Appointment systems are used by health clinics to manage access to service providers.In such systems,a specified number of patients are scheduled in advance,but certain patients may not arrive or‘show up’to their ap...Appointment systems are used by health clinics to manage access to service providers.In such systems,a specified number of patients are scheduled in advance,but certain patients may not arrive or‘show up’to their appointments.The existence of no-show behaviour influences both the operational cost of the clinics and the waiting time of the patients.In this paper,we determine an optimal schedule that takes no-show behaviour into account to determine the time intervals between patients under the framework of the individual-block/variableinterval rule for minimising the overall cost of the patient waiting time,the practitioner idle time and overtime.Under the condition that the service time of each patient is exponentially distributed,we compare the results with a schedule designed for the same expected number of patients in the absence of no-shows and analyse the effect on the system performance from the perspectives of day-length,expected workload,no-show probability,ratio of overtime costs and no-golf policy.We extend our results to an equally-spaced appointment system,which is commonly used in practice.Our results show that not only do no-shows greatly affect the system performance compared with an appointment system with the same expected workload without no-shows,but they also affect the optimal scheduling behaviours in the dome-shaped distribution.In addition,overtime cannot be eliminated completely even if the day length is adequate for all patients because of the stochastic characteristic of service time.展开更多
BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained perso...BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.展开更多
This paper focuses on an outpatient capacity allocation problem where the patient demand is quite higher than the supply. We study an adding capacity policy to mitigate the mismatch between supply and demand. Under th...This paper focuses on an outpatient capacity allocation problem where the patient demand is quite higher than the supply. We study an adding capacity policy to mitigate the mismatch between supply and demand. Under this policy, the doctor is allowed to add capacity if all regular capacity have been booked. A capacity allocation model is formulated for both possible no-show routine patients and all show-up same-day patients. The purpose is to determine the number of capacity can be added and how to allocate regular capacity among routine patients and same-day patients, towards maximizing the expected profit, which is composed of the expected income minus the cost of weighted expected doctor＇s overload work caused by the adding capacity policy and the cost of rejecting patients. To achieve the aims, we prove the expected profit monotonously decreases when the number of additional capacity exceeds a threshold, and present a two-tier enumeration search algorithm to fred the global optimal solution based on the proof. Numerical results indicate that the proposed policy performs well under different levels of demand higher than supply. The optimal number of the additional capacity is hardly affected by varying total expected patient demand. Additionally, under the change of no-show rate, the number of regular capacity allocated to routine patients becomes more stable, compared with the optimal scheme without considering adding capacity policy.展开更多
基金This paper was financially supported by National Natural Science Foundation of China(71021061,61273204).
文摘Appointment systems are used by health clinics to manage access to service providers.In such systems,a specified number of patients are scheduled in advance,but certain patients may not arrive or‘show up’to their appointments.The existence of no-show behaviour influences both the operational cost of the clinics and the waiting time of the patients.In this paper,we determine an optimal schedule that takes no-show behaviour into account to determine the time intervals between patients under the framework of the individual-block/variableinterval rule for minimising the overall cost of the patient waiting time,the practitioner idle time and overtime.Under the condition that the service time of each patient is exponentially distributed,we compare the results with a schedule designed for the same expected number of patients in the absence of no-shows and analyse the effect on the system performance from the perspectives of day-length,expected workload,no-show probability,ratio of overtime costs and no-golf policy.We extend our results to an equally-spaced appointment system,which is commonly used in practice.Our results show that not only do no-shows greatly affect the system performance compared with an appointment system with the same expected workload without no-shows,but they also affect the optimal scheduling behaviours in the dome-shaped distribution.In addition,overtime cannot be eliminated completely even if the day length is adequate for all patients because of the stochastic characteristic of service time.
基金Supported by Hospital del Mar,Parc de Salut Mar.
文摘BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.
基金This research is supported in part by the National Natural Science Foundation of China under Grant 71420107028, in part by Hong Kong Research Grant Council under Grant T32-102/14-N and in part by the National Natural Science Foundation of China under Grant 71501027.
文摘This paper focuses on an outpatient capacity allocation problem where the patient demand is quite higher than the supply. We study an adding capacity policy to mitigate the mismatch between supply and demand. Under this policy, the doctor is allowed to add capacity if all regular capacity have been booked. A capacity allocation model is formulated for both possible no-show routine patients and all show-up same-day patients. The purpose is to determine the number of capacity can be added and how to allocate regular capacity among routine patients and same-day patients, towards maximizing the expected profit, which is composed of the expected income minus the cost of weighted expected doctor＇s overload work caused by the adding capacity policy and the cost of rejecting patients. To achieve the aims, we prove the expected profit monotonously decreases when the number of additional capacity exceeds a threshold, and present a two-tier enumeration search algorithm to fred the global optimal solution based on the proof. Numerical results indicate that the proposed policy performs well under different levels of demand higher than supply. The optimal number of the additional capacity is hardly affected by varying total expected patient demand. Additionally, under the change of no-show rate, the number of regular capacity allocated to routine patients becomes more stable, compared with the optimal scheme without considering adding capacity policy.
