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Shared medical appointments, which allow greater access to care and provide peer support, may be an effective treatment modality for prediabetes. We used a retrospective propensity-matched cohort analysis to compare patients attending a prediabetes shared medical appointment to usual care. Primary outcome was patient's weight change over 24 months. Secondary outcomes included change in hemoglobin [A.sub.1c], low density lipoprotein, and systolic blood pressure. The shared medical appointments group lost more weight (2.88 kg vs 1.29 kg, P = .003), and achieved greater reduction in hemoglobin [A.sub.1c] (-0.87% vs + 0.87%, P = .001) and systolic blood pressure (-4.35 mmHg vs +0.52 mmHg, P = .044). The shared medical appointment model can be effective in treating prediabetes. Key words: insulin resistance; metabolic syndrome; prediabetic state; shared medical appointments, INTRODUCTION More than 1 in 3 adults have prediabetes, and nearly three-quarters of these will progress to diabetes. (1,2) Diabetic complications such as microvascular dysfunction may already be present in [...]

This paper examines patient preferences and choice behavior in scheduling medical appointments. We conduct four discrete choice experiments on two distinct populations and identify several 'operational' attributes (e.g., delay to care and choice of doctor) that affect patient choice. We observe an interesting gender effect with respect to how patients trade off speed (delay to care) and quality (doctor of choice), and demonstrate that risk attitudes mediate the impact of gender on the perception of speed and quality. Specifically, females (versus males) are more averse to not seeing their own doctor, and, when delay to care is relatively long, females perceive greater utility loss than males. As many operational strategies in outpatient care aim to improve the patient experience by making trade-offs between speed and quality, we make suggestions for when managers should intervene to improve their practice and how such interventions might look based on the patient mix and current delay level. History: Accepted by Gad Allon, operations management. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2016.2704. Keywords: operations management * consumer choice behavior * appointment scheduling * healthcare management * discrete choice experiment, 1. Introduction While we know reasonably well how customers choose products from retailers, we have relatively little understanding of how patients choose care in the healthcare market, a service sector [...]

Patients nationwide experience difficulties in accessing medical care in a timely manner due to long backlogs of appointments. Medical practices aim to utilize their valuable resources efficiently, deliver timely access to care, and at the same time they strive to provide short waiting times for patients present at the medical facility. We address the joint problem of determining the panel size of a medical practice and the number of offered appointment slots per day, so that patients do not face long backlogs and the clinic is not overcrowded. We explicitly model the two time scales involved in accessing medical care: appointment delay (order of days, weeks) and clinic delay (order of minutes, hours). Closed-form expressions are derived for the performance measures of interest based on diffusion approximations. Our model captures many features of the complex reality of outpatient care, including patient no-shows, balking behavior, and random service times. Our analysis provides theoretical and numerical support for the optimality of an 'open access' policy in outpatient scheduling when we account for both types of delay, and it demonstrates the importance of considering panel sizing and scheduling decisions in a joint framework. History: Accepted by Noah Gans, stochastic models and simulation. Supplemental Material: The electronic companion is available at https://doi.org/10.1287/mnsc.2016.2532. Keywords: panel size * appointment scheduling * open access * balking * diffusion approximations, 1. Introduction Patients nationwide experience difficulties in accessing medical appointments in a timely manner due to long backlogs. Merritt (2014), by surveying 1,399 medical offices in 15 U.S. metropolitan areas [...]

We conduct an empirical investigation of the impact of queue management on patients' average wait time and length of stay (LOS). Using an emergency department's (ED) patient-level data from 2007 to 2010, we find that patients' average wait time and LOS are longer when physicians are assigned patients under a pooled queuing system with a fairness constraint compared to a dedicated queuing system with the same fairness constraint. Using a difference-in-differences approach, we find the dedicated queuing system is associated with a 17% decrease in average LOS and a 9% decrease in average wait time relative to the control group--a 39-minute reduction in LOS and a four-minute reduction in wait time for an average patient of medium severity in this ED. Interviews and observations of physicians suggest that the improved performance stems from the physicians' increased ownership over patients and resources that is afforded by a dedicated queuing system, which enables physicians to more actively manage the flow of patients into and out of ED beds. Our findings suggest that the benefits from improved flow management in a dedicated queuing system can be large enough to overcome the longer wait time predicted to arise from nonpooled queues. We conduct additional analyses to rule out alternate explanations for the reduced average wait time and LOS in the dedicated system, such as stinting and decreased quality of care. Our paper has implications for healthcare organizations and others seeking to reduce patient wait time and LOS without increasing costs. Keywords: pooling; fairness; queue management; strategic servers; empirical operations; healthcare History: Received July 23, 2013; accepted October 23, 2014, by Serguei Netessine, operations management. Published online in Articles in Advance May 28, 2015., 1. Introduction Improving efficiency and customer experience is a key objective for service organizations. Skillful application of operations management principles may help achieve these goals. In particular, queue management decisions--such [...]

Physicians at a branch of the emergency department at Cincinnati Children's Hospital Medical Center complained that their schedules were too erratic because of the multitude of operating requirements, regulatory constraints, [...]

A sequential clinical scheduling method for patients with general service time distributions is developed in this paper. Patients call a medical clinic to request an appointment with their physician. During the call, the scheduler assigns the patient to an available slot in the physician's schedule. This is communicated to the patient before the call terminates and, thus, the schedule is constructed sequentially. In practice, there is very limited opportunity to adjust the schedule once the complete set of patients is known. Scheduled patients might not attend, that is, they might 'no-show,' and the service times of those attending are random. A myopic scheduling algorithm with an optimal stopping criteria for this problem assuming exponential service times already exists in the literature. This work relaxes this assumption and develops numerical techniques for general service time distributions. A special case in which service times are gamma distributed is considered and it is shown that computation is significantly reduced. Finally, exhaustive experimental results are provided along with discussions that provide insights into the practical aspects of the scheduling approach. Keywords: Overbooking, appointment scheduling, patient no-shows, outpatient clinics, 1. Introduction and literature review Between 80 and 90% of U.S. patient care is provided by approximately 200 000 non-psychiatric outpatient clinics (Bodenheimer and Grumback, 2002; United States Census, 2004). [...]

Nursing staff in various hospitals in Belgium are principally cyclically scheduled. The employed cyclic schedules embody, however, only a weak reflection of the ultimate nurse rosters constructed for a specific month. In this paper, we investigate the benefits of integrating nurse-specific characteristics in the cyclic scheduling approach. Moreover, we analyse to what extent these characteristics should be incorporated and compare this approach with a general and more robust cyclical scheduling approach and the flexible acyclical fostering of nursing personnel. doi:10.1057/jors.2008.131 Keywords: manpower planning; hospitals; timetabling; scheduling

Patient nonattendance to scheduled sessions results in excessive costs to mental health and substance abuse providers and compromises the care of clients. This paper presents a comprehensive review of interventions that have been shown to increase session attendance rates in these settings. Unique to other review papers, reliability estimates were performed in the selection and evaluation of obtained studies. Reliability of article selection and evaluation strategies was excellent (.80 to .88). Study results indicate several attendance improvement methods appear to be particularly promising, such as scheduling appointments promptly, reminder letters and telephone calls, soliciting patient commitment, and helping to resolve obstacles to attending the session. The specific manner in which these interventions are implemented appears to influence session attendance rates. Moreover, some attendance improvement interventions are clearly effective in some settings, but not others. Specific recommendations are provided in light of the study findings.

The purpose of this paper is to compare two methods of scheduling outpatient clinic appointments in the setting where the availability of surgeons for appointments depends on other clinical activities. We used discrete-event simulation to evaluate the likely impact of the scheduling methods on the number of patients waiting for appointments, and the times to appointment and to surgery. The progression of individual patients in a surgical service was modelled as a series of updates in patient records in reaction to events generated by care delivery processes in an asynchronous fashion. We used the Statecharts visual formalism to define states and transitions within each care delivery process, based on detailed functional and behavioural specifications. Our results suggest that pooling referrals, so that clinic appointments are scheduled with the first available surgeon, has a differential impact on different segments of patient flow and across surgical priority groups. doi:10.1057/palgrave.jors.2602235 Keywords: health service; simulation; hospitals; behaviour

We present a method to increase the utilization of and reduce the waiting times for an under-capacitated diagnostic resource in the presence of uncertain demand with several priority levels. We consider the case of a computed tomography (CT) scanning department that services both high-priority in-patients and lower priority outpatients. Current practice calls for all in-patient demand to be met on the day of the request. Our proposal looks at the benefit of reserving space for carrying over a percentage of non-emergency in-patient demand to the next day and utilizing a pool of on-call outpatients who can respond quickly to available capacity. We formulate and solve an optimization problem that returns a reservation policy that minimizes unused capacity subject to an overtime constraint. We use a simulation to demonstrate a significant reduction in the growth rate of outpatient waiting time resulting from using the proposed method and investigate the sensitivity of results to several model assumptions. doi: 10.1057/palgrave.jors.2602242 Keywords: scheduling; health services; optimization; simulation; reservation policies; waiting times

"I didn't think open-access scheduling would work," says Ruth A. Hamad (at left), a solo internist and geriatrician in Glendora, CA. "I thought we'd be bombarded and it would be [...]

Behavior-reduction interventions typically employ dense schedules of alternative reinforcement in conjunction with operant extinction for problem behavior. After problem behavior is reduced in the initial treatment stages, schedule thinning is routinely conducted to make the intervention more practical in natural environments. In the current investigation, two methods for thinning alternative reinforcement schedules were compared for 3 clients who exhibited severe problem behavior. In the dense-to-lean (DTL) condition, reinforcement was delivered on relatively dense schedules (using noncontingent reinforcement for 1 participant and functional communication training for 2 participants), followed by systematic schedule thinning to progressively leaner schedules. During the fixed lean (FL) condition, reinforcement was delivered on lean schedules (equivalent to the terminal schedule of the DTL condition). The FL condition produced a quicker attainment of individual treatment goals for 2 of the 3 participants. The results are discussed in terms of the potential utility of using relatively lean schedules at treatment outset. DESCRIPTORS: extinction, schedule thinning, functional communication training, noncontingent reinforcement, response-prevention hypothesis

A prioritisation system has developed in several countries to determine admission to waiting lists and selection from them for treatment. OR plays an important role in the development and implementation of prioritisation systems and in ensuring that their implications are fully understood.

A randomized trial was conducted to evaluate the combined impact of a physician reminder letter and a telephone contact on the use of Pap tests and mammograms in a low-income managed care program. Women 40 to 79 years of age who were past due for cancer screening were randomly assigned to an intervention or control group. Medical claims were reviewed after 6 months to determine intervention effectiveness. The odds of receiving all needed cancer screening tests during follow-up were four times higher in the intervention group. Women who reported having to take time off from work to see a doctor had lower odds of getting screened. (Am J Public Health. 1995; 85:834-836), Women who receive reminders by mail and telephone may be more likely to make routine screening appointments for Pap smears and mammograms. Researchers conducted inreach efforts among a low-income population of 659 women between 40 and 79 years old. Pap tests and mammography screening were covered services. A control group of 322 women received standard care and 337 women received letters signed by physicians and subsequent telephone calls by staff. The women who were reminded received 30 percent (%) of needed tests during the following six months, while controls received only 9.6% of identified cancer screening. One additional outcome was the reluctance of women to be tested if it involved time away from their jobs.

Byline: Rakesh. Garg, Anju. Bhalotra, Poonam. Bhadoria, Nishkarsh. Gupta, Raktima. Anand Late cancellation of scheduled operations is a major cause of inefficient use of operating-room time and a waste of [...]