An official website of the United States government
Healthcare spending in the United States is concentrated on a small percentage of individuals, with 5% of the population accounting for 50% of annual spending. Many patients among the top 5% of spenders have complex health and social needs. Care coordination interventions, often led by a multidisciplinary team consisting of nurses, community health workers and social workers, are one strategy for addressing the challenges facing such patients. Care teams strive to improve health outcomes by forging strong relationships with clients, visiting them on a regular basis, reconciling medications, arranging primary and speciality care visits, and addressing social needs such as housing instability, unemployment and insurance. In this paper, we propose a simulation algorithm that samples longitudinal patient-level encounter histories to estimate the staffing needs for a multidisciplinary care team. Our numerical results illustrate multiple uses of the algorithm for staffing under stationary and non-stationary patient enrollment rates.
more »
« less
Visiting nurses assignment and routing for decentralized telehealth service networks
As telehealth utilization for ambulatory and home-based care skyrockets, there has been a paradigm shift to a decentralized and hybrid care delivery modality integrating both in-person and telehealth services provided at different layers of the care delivery network, i.e., central hospitals, satellite clinics, and patient homes. The operations of such care delivery systems need to take into consideration patients’ mobility and care needs, and rely on multiple types of nurses who can support and facilitate telehealth (with hospital physicians) in clinics and patient homes. We formulate an optimization problem, aiming at operationalizing the proposed care delivery network. Decisions regarding the type of care delivered, the location of care delivered, and the scheduling of all kinds of nurses are determined jointly to minimize operating costs while simultaneously satisfying patients’ care needs. We propose a bi-level approximation that exploits the structure of the hybrid telehealth system, and develop column generation-based heuristic algorithms to identify the joint decision rules for clinic selection, patient assignment, and visiting nurse routing problems. Numerical experiment results demonstrate our algorithm’s capability to achieve high-quality solutions in reasonable computation time, and is capable of solving instances with large patient sizes and time windows. Our work supports the efficient and effective operation of the proposed hybrid telehealth systems to improve patient access to care.
more »
« less
- Award ID(s):
- 2027677
- PAR ID:
- 10505633
- Publisher / Repository:
- Springer
- Date Published:
- Journal Name:
- Annals of Operations Research
- ISSN:
- 0254-5330
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Despite providing convenience and reducing the travel burden of patients, Video-Conferencing (VC) clinical visits have not enjoyed wide uptake by patients and care providers. It is desired that the medical problems addressed by VC visits can match a face-to-face encounter in scope and quality. Subsequently, VC visits with nurse assistance are emerging; however, the scalable and financially sustainable of such services are unclear. Therefore, we explore the implementability of VC visits with nursing services using a game-theoretic model, and investigate the impact of different pricing schemes (discriminative pricing based on patient characteristics vs. non-discriminative) on patients’ care choices between VC and in-person visits. Our results shed light on the “artificial congestion” created by a profit-driven medical institution that hurts patient welfare, and subsequently identify the conditions where the interest of the social planner and the medical institution are aligned. Our results highlight that, compared to a uniform price of VC visits which seems fair, discriminative pricing can be more beneficial for patients and the medical institution alike. This heightens the importance of insurance coverage of telehealth-related services to promote the adoption of telehealth by patients and care providers, and ultimately, improving care access and patient outcomes.more » « less
-
Nurses face significant physical demands during patient care, leading to high rates of musculoskeletal disorders (MSDs) among nurses in long-term care. Exoskeletons demonstrate promise in supporting nurses and nurse managers with MSDs; however, social contextual factors are crucial to their design and implementation. Through thematic analysis of 17 semi-structured interviews, this paper reveals social contextual factors important to exoskeleton use among nurses and nurse managers in long-term care. Participants expressed concerns about workplace discrimination, co-worker perceptions of their capabilities, and patient confidence. Our findings highlight the need for supportive organizational cultures and open communication channels. Recommendations include in-depth systems analysis to assess exoskeleton feasibility and efficacy, involving input from frontline nurses/managers, management, and patients. These findings can aid human factors and ergonomics (HF/E) experts in balancing social contextual factors and other work system elements to design work system contexts and exoskeletons that promote optimal outcomes in long-term care settings.more » « less
-
IntroductionHealthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted. MethodsA systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes. ResultsThe review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users’ experience with ATP. DiscussionThe initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.more » « less
-
Patient-generated data, such as recorded Observations of Daily Living (ODL) and Patient-Reported Outcomes (PRO) data, are valued sources of information in oncology care. However, prior work largely focuses on capturing clinician-defined, patient-generated data in adult oncology care. Emerging research at the intersection of human–computer interaction and medical informatics suggests that visual narratives of patients’ observations of daily living (Visual ODLs) could better support multi-party review of patients’ everyday symptoms and quality of life, potentially improving patient–clinician communication. In this paper, we build on a prior study of Visual ODLs by describing a formative, two-phase study with 15 pediatric oncology clinicians. In Phase I, we analyzed data from ethnographic interviews in a pediatric oncology setting to capture the needs of nurses, nurse practitioners, and oncologists. In Phase II, we constructed two low-fidelity dashboard display prototypes, populated with Visual ODLs contributed by actual adolescent oncology patients, and we subsequently interviewed pediatric oncology clinicians who reviewed each dashboard design. Findings from our study contribute four key design objectives for presenting interactive Visual ODL dashboards in pediatric oncology, along with three use cases for using these dashboards for symptom tracking and communication.more » « less
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1007/s10479-024-05883-z
