HO, GN and SN services were £2493, £2547 and £2655, respectively. For longer treatment, SA appears to be optimal, although SNs provide slightly higher benefits at increased cost. NMB values for HO, GN, SN and SA services were £8240, £9550, £10,388 and £10,644, respectively. The simulation model provided useful information for planning OPAT services. The expert panel requested more guidance for service providers and commissioners. Overall, they agreed that mixed service models were preferable.LimitationsRecruitment to the qualitative study was suboptimal in the very elderly and ethnic minorities, so the preferences of patients from these groups might not be represented. The study recruited from Yorkshire, so the findings may not be applicable nationally.ConclusionsThe quantitative preference analysis and economic modelling favoured a SN model, although there are differences between sociodemographic groups. SA provides cost savings for long-term treatment but is not appropriate for all.Future workFurther research is necessary to replicate our results in other regions and populations and to evaluate mixed service models. The simulation modelling and DCE methods used here may be applicable in other health-care settings.FundingThe National Institute for Health Research Health Service and Delivery Research programme.