+publisher:"University of Texas – Austin" +contributor:("Morrice, Douglas J. (Douglas John), 1962-")

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1. Wang, Dongyang, Ph. D. Coordinating healthcare networks.

Degree: PhD, Information, risk, and operations management, 2016, University of Texas – Austin

URL: http://hdl.handle.net/2152/46613

► Current healthcare reforms advocate significantly to improve the coordination of services around a patient-centric model, with an overarching goal to maximize patient outcomes with lower… (more)

▼ Current healthcare reforms advocate significantly to improve the coordination of services around a patient-centric model, with an overarching goal to maximize patient outcomes with lower cost, i.e. a value-based care. With most patient care delivered through outpatient services, the need to coordinate different services and their patient appointment scheduling decisions becomes central to successful reform. Currently, outpatient services are particularly fragmented with minimal coordination among different providers, and the coordination is left to the patient. This approach causes compromised patient health outcomes, an increase in missed appointments and unacceptable access delays. Therefore, the potential impact of coordinating outpatient services is great, in terms of improving patient outcomes and satisfaction, optimizing providers’ utilization and reducing operational costs. In the first study, we investigate how to coordinate the delivery of care in the preoperative process for surgical outpatient. Based on the concept of the Perioperative Surgical Home proposed by the American Society of Anesthesiologists, we develop a Patient-Centered Surgical Home (PCSH) model. Using statistical analysis and simulation, we demonstrate how this can be implemented and reveal the potential benefits on cooperation of the referring clinics and integrating patient in- formation early in the preoperative process. The second study proposes a multi-station network model that sequentially schedules patient appointments in a network of stations with stochastic service times, no-show possibilities, and overbooking. We propose a myopic coordinated policy and present evidence that the policy yields a solution that is close to optimal and is computationally feasible. However, the solution is not simple enough for practical implementation. Hence, we explore a sequence of approximations and find one that offers a tremendous computational advantage. We also provide several managerial insights and discuss how network structures affect complexity. In the third study, we focuses on the cost perspective of coordination. We formulate a multi-server, multi-clinic model that represents the current practice at the PCSH and develop a coordinated scheduling method that dynamically balances the utilizations of all services as patients are sequentially scheduled in the PCSH. We compare our proposed policy against other policies found in the practice and the results shed light on the risk of improper coordination in our increasingly interdependent healthcare system. Advisors/Committee Members: Morrice, Douglas J. (Douglas John), 1962- (advisor), Muthuraman, Kumar (advisor), Anderson, Edward (committee member), Bard, Jonathan (committee member), Leykum, Luci (committee member).

Subjects/Keywords: Coordination healthcare

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APA (6^th Edition):

Wang, Dongyang, P. D. (2016). Coordinating healthcare networks. (Doctoral Dissertation). University of Texas – Austin. Retrieved from http://hdl.handle.net/2152/46613

Chicago Manual of Style (16^th Edition):

Wang, Dongyang, Ph D. “Coordinating healthcare networks.” 2016. Doctoral Dissertation, University of Texas – Austin. Accessed March 05, 2021. http://hdl.handle.net/2152/46613.

MLA Handbook (7^th Edition):

Wang, Dongyang, Ph D. “Coordinating healthcare networks.” 2016. Web. 05 Mar 2021.

Vancouver:

Wang, Dongyang PD. Coordinating healthcare networks. [Internet] [Doctoral dissertation]. University of Texas – Austin; 2016. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/2152/46613.

Council of Science Editors:

Wang, Dongyang PD. Coordinating healthcare networks. [Doctoral Dissertation]. University of Texas – Austin; 2016. Available from: http://hdl.handle.net/2152/46613

University of Texas – Austin

2. -1860-9725. Analysis, design and implementation of models for housestaff scheduling at outpatient clinics and improving patient flow at a family health clinic.

Degree: PhD, Operations Research and Industrial Engineering, 2015, University of Texas – Austin

URL: http://hdl.handle.net/2152/31603

► Clinical experiences during the three years of residencies occur in inpatient and outpatient settings on generalist and specialist clinical services. Housestaff rotate through different clinical… (more)

▼ Clinical experiences during the three years of residencies occur in inpatient and outpatient settings on generalist and specialist clinical services. Housestaff rotate through different clinical experiences monthly, with their primary care clinic time overlaid longitudinally on these other clinical services. The primary goals of this research are to construct housestaff schedules and improve efficiencies for residency programs. In the first phase of the research, we developed two models for constructing monthly clinic schedules for housestaff training in Internal Medicine. In our first model, the objective is to both maximize clinic utilization and minimize the number of violations of a prioritized set of goals while ensuring that certain clinic-level and individual constraints are satisfied. The corresponding problem is formulated as an integer goal program in which several of the hard constraints are temporarily allowed to be violated to avoid infeasibility. A three-phase methodology is then proposed to find solutions. The second model solves a similar problem with the objective of maximizing the number of interns and residents that are assigned clinic duty each month during their training in Internal Medicine. A complexity analysis is provided that demonstrates that the basic problem can be modeled as a pure network and the full problem can be modeled as a network with gains. In the second phase of the research, the goal was to redesign the monthly templates that comprise the annual block rotations to obtain better housestaff schedules. To implement this model, we investigate two different programs: Family Medicine and Internal Medicine. The problems were formulated as mixed-integer programs but proved too difficult to solve exactly. As an alternative, several heuristics were developed that yielded good feasible solutions. For the last part of the research, we focused on improving patient flow at a family health clinic. The objective was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals. Advisors/Committee Members: Bard, Jonathan F. (advisor), Morrice, Douglas J. (Douglas John), 1962- (advisor), Khajavirad, Aida (committee member), Dimitrov, Ned (committee member), Leykum, Luci (committee member).

Subjects/Keywords: Resident scheduling; Residency outpatient clinic; Medical rotations; Goal programming; Mixed-integer programming; Patient flow; Simulation; Performance analysis

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APA (6^th Edition):

-1860-9725. (2015). Analysis, design and implementation of models for housestaff scheduling at outpatient clinics and improving patient flow at a family health clinic. (Doctoral Dissertation). University of Texas – Austin. Retrieved from http://hdl.handle.net/2152/31603