XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

计量经济分析 = Econometric analysis

行銷硏究 : Marketing research

Research in closed-loop supply chains (CLSCs) has grown rapidly over the last 10 years. The authors offer a critical review of influential CLSC research that takes a business economics perspective. Much of the research was inspired by practice-driven thoughtpieces, and this helped to keep research focused on relevant issues. However, CLSC research has several assumptions, such as perfect substitution between new and remanufactured products that risk becoming institutionalized. There is a strong need to carefully examine current industrial practice so that research remains focused on relevant problems. Deeper understanding of consumer perceptions of remanufactured products, product diffusion, and valuation of returned products are needed for the field to continue to add insights into developing sustainable economies.

Production and Operations Management

The Theory of Incentives I: The Principal-Agent Model

This paper is a complete survey of flowshop-scheduling problems and contributions from early works of Johnson of 1954 to recent approaches of metaheuristics of 2004. It mainly considers a flowshop problem with a makespan criterion and it surveys some exact methods (for small size problems), constructive heuristics and developed improving metaheuristic and evolutionary approaches as well as some well-known properties and rules for this problem. Each part has a brief literature review of the contributions and a glimpse of that approach before discussing the implementation for a flowshop problem. Moreover, in the first section, a complete literature review of flowshop-related scheduling problems with different assumptions as well as contributions in solving these other aspects is considered. This paper can be seen as a reference to past contributions (particularly in n/m/p/c max or equivalently F/prmu/c max) for future research needs of improving and developing better approaches to flowshop-related schedulin...

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Flowshop-scheduling problems with makespan criterion: a review

Crisis-level overcrowding conditions in emergency departments EDs have led hospitals to seek out new patient-flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are “streamed” based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new “virtual-streaming” patient flow design for EDs. Second, this type of streaming is most effective in EDs with 1 a high percentage of admitted patients, 2 longer care times for admitted patients than discharged patients, 3 a high day-to-day variation in the percentage of admitted patients, 4 long patient boarding times e.g., caused by hospital “bed-block”, and 5 high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream new patients, whereas physicians assigned to discharge patients should prioritize downstream old patients.

/pdf/patient-streaming-as-a-mechanism-for-improving-54a77c8rp3.pdf

Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments

In this paper we propose a modified fuzzy technique for order performance by similarity to ideal solution (modified fuzzy TOPSIS) for the multi-criteria decision making (MCDM) problem when there is a group of decision makers. Regarding the value of the truth that a fuzzy number is greater than or equal to another fuzzy number, a new distance measure is proposed in this paper. This distance measure calculates the distance of each fuzzy number from both fuzzy positive ideal solution (FPIS) and fuzzy negative ideal solution (FNIS). Then, the alternative which is simultaneously closer to FPIS and farther from FNIS would be selected as the best choice. To clarify our proposed procedure, a numerical example is discussed

Multi-criteria Group Decision Making Using A Modified Fuzzy TOPSIS Procedure

In recent years, Operations Research/Management (OR/OM) has had a significant impact on improving the performance of hospital Emergency Departments (EDs). This includes improving a wide range of processes involving patient flow from the initial call to the ED through disposition, discharge home, or admission to the hospital. We review approximately 350 related papers to (i) demonstrate the influence of OR/OM in EDs, and (ii) assist both researchers and practitioners with the OR/OM techniques already available to optimize ED patient flow. In addition, we elaborate on some practical challenges yet to be addressed. By shedding light on some less studied aspects that can have significant impacts on ED operations, we also discuss important possibilities for future OR/OM researchers.

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Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Hospital Emergency Departments (ED's) typically use triage systems that classify and prioritize patients almost exclusively in terms of their need for timely care. Using a combination of analytic and simulation models, we demonstrate that adding an up-front estimate of patient complexity to conventional urgency-based classification can substantially improve both patient safety (by reducing the risk of adverse events) and operational efficiency (by shortening the average length of stay). Moreover, we find that ED's with high resource (physician and/or examination room) utilization, high heterogeneity in the treatment time between simple and complex patients, and a relatively equal number of simple and complex patients benefit most from complexity-augmented triage. Finally, we find that: (1) Although misclassification of a complex patient as simple is slightly more harmful than vice versa, complexity-augmented triage is relatively robust to misclassification error rates as high as 25%. (2) Streaming patients based on complexity information and prioritizing them based on urgency is better than doing the reverse. (3) Separating simple and complex patients via streaming facilitates the application of lean methods that can further amplify the benefit of complexity-augmented triage.

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID2375830_code561150.pdf?abstractid=1911847&mirid=1

Soroush Saghafian

Papers

Flowshop-scheduling problems with makespan criterion: a review

Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments

Multi-criteria Group Decision Making Using A Modified Fuzzy TOPSIS Procedure

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Complexity-Augmented Triage: A Tool for Improving Patient Safety and Operational Efficiency