Travel Savings Research Articles

Remote kaizen events: a response to COVID-19 and the new normal

Kaizen events are an important part of lean programmes. Traditionally, these events bring a small team to work together over a 3-to-5-day period with a facilitator. This paper explores how these events can be run remotely. We ask: What are the impacts and challenges posed by COVID-19 on kaizen events? What would you need to change in their design and deployment to run them successfully remotely? Could remote kaizens be the way forward for firms with advanced Lean in place? These RQs are investigated in a multi-method approach with multi-national construction technology group Hilti. We found, after readjustment, that it was possible to run successful kaizen events on a global basis with remote facilitation. The cost of running the events was lower due to the savings in travel, they provided a better work-life balance for facilitators, allowed for a more expert work teams although events did involve a greater preparation time. The cost-saving results were as good as or better than physical events. However, the events often felt worse for the participants raising questions about future success. Even so, within the advanced Lean Hilti organisations remote kaizen events will be the de facto new normal standard going forward.

Telerheumatology Shared-Care Model: Leveraging the Expertise of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-Trained Extended Role Practitioner in Rural-Remote Ontario.

A shortage of rheumatologists has led to gaps in inflammatory arthritis (IA) care in Canada. Amplified in rural-remote communities, the number of rheumatologists practicing rurally has not been meaningfully increased, and alternate care strategies must be adopted. In this retrospective chart review, we describe the impact of a shared-care telerheumatology model using a community-embedded Advanced Clinician Practitioner in Arthritis Care (ACPAC)-extended role practitioner (ERP) and an urban-based rheumatologist. A rheumatologist and an ACPAC-ERP established a monthly half-day hub-and-spoke-telerheumatology clinic to care for patients with suspected IA, triaged by the ACPAC-ERP. Comprehensive initial assessments were conducted in-person by the ACPAC-ERP (spoke); investigations were completed prior to the telerheumatology visit. Subsequent collaborative visits occurred with the rheumatologist (hub) attending virtually. Retrospective analysis of demographics, time-to-key care indices, patient-reported outcomes, clinical data, and estimated travel savings was performed. Data from 124 patients seen between January 2013 and January 2022 were collected; 98% (n = 494/504 visits) were virtual. The average age of patients at first visit was 55.6 years, and 75.8% were female. IA/connective tissue disease (CTD) was confirmed in 65% of patients. Mean time from primary care referral to ACPAC-ERP assessment was 52.5 days, and mean time from ACPAC-ERP assessment to the telerheumatology visit was 64.5 days. An estimated 493,470 km of patient-related travel was avoided. An ACPAC-ERP (spoke) and rheumatologist (hub) telerheumatology model of care assessing and managing patients with suspected IA in rural-remote Ontario was described. This model can be leveraged to increase capacity by delivering comprehensive virtual rheumatologic care in underserved communities.

The Landscape of Health Technology for Equity Deserving Groups in Rural Communities: A Systematic Review.

Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes. The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups. The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool. Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings. This evidence synthesis includes papers (n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients. There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.

Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis

BackgroundTelemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel...

An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study.

Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto's Hospital for Sick Children (SickKids). This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids' electronic medical records (Epic) with a chief complaint of "medical device problems," after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to "medical device problems" over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits.

The virtual knee clinic – A tool to streamline new outpatient referrals

IntroductionTraditionally it has been the case for orthopaedic consultants to review GP referrals for the orthopaedic outpatient clinic where possible in amongst other clinical commitments. This could sometimes lead to unsuitable patients being reviewed and both patients and clinicians becoming frustrated. Building on the virtual fracture clinic, a new screening tool was implemented to streamline new referrals. The aim of this study is to investigate the change in patients given outpatient appointments following the introduction of a new streamlining protocol. MethodsReferrals had to meet the criteria of BMI under 40 or evidence of weight loss effort, recent radiographs and appropriate clinical details in keeping with Getting It Right First Time (GIRFT). Consultant were given dedicated clinical time to review and either triage the patient to the most appropriate clinic type, or return the referral with advice to the GP. 10 months of data was collected prior to the protocol and 10 months after implementation. Results1781 patients were referred pre-protocol with an average of 14.2% of these being returned. Post protocol there were 2110 patients referred with 31.2% returned. There was an increase in 195% of referrals returned to the GP (p < 0.0001). The highest proportion of these was for mild to moderate osteoarthritis on the radiograph which has been proven to be unsuitable for intervention. At 12 month analysis there was no significant increase in patients re-referred to the service (p = 0.53) DiscussionThe new screening tool allows more appropriate referrals to be seen in clinic allowing less frustration to clinicians and patients by reducing therapeutic inertia. Furthermore it allows new referrals to be seen by the most appropriate sub-specialist. It allows advice to be given to GPs on further management for the patient. 619 appointments were saved. At a cost of £120 per appointment, this leads to a real terms cost saving of £74,280, with further savings in time and travel.

Comparison of Telehealth and In-Person Behavioral Health Services and Payment in a Large Rural Multisite Usual Care Study.

Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.

Analysis of the financial impact and efficiency of the One Stop Prostate Clinic: A same day prostate cancer diagnostic clinic in the Australian public health system.

Access to prostate cancer diagnostic clinics are challenging for rural men in Western Australia due to remoteness and long travel distances. The One Stop Prostate Clinic (OSPC) provided same day assessment and diagnosis for prostate cancer in a public tertiary hospital to reduce access barriers for rural men. The objective of this study was to determine the financial and resource utilisation impact of the OSPC compared to a usual care pathway (UCP). Study design: Cost minimisation analysis of the OSPC model (assuming 100% new referrals) compared with a UCP, including impact on the Patient Assisted Transport Scheme (PATS) for rural men. An estimate of total cost comparison of OSPC and UCP pathways of outpatient and diagnostic costs was calculated based on journey mapping of attendance and follow up. Prospective data collection between August 2011 and November 2017 of referral, attendance and follow up outcomes. Journey mapping to identify time from referral to diagnosis, number of outpatient appointment (OPA) and travel savings. A total of 1000 men attended - 466 (47%) rural and 534 (53%) metro. Mean time from referral to diagnosis was 57 days (rural) versus 63 (metro; p = 0.034)). The OSPC saved 543 travel episodes (distance of 1.5M km) and 658 OPA's. Total episode of care costs for the OSPC (100% new) pathway estimated as $2237.34, compared to $2847.00 for a UCP, generating savings of $609.66 per attendance ($609,658.22 overall). The OSPC was more cost effective and efficient in comparison to a UCP.

Do highway widenings reduce congestion?

Abstract Highway construction occurs nowadays mainly through widening of existing roads rather than building new roads. This article documents that highway widenings considerably reduce congestion in the short run, defined here as 6 years. Using longitudinal microdata from highway detector loops in the Netherlands, we find substantial travel time savings. These savings occur despite strong increases in traffic flow. The welfare benefits in the short run already cover 40% of the widenings’ investment costs. Our article contributes to an explanation why countries invest in roadworks even when the fundamental law of congestion predicts that travel savings disappear in the long run.

The use of video consultations to support orthopedic patients' treatment at the interface of a clinic and general practitioners

IntroductionVideo consultations have proven to be a powerful support tool for patient–doctor interactions in general, not only during the COVID-19 pandemic. This study analyzed the feasibility and usefulness of orthopedic telemedical consultations (OTCs) for orthopedic patients at the interface of a clinic and general practitioners.MethodsThe study was carried out at an orthopedic department of a German hospital between April 2020 and October 2020. After written informed consent was obtained, general practitioners (GPs) of a large adjunct health region could present their patients with orthopedic pathologies to specialists at the hospital via OTCs instead of the usual live consultation (LC). The patients, specialists and GPs were evaluated for their OTC experience and attitude (5-point Likert-scale and open questions, 19 to 27 items).ResultsA total of 89 video consultations took place with 76 patients, 16 GPs and six specialists. The average distance between the GPs/patients and the hospital was 141.9 km. The OTCs were rated as pleasant, and the experience was rated as very satisfying (average Likert-Scale rating, with 5 as strong agreement: specialists = 4.8; GPs = 4.9; patients = 4.7). Following the OTC, a LC was not necessary in 76.4% of cases. Patients with a necessary LC after an OTC showed significantly lower satisfaction with the OTC (p = 0.005). Time savings, the elimination of travel and quick contact with orthopedic consultants were positively highlighted by the participants. A total of 123 recommendations for further treatment were given, such as the initiation of physiotherapy/medication and the use of imaging diagnostics. Different technical and organizational challenges could be identified and addressed.DiscussionThe vast majority of the participants stated they had a very positive impression. In particular, the potential savings in travel and time as well as straightforward contact with specialists were rated positively. However, limitations in the assessment of initial presentations of complex medical conditions were also highlighted. Further studies on OTCs with a consultative health professional may show other fields of use for this mode of interdisciplinary remote communication.

Environmental impact of telerehabilitation visits in an urban setting

• Travel cost and time burden are reduced using telehealth. • Telehealth positively impacted the environment by eliminating travel related gas emissions. • Patients and providers report high satisfaction with care delivered by SVV. Climate change has been described as the largest public health concern of the 21st century. In response to climate change over 50 countries have pledged to go carbon neutral in the provision of health care services and telemedicine can be an integral part of decreasing emissions related travel associated with health care. While telemedicine rapidly expanded to increase access to care during the Covid-19 pandemic, the impact of telerehabilitation on climate change as part of the provision of physical rehabilitation services has not been assessed. This study focuses on physical medicine and rehabilitation physicians in an urban physical medicine and rehabilitation (PM&R) department and assesses patient satisfaction with synchronous video visits (SVVs) as well as the estimated value of SVVs in travel savings and carbon emissions. We conducted a retrospective chart review, implemented a patient survey, and conducted a commuter analysis to report our experience using SVVs to provide follow-up care across multiple rehabilitation sub-specialties A total of 154 SVVs were conducted before the pandemic over an 18-month period. The most commonly addressed issues during the SVVs were rehabilitation and medication management, followed by equipment, lab and imaging results. About one-third of the patients (31%) were non-ambulatory at the time of their SVV. On average, SVVs reduced travel distance (95 miles), travel time (2.23 h), travel cost ($15) and carbon emissions. The use of telerehabilitation should be an integral part of decreasing the carbon footprint of provision of physical medicine and rehabilitation services.

Global adoption of single-shot targeted intraoperative radiotherapy (TARGIT-IORT) for breast cancer-better for patients, better for healthcare systems.

Micro abstractTargeted intraoperative radiotherapy (TARGIT-IORT) is delivered immediately after lumpectomy for breast cancer. We estimated its impact. At least 44,752 patients with breast cancer were treated with TARGIT-IORT in 260 centres in 35 countries, saving >20 million miles of travel and preventing ~2,000 non–breast cancer deaths. The TARGIT-IORT website (https://targit.org.uk/travel) provides maps and tools to find the nearest centre offering TARGIT-IORT and travel savings.BackgroundTargeted intraoperative radiotherapy (TARGIT-IORT) delivers radiotherapy targeted to the fresh tumour bed exposed immediately after lumpectomy for breast cancer. TARGIT-A trial found TARGIT-IORT to be as effective as whole-breast radiotherapy, with significantly fewer deaths from non–breast cancer causes. This paper documents its worldwide impact and provides interactive tools for clinicians and patients.MethodCentres using TARGIT-IORT provided the date of the first case and the total number of patients. We plotted these data on a customised Google Map. An interactive web-based tool provided directions to the closest centre. Using the data from the TARGIT-A trial, we estimated the total savings in travel miles, carbon footprint, and the number of non–breast cancer deaths that might be prevented.ResultsData from 242 (93%) of the 260 centres treating patients from 35 countries were available. From the first patient treated in 1998 to early 2020, at least 44,752 women with breast cancer have been treated with TARGIT-IORT. The TARGIT-IORT website (https://targit.org.uk/travel) displays the Google Map of centres with number of cases and an interactive tool for patients to find the nearest centre offering TARGIT-IORT and their travel savings. Scaling up to the already treated patients, >20 million miles of travel would have been saved and about 2,000 deaths prevented.ConclusionOne can ascertain the number of patients treated with a novel treatment. These data show how widely TARGIT-IORT has now been adopted and gives an indication of its beneficial worldwide impact on a large number of women with breast cancer.

The viability and acceptability of a Virtual Wound Care Command Centre in Australia.

The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.

A Decision Support System for Re-Slotting a Case Pick Distribution Center

This research presents a class-based re-slotting procedure that re-assigns stock-keeping units (SKUs) in a warehouse secondary storage area to new locations based on the SKU activity. The general notion of re-slotting is to place high activity SKUs in premium locations near the pickup/drop-off points of shipping and receiving. This simulation study examines the performance of an ABC class-based rule for guiding SKU swaps between the front and rear sections using case pick data provided by a large regional pharmaceutical distributor. The simulation results show this class-based case pick re-slotting heuristic provides significant savings in picker travel.

Care coordination for rural residents with chronic disease: Predictors of improved outcomes.

The purpose of this study was to assess the effect of an integrated system of coordinated care on chronic disease health outcomes of patients with poorly controlled diabetes, hypertension, and congestive heart failure (CHF) living in a rural area. Longitudinal study of patients aged 18 years or older, living in a rural area, with diabetes glycated hemoglobin (A1C)>8%, hypertension blood pressure (BP)>150/90, heart failure, and suffering excessive weight gain and hospital admission in last 6 months. Dependent variables were A1C, cholesterol, microalbumin, body mass index (BMI), BP, emergency department (ED) visits, and hospital admissions. Predictor variables included time in the program, age, sex, race, and Diabetes Self-Management Education (DSME) completion. Descriptive variables included telemedicine and specialty referrals and travel savings. Time had a significant effect on A1C, microalbumin, BP, and ED visits. Race, sex, and DSME also impacted A1C and BP outcomes. Length of time in the program played a crucial role in improved outcomes for patients in the program for a year or more. Long-term, consistent reinforcement in the form of education and coordinated care provided by certified care coordination nurses achieve better health outcomes.

Benefits and Challenges of Implementing Telehealth in Rural Settings: A Mixed-Methods Study of Behavioral Medicine Providers.

Social workers and other healthcare professionals face increasing pressure to expand access, efficiency, and quality of healthcare to rural patients. Telehealth has become a viable and necessary tool to address gaps in healthcare for rural areas. Unfortunately, little is known about the benefits and challenges of using these services to meet the needs of rural communities. This mixed-methods study examines telehealth implementation among healthcare organizations in a predominantly rural state. Seventeen providers from 11 organizations were interviewed. Most had used live video conferencing, and about a third used mobile technologies, but fewer providers had experience with store-and-forward or remote patient monitoring. Analyses of qualitative data collected via interviews revealed two main themes among benefits of telehealth implementation: (1) increased inter- and intra-agency coordination and (2) savings in time, travel, and efficiency. Three main themes emerged among barriers to telehealth: (1) organizational capacity, (2) patient skills and comfort, and (3) provider knowledge and skills. Recommendations are provided for social workers and other healthcare professionals related to expanding utilization of telehealth services to improve access to healthcare for rural populations.

A Dynamic Tree Algorithm for Peer-to-Peer Ridesharing Matching

On-demand peer-to-peer ridesharing services provide flexible mobility options and are expected to alleviate congestion by sharing empty car seats. An efficient matching algorithm is essential to the success of a ridesharing system. The matching problem is related to the well-known dial-a-ride problem, which also tries to find the optimal pickup and delivery sequence for a given set of passengers. In this paper, we propose an efficient dynamic tree algorithm to solve the on-demand peer-to-peer ridesharing matching problem. The dynamic tree algorithm benefits from given ridesharing driver schedules and provides satisfactory runtime performances. In addition, an efficient pre-processing procedure to select candidate passenger requests is proposed, which further improves the algorithm performance. Numerical experiments conducted in a small network show that the dynamic tree algorithm reaches the same objective function values of the exact algorithm, but with shorter runtimes. Furthermore, the proposed method is applied to a larger size problem. Results show that the spatial distribution of ridesharing participants influences the algorithm performance. Sensitivity analysis confirms that the most critical ridesharing matching constraints are the excess travel times. The network analysis suggests that small vehicle capacities do not guarantee overall vehicle-kilometer travel savings.

Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study.

BackgroundThe National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom.ObjectiveWe aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving.MethodsFrom April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected.ResultsA total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment.ConclusionsTeleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses.

Response to Telemedicine Visits From Patients With Parkinsonism During the COVID-19 Pandemic on Postvisit Surveys.

Parkinson’s disease and parkinsonism are common chronic neurodegenerative disorders that tend to affect older adults and cause physical and sometimes cognitive limitations. Given that these limitations could impact successful telemedicine use, we aimed to investigate the experiences of patients with parkinsonism using telemedicine during the COVID-19 pandemic. A 19-item survey was emailed to patients with parkinsonism following telemedicine visits at a single US tertiary care parkinsonism specialty clinic. Seventy-four individuals responded, out of 270 invitations sent. Almost two-thirds (61.6%) of the respondents were comfortable with using technology in general, and almost all were very satisfied with their telemedicine experience. The most commonly reported benefits included cost and travel savings, ease of access to a specialist, and time savings. Issues with technology and previsit instructions were the most commonly identified challenges (28%). Urgent implementation, due to the pandemic, of telemedicine care for patients with parkinsonism was feasible and well received. The challenges most commonly reported by patients could be potentially alleviated by better education and support.

Mental Time Travel and Retirement Savings

Mental Time Travel and Retirement Savings