Search results

The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.

A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.

In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.

Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.

While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

The purpose of this paper is to explore the key aspects of service quality within the outpatient context. The secondary aim is to compare views on quality of health service by Caucasian and non-Caucasian patients in Australia.

A mixed-method approach was adopted for this study. Qualitative data were collected from 40 patients to develop a scale for measuring health service quality. Quantitative data were collected using self-administered questionnaires available in English, Arabic, Persian, Chinese and Vietnamese. A total of 447 patients in six outpatient clinics completed the survey and data were analyzed using the structural equation modeling technique.

The qualitative findings determined eight dimensions of quality for outpatient care as follows: doctor professionalism; doctor empathy; doctor expertise; treatment outcome; staff concern; timeliness; tangibles; and operation. The quantitative findings indicated that factors related to technical aspect of care, including doctor expertise and treatment outcome were assumed the strongest predictors of overall health care quality in both Caucasian and non-Caucasian groups. Furthermore, no significant discrepancy was found between these two groups’ ratings of overall service quality and satisfaction with care.

The study captured ethnically diverse patients’ perspectives on health service quality and highlighted the significance of technical quality, which is generally neglected in service quality measures.

Disasters and pandemics pose challenges to health-care provision. Accordingly, the need for adopting innovative approach is required in providing care to patient. Therefore, the purpose of this study is to present telehealth as an innovative approach for providing care to patients and reducing spread of the infection and advocates for the adoption of telehealth for digitalized treatment of patients.

An integrative review methodology of existing evidence was conducted to provide implications for integration of telehealth for digitalized treatment of patients. This paper draws on Technology Organization Environment (TOE) framework to develop a model and propositions to investigate the factors that influence telehealth adoption from the perspective of the supply side and the demand side of medical services.

Findings from this study discuss applications adopted for telehealth and recommendations on how telehealth can be adopted for medical-care delivery. More importantly, the findings and propositions of this study can act as a roadmap to potential research opportunities within and beyond the pandemic. In addition, findings from this study help provide guidelines on how health practitioners can rapidly integrate telehealth into practice for public health emergencies.

This study identifies the social, technological and organizational factors that influence telehealth adoption, and opportunities of adopting telehealth during the public health emergencies. This study concludes that specific policy changes to improve integration of interoperable solutions; data security; better physical infrastructures; broadband access; better transition and workflow balance; availability of funding and remuneration; regulations and reimbursement; awareness; and training will improve telehealth adoption during public health emergencies.

Artificial intelligence (AI) applications are increasingly used for day-to-day operations in healthcare. Each has a relatively limited scope or task, and several find application in managerial and organizational processes. More and more, AI and machine learning (ML) devices have received US FDA approval in the last decade. This chapter covers the main AI applications in healthcare, with a focus on organizational AI solutions (administrative AI), the main AI developers, their investment and real-world data and case studies in healthcare and other sectors. AI can be applied in resource management and procurement, resource allocation, clinical case management, staff work shift scheduling and handling of emergencies. AI applications are becoming ubiquitous in hospital (e.g. emergency room and operating theatre) and outpatient settings (e.g. ambulatory care and dentistry clinics). Their implementation is expected to bring direct benefits for patient care and satisfaction. This chapter gives a broad definition of AI in healthcare settings, with a focus on administrative applications and their use in case study data.

This study aims to evaluate the delivery of a virtual community-based mental health and substance use program for Filipino drug users during the COVID-19 pandemic.

It used a randomized control longitudinal design with data collected prior to the program and every two months for 10 months. The programs focused on building recovery skills, life skills and family modules. Program length ranged from a brief intervention of three sessions to 24 sessions depending on whether clients were low risk, moderate risk or those arrested for drug use.

Results revealed significant improvements in recovery skills of participants in the treatment group compared to those in the control group. Mental health illness symptoms decreased for both control and treatment groups; however, no differences were found in recovery capital and cravings.

The lack of significant changes in certain variables, such as recovery capital, requires more data to understand the barriers to enable greater recovery. The study was limited to virtual delivery of rehabilitation services conducted during the COVID-19 pandemic. Future studies may wish to compare modalities of online and onsite delivery to enable a comparison of effectiveness.

Results suggest the feasibility of virtual delivery of mental health and substance use treatment implemented by trained paraprofessionals. However, it also highlights the necessity to build the capacity of service providers and address connectivity challenges.

Stigma and discrimination prevent people who use drugs from seeking treatment. Virtual delivery of mental health and substance use treatment can provide a platform where people can seek help while maintaining some privacy.

The study provides evidence from under-represented populations – persons who use drugs in the Philippines.

The purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences.

A mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption.

Virtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators.

The study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.

Efficient delivery of integrated healthcare requires solid alliances and collaboration with stakeholders on a regular basis. Due to coronavirus disease 2019 (COVID-19), it has become necessary to explore new ways of delivering integrated healthcare, and virtual clinics have offered one solution and are likely to continue due to the uncertainty with COVID-19. This study aims to explore clinicians’ experiences of how efficient virtual elective knee clinics (VEKC) are in an orthopaedic setting in comparison to traditional face-to-face clinics.

The study utilised a mixed-methods study to obtain qualitative and quantitative data. This involved an anonymous online survey in addition to in-depth qualitative interviews conducted with a purposive sample of multidisciplinary colleagues who work with the VEKC in an acute hospital.

Three overarching themes and nine sub-themes emerged in the qualitative analysis. Overall, clinicians in both the quantitative and qualitative aspects of the study highlighted several ways that virtual clinics are efficient from both the patient and health service perspective. However, participants also highlighted barriers in relation to virtual clinics not being suitable for certain cohorts of patients and pathologies.

This is the first study in Ireland to provide valuable insights into the experiences of multidisciplinary clinicians using VEKC and their efficiency compared to traditional face-to-face clinics.

This study presented the experience of improving the nucleic acid sample collection and transportation service in response to the epidemic. The main purpose is that through intelligent path planning, combined with the time scheduling of sample points, the process of obtaining results to determine the state of COVID-19 patients could be speeding up.

The research optimized the process, including finding an optimal path to traverse all sample points in the hospital area via intelligent path planning method and standardizing the operation through the time sequence scheduling of each round of support staff to collect and send samples in the hospital area, so as to ensure the shortest time in each round. And the study examines these real-time experiments through retrospective examination.

The real-time experiments' data showed that the proposed path planning and scheduling model could provide a reliable reference for improving the efficiency of hospital logistics. Testing is a very important part of diagnosis and prompt results are essential. It shows the possibility of applying the shortest-path algorithms to optimize sample collection processes in the hospital and presents the case study that gives the expected outcomes of such a process.

The value of the study lies in the abstraction of a very practical and urgent problem into a TSP. Combining the ant colony algorithm with the genetic algorithm (ACAGA), the performance of path planning is improved. Under the intervention and guidance, the efficiency of hospital regional logistics planning was greatly improved, which may be of greater benefit to critical patients who must go through fever clinic during the epidemic. By detailing how to more rapidly obtain results through engineering method, the paper contributes ideas and plans for practitioners to use. The experience and lessons learned from Tongji Hospital are expected to provide guidance for supporting service measures in national public health infrastructure management and valuable reference for the development of hospitals in other countries or regions.

The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains.

In a retrospective case study an in‐depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands.

The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non‐compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion “patient value” needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes.

The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings.

QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.