Digital Commons Network^™

System-Wide Prediction Of General, All-Cause, Preventable Hospital Readmissions, Ken Musselman, Brandon Pope, Steve Witz, Zhiyi Tian, Lingsong Zhang, Linda Leon, Ann Davis

RCHE Publications

Existing studies of hospital readmissions typically focus on specific diagnoses, age groups, discharge dispositions, payer classes, or hospitals, and often use small samples. It is not clear how predictive models generated from such studies generalize across diseases, hospitals, or time periods. In this study, a logistic regression model of readmission risk within 30 days based on hospital administrative data was constructed and validated across hospitals and time periods. The hospitals included both general and specialty hospitals such as long-term care, women’s, and children’s hospitals. The administrative data included information on patient’s demographics, diagnoses, procedures, and discharge disposition. Derivation and validation …

Do Gpos Promote Or Stifle Competition In Healthcare-Product Supply Chains?, Qiaohai Hu, Leroy B. Schwarz

RCHE Publications

This paper uses economic modeling to examine the controversial role that Group Purchasing Organizations (GPOs) play in the supply chains for healthcare products. Among the controversies, perhaps the most fundamental one is whether or not GPO-contracted prices are the lowest available. However, the fiercest controversy is around the "Contract Administration Fees (CAFs)" that GPOs charge to manufacturers. We examine these and other controversies using a Hotelling duopoly model.

A 36-Hospital Time And Motion Study: How Do Medical-Surgical Nurses Spend Their Time?, Ann Hendrich, Marilyn Chow, Boguslaw A. Skierczynski, Zhenqiang Lu

RCHE Publications

Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness of nursing care is essential to hospital function and the delivery of safe patient care.

Workshop: Healthcare Engineering And Health Services Research: Building Bridges, Breaking Barriers;, Stephen Roberts, Reha Uzsoy, Julie Ivy, Brian Denton

RCHE Publications

Few would dispute that the rapidly escalating cost of health care is one of the most pressing issues facing our nation today. Even a cursory review of the media reveals intense public concern over a healthcare system that can use the most advanced technology to miraculous therapeutic effect, but whose emergent behavior is far from ideal. Rapidly rising healthcare costs threaten the competitiveness of U. S. manufacturing and service companies in the global econmy, creating intense pressure to move offshore. Indeed one can make the case that the best way to help competitiveness prospects for U. S. industries as a …

Comparison Of Resource Utilization For Medicaid Dementia Patients Using Nursing Homes Versus Home And Community Based Waivers For Long-Term Care, Laura P. Sands, Huiping Xu, Michael Weiner, Marc B. Rosenman, Bruce A. Craig, Joseph Thomas Iii

RCHE Publications

Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings.

Pay For Performance: Advances In Understanding How Provider Incentives Produce Quality Healthcare, George H. Avery

RCHE Publications

Since the 2000 publication of the Institute of Medicine report, "To Err is Human" the issue of healthcare quality has been one of the foremost issues in healthcare. According to this report, as many as 99,000 preventable deaths occur annually due to medical errors. Most of these are believed to occur as a result of system errors rather than failure of an individual provider.

Applying Systems Engineering Principles In Inproving Health Care Delivery, Renata Kopach-Konrad Msc, Mark Lawley Phd, Mike Criswell Msn,Rn,Ccns, Imran Hasan Msc, Santanu Chakraborty Msc, Joe Pekney Phd, Bradley Doebbeling Md,Msc

RCHE Publications

BACKGROUND: In a highly publicized joint report, the National Academy of Engineering and the Institute of Medicine recently recommended the systematic application of systems engineering approaches for reforming our health care delivery system. For this to happen,‎ medical professionals and managers need to understand and appreciate the power that systems engineering concepts and tools can bring to redesigning and improving health care environments and practices.‎ OBJECTIVE: To present and discuss fundamental concepts and tools of systems engineering and important parallels between systems engineering, health services, and implementation research as it pertains to the care of complex patients.‎ DESIGN: An exploratory, …

Dual Use Of Bladder Anticholinergics And Cholinesterase Inhibitors: Long-Term Functional And Cognitive Outcomes, Kaycee M. Sink, Joseph Thomas Iii, Huiping Xu, Bruce Craig, Steven Kritchevsky, Laura P. Sands

RCHE Publications

To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine.

Planning For Pandemic Influenza: Lessons From The Experiences Of Thirteen Indiana Counties, George H. Avery, Mark Lawley, Sandra Garrett, Barrett Caldwell, Marshall P. Durr, Dulcy Abraham, Feng Lin, Po-Ching C. Delaurentis, Maria L. Peralta, Alice Russell, Renata A. Kopach-Conrad, Lalaine M. Ignacio, Rebeca Sandino, Deanna J. Staples

RCHE Publications

Significant concerns exist over the ability of the healthcare and public health systems to meet the surge demands that would result from an event such as an influenza pandemic. Current guidance for public health planners is largely based on expert opinion and may lack connection to the problems of street-level public health practice. To identify the problems of local planners and prepare a state-level planning template for increasing health care surge capacity that accounted for these issues,a study was conducted of local pandemic planning efforts in thirteen counties, finding that cognitive biases, coordination problems, institutional structures in the healthcare system, …

The Regenstrief Center For Healthcare Engineering: Designing, Implementing And Sustaining Interdisciplinary Solutions To Transform Healthcare Delivery Systems, Steve Witz

RCHE Publications

With start-up funding provided by the Regenstrief Foundation,Purdue University has created the Regenstrief Center for Healthcare Engineering (RCHE) ‎to design, implement and sustain interdisciplinary solutions to improve the safety, ‎quality, efficiency and accessibility of healthcare delivery systems. RCHE’s primary ‎goal is to bring a systems-analysis approach to improving the processes of healthcare ‎delivery, not to provide tools or techniques for medical research, diagnosis, or treatment. ‎This article will describe RCHE’s business model; that is, how RCHE ‘engineers’ ‎interdisciplinary solutions, using the multiple perspectives of healthcare and multiple ‎project time scales to organize and leverage healthcare delivery transformation. We then ‎illustrate …

Regional Patient Safety Initiatives: The Missing Element Of Organizational Change, James G. Anderson

RCHE Publications

Data-sharing systems—where healthcare providers jointly implement a common ‎reporting system to promote voluntary reporting, information sharing, and learning—are ‎emerging as an important regional, state-level, and national strategy for improving ‎patient safety. The objective of this chapter is to review the evidence regarding the ‎effectiveness of these data-sharing systems and to report on the results of an analysis of ‎data from the Pittsburgh Regional Healthcare Initiative (PRHI). PRHI consists of 42 ‎hospitals, purchasers and insurers in southwestern Pennsylvania that implemented ‎Medmarx, an on-line medication error reporting systems. Analysis of data from the PRHI ‎hospitals indicated that the number of errors and …

Influences On Nurse Perception Of Hospital Unit Safety Climate:An Hlm Approach, Rangaraj Ramanujam Phd, Kathleen Abrahamson Rn,Ms, James Anderson Phd

RCHE Publications

Patient safety is a critical issue in healthcare. The Institute of Medicine[1] estimates up to 98,000 hopitalized patients die annually as a result if medical error. Nurses serve as a hospital unit's twenty-four hour surveillance team[2]. Assesment of patient condition, evaluation of physician orders, administration of medications, and supervision of patient activity are all safety functions which fall within the nurse's scope of practice. Health care organizations have introduced a variety of technological upgrades and structural changes in an effort to encourage a system, or root cause, approach to error reduction. However, these changes have failed to provide an adequate …

Lean Healthcare Applications, Heather Hagg

RCHE Publications

Interdisciplinary collaborative of Engineering, Technology and Clinical Faculty from Purdue Statewide Campuses. Focus on partnerships with hospitals and healthcare providers to provide training/facilitation through implementation to cretate self-sustaining programs.

Implementing Lean Six Sigma Methodologies In The Radiology Department Of A Hospital Healthcare System, Jamie Workman-Germann, Heather (Woodward) Hagg

RCHE Publications

Increased focus is being placed on the quality of care provided by Hospitals and Healthcare Systems around the country. Caught in the middle between tightening govenment standards, stricter compliance guidelines for insurance companies, and the basic mission to serve those in need with quality and compassion, hospitals are searching for ways to improve their processes and services for the benefit of all. CT (Computed Tomography - CAT Scan) and MRI (Magnetic Resonance Imaging) services in the hospital radiology departments are revenue generating areas. The reimbursement rates for these services are very high, the scan times (especially in CT) are relatively …

Impact Of Patient Selection Criteria On Prevalence Estimates And Prevalence Of Diagnosed Dementia In A Medicaid Population, Murtuza F. Bharmal, Michael Weiner, Laura P. Sands, Huiping Xu, Bruce A. Craig, Joseph Thomas Iii

RCHE Publications

This study estimated the prevalence of diagnosed dementia among Indiana Medicaid beneficiaries in 2004. The dependence of prevalence estimates upon use of several patient selection criteria to identify patients with dementia also was evaluated.

“All Bundled Out” - Application Of Lean Six Sigma Techniques To Reduce Workload Impact During Implementation Of Patient Care Bundles Within Critical Care – A Case Study, Heather (Woodward) Hagg, Jamie El-Harit, Chris Vanni, Penny Scott

RCHE Publications

Within healthcare, clinical practice bundles have been used to implement standardized, nursing driven protocols resulting in standardized patient care and improved patient outcomes. Examples of these types of bundles include clinical practices shown through evidence based medicine to reduce occurrences of Ventilator Associated Pneumonia – VAP bundle; those shown to reduce the occurrences of central line infections – CL bundle; and those shown to significantly improve the outcomes of patients presenting with sepsis – Sepsis Bundle.

Unfortunately, as critical care units cycle through the implementation of multiple bundles without adjustment in workflow practices the result is often increased staff fatigue …

Improving Process Throughput Of Cardiac Catheterization Using Six Sigma Training, Daphene Koch, Heather (Woodward) Hagg, Dianna Brown, Kenney Montgomery, Mark Manning

RCHE Publications

Healthcare is changing daily with the introduction of technology. Heart catheterization is one area that has excelled in the new technology that is constantly being introduced. Facilities are being built which provide patients with diagnostics and treatments that save lives daily. Due to the continual improvement of healthcare processes, it is also important to review process and continually improve efficiency. The catheterization lab patient care process must provide quality patient care that exceeds expectations of all involved. A project was completed to train a team that would implement process improvement. The team was made up of the technicians, nurses and …

Application Of Lean Six Sigma Techniques To Optimize Hospital Laboratory Emergency Department Turnaround Time Across A Multi-Hospital System, Heather (Woodward) Hagg, Susan Scachitti, Lash Mapa, Lillie Brandford, Chris Vanni, Catherine Cox

RCHE Publications

In January 2005, Indiana University, Purdue University at Indianapolis (IUPUI) and Purdue- Calumet were invited to partner with the Alverno Clinical Labs in adapting Lean Six Sigma methodologies for use within healthcare. Our initial project focused on optimization of lab services for the emergency department at the Saint Margaret Mercy Hospitals in Hammond, IN. This project resulted in reduction of lab test report time to the emergency department from 75 minutes to less than 35 minutes. These results have been sustained from the initial implementation to present – over 14 months. Additionally, this project has been successfully implemented across two …

Reporting Adverse Medical Events In Indiana:, Pamela Whitten, Mohan Dutta, Serena Carpenter, Graham Bodie

RCHE Publications

The purpose of this report is to identify how Indiana news media professionals and Indiana health and medical professionals perceive adverse events and the regulation requiring health and medical professionals to report medical adverse events data to the state. To accomplish this goal, Purdue University researchers conducted an email survey targeting Indiana news media professionals and focus groups with Indiana health and medical professionals. Specifically, the goals of this project were to 1) identify barriers to the medical adverse events regulation and to identify solutions to those barriers, 2) to better understand how the data should be communicated to the …

Provider Centered Coordination, Resource Foraging, And Event Management In Healthcare Tasks, Sandra Kay Garrett

RCHE Publications

The increasing complexity of healthcare and recent awareness of deaths and injuries associated with system errors has made patient safety an issue of national concern. Improving the quality and efficiency of the U.S. healthcare delivery system is a major theme in healthcare engineering, including the research presented in this dissertation.

This research was focused on the task and resource needs of healthcare providers in clinic-based healthcare delivery. The original purpose of this study was to investigate how and when healthcare providers seek the information and resources necessary to deliver effective patient care, but quickly branched out to incorporate more global …

Value-Driven Consumer E-Health Information Search Behavior, Lynn Goetzinger, Jungkun Park, Yun Jung Lee, Rick Widdows

RCHE Publications

This study examines online health information quality (relevance and clarity) and the perceived value of online health information search (social, utilitarian and epistemic) and how they relate to cunsumers' satisfaction with their online health information search experience. The resulting intention to repeat a health information search over the internet is also included in a conceptual model to illustrate what drives the process.

Adaptation Of Lean Methodologies For Healthcare Applications, Heather (Woodward) Hagg, Deanna Suskovich, Jamie Workman-Germann, Susan Scachitti, Brian Hudson, Joseph Swartz, Chris Vanni

RCHE Publications

Lean and Six Sigma quality concepts and terminology have been applied in the manufacturing arena since the late 1980’s and early 1990’s. It has only been in recent years that healthcare administrators have identified these methods as being adaptable to their organizations so that they may realize organizational improvements for continuing success and delighting customers. Unfortunately, this is not an application that is widely taught in typical Industrial Engineering curriculum and therefore there are few educated professionals coming right out of college that are able to apply these principles to healthcare. There are however, many experienced professionals knowledgeable in the …

Stochastic Overbooking Model For Outpatient Clinical Scheduling With No-Shows, Mark Lawley, Kumar Muthuraman

RCHE Publications

In this paper we formulate a stochastic overbooking model and develop an appointment scheduling policy for outpatient clinics. This schedule is constructed for a single service period partitioned into time slots of equal length. A clinic scheduler must provide each calling patient with an appointment time before the patient's call terminates. Once an appointment is added to the schedule, it cannot be changed. Each callling patient has a no-show probability, and overbooking is used to compensate for patient no-shows. The scheduling objective captures patient waiting time, staff overtime, and patient revenue.

Voluntary Reporting Of Medical Errors And Organizational Change: A Simulation Study, James Anderson, Rangaraj Ramanujam, Devon Hensel, Marilyn Anderson

RCHE Publications

In this study we describe a computer simulation model that can be used to explore organizational changes that are required to improve patient safety based on a medication error reporting system.

The Power Of Collaboration With Patient Safety Programs, Kathryn Rapala, Karlene Kerfoot, Patricia Ebright, Suzanne Rogers

RCHE Publications

Patient safety is a relatively new field, with many options and few effectively proven approaches. One factor is clear: optimal patient safety outcomes cannot be achieved in isolation. Although it is well recognized that multidisciplinary collaboration in the healthcare setting is necessry to effect patient safety, collaboration with resources external to healthcare- academia and industry in particular - will not only aid but also quicken the patient safety efforts.

Regional Patient Safety Initiatives: The Missing Element Of Organizational Change, James G. Anderson

RCHE Publications

Data-sharing systems- where healthcare providers jointly implement a common reporting system to promote voluntary reporting, information sharing and learning are emerging as an important regional, state level and national strategy for improving patient safety[1].

The Need For Organizational Change In Patient Safety Initiatives, James G. Anderson

RCHE Publications

This study describes a computer model that has beed developed to explore organizational changes required to improve patient safety based on a medication error reporting system.

Computerization Of Primary Care In The United States, James Anderson, E. Andrew Balas

RCHE Publications

The objective of this study was to assess the current level of information technology use by primary care ‎physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted ‎by e-mail and asked to complete a Web-based questionnaire. A to¬tal of 2,145 physicians responded. ‎Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-‎prescribing, point-of-care decision support tools, and electronic communication with patients. This ‎indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need ‎to differentiate primary care and office-based physicians by specialty. An …

Healthcare Quality Partnerships: An Emerging Educational Frontier For Industrial Engineering Technology Programs, Susan Scachitti, Heather (Woodward) Hagg, Lash Mapa

RCHE Publications

Wtih the understanding that the industrial engineering profession has grown out of industrial/manufacturing oganizations, it is important to note that the profession has gradually matured to the point where it is readily being accepted in service industries, such as hospitals, retail stores and banking. Today, this means that industrial engineers are among the most versatile of the engineering professions, spanning various degrees of functions within various types of organizations. Therefore, educational institutions that offer Industrial Egnieering (IE) and Industrial Engineering Technology (IET) curriculum must also offer a versatile curriculum that will allow their graduates to gain experience in various areas …

The Need For Organizational Change In Patient Safety Initiatives, James G. Anderson

RCHE Publications

This study describes a computer simulation model that has been developed to explore organizational changes required to improve patient safety based on a medication error reporting system.