Prognostic factors affecting ALS progression through disease tollgates.

Background And Objectives: Understanding factors affecting the timing of critical clinical events in ALS progression.

Methods: We captured ALS progression based on the timing of critical events (tollgates), by augmenting 6366 patients' data from the PRO-ACT database with tollgate-passed information using classification. Time trajectories of passing ALS tollgates after the first visit were derived using Kaplan-Meier analyses.

A Decision-Support System to Schedule Rotations for Trainees.

Background: Each training program has its own internal policies and restrictions, which must be considered while developing trainee schedules. Designing these schedules is complex and time consuming, and the final schedules often contain undesirable aspects for trainees.

Objective: We developed a decision-support system (DSS) to optimally schedule daily assignments and monthly rotations for trainees.

Non-invasive Hemoglobin Measurement Predictive Analytics with Missing Data and Accuracy Improvement Using Gaussian Process and Functional Regression Model.

Recent use of noninvasive and continuous hemoglobin (SpHb) concentration monitor has emerged as an alternative to invasive laboratory-based hematological analysis. Unlike delayed laboratory based measures of hemoglobin (HgB), SpHb monitors can provide real-time information about the HgB levels. Real-time SpHb measurements will offer healthcare providers with warnings and early detections of abnormal health status, e.

Predicting Risk of Surgery in Patients With Small Bowel Crohn's Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography.

Background: We aimed to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict near-term risk of surgery in patients with small bowel Crohn's disease (CD).

Methods: CD patients with small bowel strictures undergoing serial CTE or MRE were retrospectively identified. Strictures were defined by luminal narrowing, bowel wall thickening, and unequivocal proximal small bowel dilation.

Mapping of critical events in disease progression through binary classification: Application to amyotrophic lateral sclerosis.

Background: The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e.

A discrete event simulation to evaluate impact of radiology process changes on emergency department computed tomography access.

Background: Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access.

Methods: A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines that serve unscheduled emergency, semi-scheduled inpatient, and scheduled outpatient demand. Three operational interventions were tested: adding additional patient transporters, using an alternative creatinine lab, and adding a registered nurse dedicated to monitoring CT patients in the ED.

Using operative features to identify surgical complexity: a case in breast surgery practice.

Increasing workload is one of the main problems that surgical practices face. This increase is not only due to the increasing demand volume but also due to increasing case complexity. This raises the question on how to measure and predict the complexity to address this issue.

A new optimization algorithm for HDR brachytherapy that improves DVH-based planning: Truncated Conditional Value-at-Risk (TCVaR).

To introduce a new optimization algorithm that improves DVH results and is designed for the type of heterogeneous dose distributions that occur in brachytherapy.The new optimization algorithm is based on a prior mathematical approach that uses mean doses of the DVH metric tails. The prior mean dose approach is referred to as conditional value-at-risk (CVaR), and unfortunately produces noticeably worse DVH metric results than gradient-based approaches.

Unnecessary wait hours: a novel ED system-level metric.

Background: Emergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the 'Number of Unnecessary Waits (NUW)' and the corresponding 'Unnecessary Wait Hours (UWH)', to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.

PNaV: A tool for generating a high-dose-rate brachytherapy treatment plan by navigating the Pareto surface guided by the visualization of multidimensional trade-offs.

Purpose: A Pareto Navigation and Visualization (PNaV) tool is presented for interactively constructing a high-dose-rate (HDR) brachytherapy treatment plan by navigating and visualizing the multidimensional Pareto surface. PNaV aims to improve treatment planning time and quality and is generalizable to any number of dose-volume histogram (DVH) and convex dose metrics.

Methods And Materials: Pareto surface visualization and navigation were demonstrated for prostate, breast, and cervix HDR brachytherapy sites.

Attitudes and Behavior of Health Care Workers Before, During, and After Implementation of Real-Time Location System Technology.

Objective: To assess how staff attitudes before, during, and after implementation of a real-time location system (RTLS) that uses radio-frequency identification tags on staff and patient identification badges and on equipment affected staff's intention to use and actual use of an RTLS.

Participants And Methods: A series of 3 online surveys were sent to staff at an emergency department with plans to implement an RTLS between June 1, 2015, and November 29, 2016. Each survey corresponded with a different phase of implementation: preimplementation, midimplementation, and postimplementation.

Getting to the Heart of the Matter: A Triage Model to Improve Utilization of Cardiology Consultative Services.

Objective: To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments.

Patient And Methods: We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow-up. There were 303 and 267 unique patients in the pre-triage implementation and post-triage implementation cohorts, respectively.

Patient-Care Team Contact Patterns Impact Treatment Length of Stay in the Emergency Department.

Real-time location systems (RTLS) has found extensive application in the healthcare setting, that is shown to improve safety, save cost, and increase patient satisfaction. More specifically, some studies have shown the efficacy of RTLS leading to an improved workflow in the emergency department. However, due to substantial implementation costs of such technologies, hospital administrators show reluctance in RTLS adoption.

CCMapper: An adaptive NLP-based free-text chief complaint mapping algorithm.

Objective: Chief complaint (CC) is among the earliest health information recorded at the beginning of a patient's visit to an emergency department (ED). We propose a heuristic methodology for automatically mapping the free-text data into a structured list of CCs.

Methods: A comprehensive structured list categorizing CCs was developed by experienced Emergency Medicine (EM) physicians.

Characterization of emergency department abandonment using a real-time location system.

Background: Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quantifying patient tolerance to wait times and targeting interventions to improve patient tolerance to waiting.

Objective: Compare traditional methods of estimating time to LWBS with an objective method using a real-time location tracking system (RTLS); examine temporal factors associated with greater LWBS rates.

Pattern-based strategic surgical capacity allocation.

Strategic allocation of limited operating room (OR) capacity to surgeons is crucial for the coordination of surgical work flow, including planning of consultation and surgery days, and staff assignment to perioperative teams. However, it is a challenging problem in practice, since the capacity allocation needs to be cyclic for schedule predictability and surgical team coordination, and also needs to satisfy surgeons' preferences. It is further complicated by the practice of surgeons sharing ORs.

A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes.

Objective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes.

Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician-scribe interactions and ED workflow shadowed attending physicians for a total of 64 hours in the adult emergency department.

Tollgate-based progression pathways of ALS patients.

Objective: To capture ALS progression in arm, leg, speech, swallowing, and breathing segments using a disease-specific staging system, namely tollgate-based ALS staging system (TASS), where tollgates refer to a set of critical clinical events including having slight weakness in arms, needing a wheelchair, needing a feeding tube, etc. METHODS: We compiled a longitudinal dataset from medical records including free-text clinical notes of 514 ALS patients from Mayo Clinic, Rochester-MN. We derived tollgate-based progression pathways of patients up to a 1-year period starting from the first clinic visit.

Maximizing Patient Coverage Through Optimal Allocation of Residents and Scribes to Shifts in an Emergency Department.

Residents and scribes in an Emergency Department (ED) work closely with an attending physician. Residents care for patients under the supervision of the attending physician, whereas scribes assist physicians with documentation contemporaneously with the patient encounter. Optimal allocation of these roles to shifts is crucial to improve patient care, physician productivity, and to increase learning opportunities for residents.

Application of Constrained Optimization Methods in Health Services Research: Report 2 of the ISPOR Optimization Methods Emerging Good Practices Task Force.

Background: Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity.

Objectives: In this paper we illustrate the potential utility of these methods for finding optimal solutions to problems in health care delivery and policy. To do so, we selected three award-winning papers in health care delivery or policy development, reflecting a range of optimization algorithms.

Improving Accuracy of Noninvasive Hemoglobin Monitors: A Functional Regression Model for Streaming SpHb Data.

Objective: The purpose of this paper is to develop a method for improving the accuracy of SpHb monitors, which are noninvasive hemoglobin monitoring tools, leading to better critical care protocols in trauma care.

Methods: The proposed method is based on fitting smooth spline functions to SpHb measurements collected over a time window and then using a functional regression model to predict the true HgB value for the end of the time window.

Results: The accuracy of the proposed method is compared to traditional methods.

Constrained Optimization Methods in Health Services Research-An Introduction: Report 1 of the ISPOR Optimization Methods Emerging Good Practices Task Force.

Providing health services with the greatest possible value to patients and society given the constraints imposed by patient characteristics, health care system characteristics, budgets, and so forth relies heavily on the design of structures and processes. Such problems are complex and require a rigorous and systematic approach to identify the best solution. Constrained optimization is a set of methods designed to identify efficiently and systematically the best solution (the optimal solution) to a problem characterized by a number of potential solutions in the presence of identified constraints.

A Data-Driven Approach For Better Assignment Of Clinical And Surgical Capacity In An Elective Surgical Practice.

This work analyzes strategies for better allocation of surgeon resources in an elective surgical practice. Among the metrics considered to evaluate the assignment of tasks are OR-to-Clinic ratio per provider, OR-to-Clinic ratio per day, patient access to clinic, and patient access to surgery. In addition, a simulation model is used to evaluate the clinical and surgical capacity of the calendar to identify potential inefficiencies and propose strategic changes to the calendar.

Coordinating clinic and surgery appointments to meet access service levels for elective surgery.

Providing timely access to surgery is crucial for patients with high acuity diseases like cancer. We present a methodological framework to make efficient use of scarce resources including surgeons, operating rooms, and clinic appointment slots with a goal of coordinating clinic and surgery appointments so that patients with different acuity levels can see a surgeon in the clinic and schedule their surgery within a maximum wait time target that is clinically safe for them. We propose six heuristic scheduling policies with two underlying ideas behind them: (1) proactively book a tentative surgery day along with the clinic appointment at the time an appointment request is received, and (2) intelligently space out clinic and surgery appointments such that if the patient does not need his/her surgery appointment there is sufficient time to offer it to another patient.