Outpatient appointment scheduling problem considering patient selection behavior: data modeling and simulation optimization

Involuntary commitment in mental health represent a challenge for professionals working in outpatient services, due to tensions between therapeutic necessity and criticisms from a human rights perspective. Effective management of involuntary commitment requires a dual-level approach: comprehensive risk assessment followed by appropriate risk management. This paper outlines practical guidelines for managing involuntary detention across diverse outpatient settings. We analyze six distinct healthcare scenarios: 1) outpatient services within specialized or general hospitals; 2) public outpatient care services; 3) private outpatient care services within healthcare centers; 4) private outpatient care services outside healthcare centers; 5) private practice offices; and 6) telepsychiatry. For each scenario, we provide detailed recommendations addressing referral protocols, patient safety measures, and inter-professional-institutional coordination. Our findings suggest that implementing clear protocols and standardized guidelines significantly reduces professional uncertainty, minimizes improvisation in critical situations, and ensures consistent, high-quality patient care.

In the UK outpatient services are a major element of the health service for older people and large numbers are requested to attend hospital-based outpatient clinics. However, it has been reported that outpatient clinics have fallen behind improvements in inpatient and primary care and they are seldom the focus of the patient-centred quality agenda that promotes personalised care. Significant proportions of older people fail to attend their appointments and there are few studies into the experience of older patients using outpatient services. In this paper we report on a design-led service improvement project that involved older people using a medical outpatient service and its staff. The project was facilitated by an interdisciplinary user-centred healthcare design team consisting of designers, technologists and health professionals formed to develop new participatory design methodologies and translate design thinking and practices into health services. A significant finding of the project is that an outpatient service extends beyond both the clinical encounter and the physical extent of the building, with many touchpoints before and after an appointment, such as confirmation letters, journeys and wayfinding, and staff interactions. These significant interfaces and interactions constitute critical factors in the experience of patients and staff and impact upon the ability of the service to perform its clinical role. We argue that through the deep engagement, achieved by capturing the lived experience of patients and staff, the clinic can be reconceived and reconstructed from a user perspective and thus improve its clinical effectiveness and enhance the quality of its service. We discuss the benefits and practicalities of using an experience-based approach to service improvement in health care, and we describe the improvements and changes co-produced with the users of this outpatient system.

One of the quality of outpatient services in hospitals is the provision of fast and accurate medical record files so that they can support good health services. Provision of medical record documents in outpatient services in accordance with Hospital Minimum Service Standards No.129/Menkes/SK/II/2008 that is less than or equal to 10 minutes, but to determine the continuity of the time suitability, monitoring analysis needs to be carried out, whether there is an increase in speed of medical record services or experiencing a decline in medical record services. So if there are significant obstacles, it is necessary to look for the causative factors, then if the speed of service increases, it is necessary to know and improve what factors greatly influence the increase of speed in medical record services of the outpatient unit of X Hospital. The purpose of this study is to monitor and analyze the speed of medical record services in the outpatient unit of X Hospital. The type of research conducted is qualitative research. The subject of this research is the coordinator in each part of processing (assembling, coding, indexing, analyzing), distribution, filing or storage and retrieval of medical records.

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family’s socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.

The major problem of furrow irrigation systems is their low efficiency resulting from weakness in design and irrigation management. Flow rate, furrow length and cut‐off time are the most important furrow irrigation design parameters that affect efficiency and irrigation management. Therefore, in this paper, it is attempted to provide optimal values of these parameters by optimizing them in a simulation–optimization framework. This is a combination of FURDEV (a module of SURDEV) and AMALGAM as a multi‐objective optimization algorithm developed in MATLAB. Here, maximizing the application and the water requirement (storage) efficiencies and minimizing the percolation and tail water ratios simultaneously were considered as the objectives. This framework was used for five open‐ended furrow irrigations with corn yield and loam soil texture. The results showed that the increase of 0 to 40.5% in the flow rate, from 23.2 to 66.9% during the furrow and 18.9% up to 11.9% at the cut‐off time, caused the application efficiency to increase by between 13.8 and 44.9%. Also, the water requirement efficiency increased by 14.2–76.8%, and the tail water ratio decreased significantly. It is shown that this framework plays an effective role in improving irrigation efficiency. © 2020 John Wiley & Sons, Ltd

Maintenance workflow management in hospitals: An automated multi-agent facility management system

EE213 Long COVID-19 Associated with 5-Fold Increase in Total Medical Costs and Greater Use of Inpatient and Outpatient Services Compared to Non-Long COVID-19: An Analysis of Real-World Data

Outpatient care in Germany is mainly provided in physicians’ private practices. Data from health surveys enable to analyse the utilization of outpatient services from the patient’s perspective, and to identify associations with social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator ‘utilization of outpatient medical care in the last 12 months’. The analysis found that 90.9% of women aged 18 years and over and 84.1% of men had used outpatient medical services within the last 12 months. The utilization of outpatient medical care increases with age: about 94% of people aged 65 or over were provided with outpatient medical treatment in the last 12 months. There were significant differences in utilization between younger men and women, which balance out with age. No differences were identified in relation to educational level or federal state.

As the world is progressing towards faster and more efficient computing techniques, cloud computing has emerged as an efficient and cheaper solution to such increasing and demanding requirements. Cloud computing is a computing model which facilitates not only the end-users but also organizational and other enterprise users with high availability of resources on demand basis. This involves the use of scientific workflows that require large amount of data processing, which can be costly and time-consuming if not properly scheduled in cloud environment. Various scheduling strategies have been developed, which include swarm-based optimization approaches as well. Due to the presence of multiple and conflicting requirements of users, multi-objective optimization techniques have become popular for workflow scheduling. This paper deals with cat swarm-based multi-objective optimization approach to schedule workflows in a cloud computing environment. The objectives considered are minimization of cost, makespan and CPU idle time. Proposed technique gives improved performance, compared with multi-objective particle swarm optimization (MOPSO) technique.

Decentralized multi-echelon supply chains are often computationally intractable and difficult to analyze due to the complex network structure and various decision makings. This paper develops a simulation optimization framework for a general decentralized supply chain composed of sup-pliers, plants, distributors and customers. Each facility in the network is under local control and makes decisions based on a myopic policy. The simulation optimization framework is composed of an event simulator, an optimization engine, a system updater and a process controller. The simulation test bed can help the network facilities asymptotically optimize their decisions based on the feed-back during the simulation process, and evaluate the performance of each facility.

The third leading cause of cardiovascular-associated death, venous thromboembolism (VTE), represents a significant health care and economic burden. Although the burden of a one-time VTE event has been assessed, there are limited data regarding the burden of VTE recurrence. To assess the rate and predictors of VTE recurrence within 1 year in the United States and evaluate the incremental health care resource utilization and costs associated with such VTE recurrences. Patients (≥ 18 years) diagnosed with deep vein thrombosis and/or pulmonary embolism between January 1, 2008, and December 31, 2010, were identified from the Truven Health Analytics MarketScan Commercial and Medicare databases. The earliest VTE diagnosis was defined as the index VTE event. Patients were required to have 12 months of continuous insurance coverage before (baseline period) and after (follow-up period) the index event. Patients were further required to have initiated anticoagulant usage within 30 days of the index VTE event and have at least 30 days of treatment. The incidence of recurrent VTE, defined as a hospitalization or emergency room (ER) visit with a VTE diagnosis in the follow-up period, was determined for the commercially insured and Medicare populations separately. A proportional hazards model was used to assess the predictors of time to VTE recurrences. All cause and VTE-related health care resource utilization including hospitalizations, length of stay, outpatient medical service claims, and outpatient pharmacy claims were assessed along with the associated costs incurred during the 30-day and 12-month post-index event periods. Commercially insured and Medicare patients with and without recurrent VTE were evaluated and compared separately. Generalized linear models were used to further assess the incremental cost burden of recurrent VTE. Among the commercially insured population, 29,275 patients were diagnosed with VTE and received anticoagulant therapy. A recurrence of VTE associated with a hospitalization or ER visit occurred within 12 months of the index VTE in 15.4% of patients with a mean time to recurrence of 74.1 days. Among the Medicare insured population (n = 14,509), 11.4% of patients experienced another VTE with a mean time to recurrence of 115.6 days. A consistent predictor of VTE recurrence across both populations was greater comorbidity as indicated by Charlson Comorbidity Index scores. Among commercially insured VTE patients, total payments for health care resource utilization for all causes, including inpatient, outpatient medical services, and outpatient pharmacy use were higher for patients with a recurrent VTE relative to those without a recurrent VTE ($82,110 [$106,918] vs. $36,918 [$54,852], P less than 0.001). The primary driver for the higher health care payments was greater use of inpatient care. Total payments for VTE-related resource use was also greater for patients with a VTE recurrence ($38,591 [$51,479] vs. $15,123 [$22,186], P less than 0.001) with the majority (62.9%) attributed to care that took place within 30 days of the index VTE. After adjustment for key patient characteristics, VTE recurrence was associated with 2.2-fold and 3.0-fold higher post-index health care payments for all causes and for VTE-related claims, respectively. Similar results were observed for the Medicare population. VTE recurrence associated with a hospitalization or ER visit is associated with substantial health care resource utilization, which is primarily inpatient care undergone within the first 30 days following an initial VTE event. Thus, a sizeable portion of the economic burden of recurrent VTE is also incurred during this short period of time following an initial VTE event. Given that rates of VTE recurrence were high among patients identified as having received anticoagulant treatment, strategies to improve anticoagulation therapy among VTE patients in addition to other preventative measures are needed to lessen the health care and economic burdens of VTE.

BackgroundJapan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP.MethodThis longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time.ResultsThe rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to “prevent exacerbation of somatic symptoms” and “care for families”.ConclusionThese results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.

Inter-brand competition in the convenience store industry, store density and healthcare utilization

BACKGROUND: Cognitive impairment is a widespread issue that affects patients’ quality of life and social functioning. Such impairments may result from neurological and psychiatric disorders, as well as from somatic diseases such as diabetes and hypertension, and from COVID-19 and post-acute COVID-19 syndrome. In recent years, increasing attention has been paid to the relationship between cognitive impairment and pharmacotherapy, particularly the use of antipsychotic medications, which may worsen cognitive deficits. However, data enabling prediction of such impairments, necessary for developing recommendations for pharmacotherapy adjustment based on cognitive-risk profiles, remain insufficient. AIM: This study aimed to identify quantitative associations between risk factors and the development of cognitive impairment in patients with COVID-19. METHODS: This cross-sectional study included patients from outpatient medical services in Saint Petersburg and the Leningrad Region who sought assistance for COVID-19 between December 2020 and May 2021. Inclusion required written informed consent and the ability to complete all required study procedures. Exclusion criteria were acute medical conditions, severe adverse effects of pharmacotherapy, and preexisting cognitive impairment. Current cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) with a diagnostic threshold of 25 points. Predictors included sociodemographic data, medical history, and respiratory rate. RESULTS: The study involved 66 patients (38 women and 28 men). The median age was 39.5 years [35; 60], and 14% of participants demonstrated clinically significant cognitive impairment. Logistic regression analysis showed that lower educational attainment, older age, endocrine disorders, and a respiratory rate above 22 breaths per minute were associated with an increased risk of cognitive impairment. The model demonstrated a sensitivity of 98.4% and specificity of 90%. A scoring scale was developed to estimate risk without computing the logit function, thereby facilitating clinical usability. CONCLUSION: Social-demographic and clinical risk factors associated with cognitive impairment were identified in patients with COVID-19. The most significant predictors were lower educational attainment and older age, whereas endocrine comorbidity and elevated respiratory rate increased the likelihood of cognitive impairment. These findings may be considered when selecting psychopharmacotherapeutic strategies.

Objective To define basic medical service items in Shanghai community health centers. Methods Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice, general practitioner training, internal practice, public health and health management, then the scope of medical service system was set up based on experts' opinions. Results The newly-defined system consisted of three first-grade items: outpatient medical service, hospital medical service and medical service for home beds and temporary home visits. The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items, including 17 baseline items, 8 optional items and 1 restrained item. In two rounds of Delphi consultation the activity coefficient of experts was all 100%, authority coefficients of experts was 0.825, and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 (all P<0.01), respectively. Conclusion The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making. Key words: Community health services; Delphi technique; Basic medical service items