Medicine and Health Sciences Commons^™

Analysis And Modeling Of Strategic Interactions In Health Systems To Improve Patient Care Access, Jorge A. Acuña Melo

USF Tampa Graduate Theses and Dissertations

Affordable health care access that provides well-coordinated and high-quality services on time is a goal that governments and health organizations strive for. Regrettably, most countries deal with access problems that affect the population's health, such as long waiting lists for specialized medical services, overcrowding of emergency departments, and high health prices. In the present doctoral dissertation, I model and analyze the strategic interactions that inhabit the health system machinery to uncover possible structural problems that led to the aforementioned issues. The study involves operation research, data science, and game theory techniques to address the health care access predicament.

Each research …

Strategies For Achieving The United States Health System's Quadruple Aim By Enhancing The Primary Care Level, Jennifer L. Mendoza-Alonzo

USF Tampa Graduate Theses and Dissertations

The quadruple aim is an approach to optimize the performance of the health system in the United States and consists of four dimensions. The main objective is to improve the population's health, followed by reducing cost, improving patients' experience, and increasing providers' satisfaction. In the present doctoral dissertation, I explore three strategies that help accomplish the quadruple aim at the primary care level. The analysis combines data science and operation research principles to address health system engineering questions.

Each strategy proposed in this document emphasizes one objective more than another; however, all of them in conjunction serve to attain the …

Identification Of Patterns And Disruptions In Ambient Sensor Data From Private Homes, Yan Wang

USF Tampa Graduate Theses and Dissertations

The world’s population is rapidly aging and the increasing demand for home and health care services from this aging population brings unprecedented challenges to the economy and society. Ambient-assisted smart homes, residences equipped with ambient sensors to monitor the resident’s daily activities in a continuous and unobtrusive way, present great potential to manage the growing care service needs of this older population segment, and enable them to age-in-place.

Despite growing research, using ambient sensor data from private homes to monitor daily activities, health and wellness still faces significant challenges. To study ambient sensor data from private homes where annotated data …

Analysis Of A Potential A(H7n9) Influenza Pandemic Outbreak In The U.S., Walter A. Silva Sotillo

USF Tampa Graduate Theses and Dissertations

This dissertation presents a collection of manuscripts that describe development of models and model implementation to analyze impact of potential A(H7N9) pandemic influenza outbreak in the U.S. Though this virus is still only animal-to-human transmittable, it has potential to become human-to-human transmittable and trigger a pandemic. This work is motivated by the negative impact on human lives that this virus has already caused in China, and is intended to support public health officials in preparing to protect U.S. population from a potential outbreak of pandemic scale.

An agent-based (AB) simulation model is used to replicate the social dynamics of the …

Strategies For Reducing Preventable Hospital Readmissions On Medicare Patients, Andres Patricio Garcia-Arce

USF Tampa Graduate Theses and Dissertations

The high expenditure of healthcare in the United States (U.S.) does not translate into better quality of care. Indeed, the U.S. healthcare system is recognized by its lack of efficiency and waste (which represents about 20% of the country’s healthcare expenses). Lack of coordination is one of the most referenced causes of waste in the U.S. healthcare system, and preventable hospital readmissions have been acknowledged to be evidence of poor coordination of care. In fiscal year 2013, the Centers for Medicare and Medicaid Services (CMS) established financial penalties for inpatient care reimbursements in hospitals with excessive readmissions. All the same, …

Oversampling Methods For Imbalanced Dataset Classification And Their Application To Gynecological Disorder Diagnosis, Iman Nekooeimehr

USF Tampa Graduate Theses and Dissertations

In many applications, the dataset for classification may be highly imbalanced where most of the instances in the training set may belong to some of the classes (majority classes), while only a few instances are from the other classes (minority classes). Conventional classifiers will strongly favor the majority class and ignore the minority instances. The imbalance problem can occur in both binary data classification and also in ordinal regression. Ordinal regression is a supervised approach for learning the ordinal relationship between classes. Extensive research has been performed for addressing imbalanced datasets for binary classification; however, current methods do not address …

Estimating Likelihood Of Having A Brca Gene Mutation Based On Family History Of Cancers And Recommending Optimized Cancer Preventive Actions, Mehrnaz Abdollahian

USF Tampa Graduate Theses and Dissertations

BRCA1 and BRCA2 are gene mutations that drastically increase chances of developing breast and ovarian cancers, up to 20-fold, for women. A genetic blood test is used to detect BRCA mutations. Though these mutations occur in one of every 400 in the general population (excluding Ashkenazi Jewish ethnicity), they are present in most cases of hereditary breast and ovarian cancer patients. Hence, it is common practice for the physicians to require genetic testing for those that fit the rules as recommended by the National Cancer Comprehensive Network. However, data from the Myriad Laboratory, the only provider of the test until …

Patient Populations, Clinical Associations, And System Efficiency In Healthcare Delivery System, Yazhuo Liu

USF Tampa Graduate Theses and Dissertations

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes’ perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease’ correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

Statistical And Prognostic Modeling Of Clinical Outcomes With Complex Physiologic Data, Monica A. Puertas

USF Tampa Graduate Theses and Dissertations

Laboratory tests are a primary resource for diagnosing patient diseases. However, physicians often make decisions based on a single laboratory result and have a limited perspective of the role of commonly-measured parameters in enhancing the diagnostic process. By providing a dynamic patient profile, the diagnosis could be more accurate and timely, allowing physicians to anticipate changes in the recovery trajectory and intervene more effectively.

The assessment and monitoring of the circulatory system is essential for patients in intensive care units (ICU). One component of this system is the platelet count, which is used in assessing blood clotting. However, platelet counts …

Supply Chain Optimization Of Blood Products, Serkan Gunpinar

USF Tampa Graduate Theses and Dissertations

Major challenges in the management of blood supply chain are related to the shortage and wastage of the blood products. Given the perishability characteristics of blood which can be stored up to a limited number of days, if hospitals and blood centers keep an excessive number of blood units on inventory, wastages may occur. On the other hand, if sufficient number of blood units are not stored on inventory, shortages of this resource may cause the cancellations of important activities and increase the fatality rates at hospitals. Three mathematical models have been developed with the goal to improve the efficiency …

Classification Models In Clinical Decision Making, Eleazar Gil-Herrera

USF Tampa Graduate Theses and Dissertations

In this dissertation, we present a collection of manuscripts describing the development of prognostic models designed to assist clinical decision making. This work is motivated by limitations of commonly used techniques to produce accessible prognostic models with easily interpretable and clinically credible results. Such limitations hinder prognostic model widespread utilization in medical practice.

Our methodology is based on Rough Set Theory (RST) as a mathematical tool for clinical data anal- ysis. We focus on developing rule-based prognostic models for end-of life care decision making in an effort to improve the hospice referral process. The development of the prognostic models is …

A Methodology For Scheduling Operating Rooms Under Uncertainty, Marbelly Paola Davila

USF Tampa Graduate Theses and Dissertations

An operating room (OR) is considered to be one of the most costly functional areas within hospitals as well as its major profit center. It is known that managing an OR department is a challenging task, which requires the integration of many actors (e.g., patients, surgeons, nurses, technicians) who may have conflicting interests and priorities.

Considering these aspects, this dissertation focuses on developing a simulation based methodology for scheduling operating rooms under uncertainty, which reflects the complexity, uncertainty and variability associated with surgery.

We split the process of scheduling ORs under uncertainty into two main components. First, we designed a …

The Impact Of Pharmacy Work Design On Pharmacist Productivity, Nicholas Allen Coblio

USF Tampa Graduate Theses and Dissertations

Healthcare costs in the United States continue to grow at an alarming rate. Concerning the cost of medications, there are a number of factors that drive these costs. While personnel costs are not the largest of these, they do contribute a significant portion. The cost of the cognitive component of order processing by pharmacists can range from three dollars to over six dollars per prescription depending on the production throughput of the pharmacist.

Studies at the organization which was the focus of the research, as well as reports in the literature, indicated that work disruption and other environmental factors could …

Analytical Methods To Support Risk Identification And Analysis In Healthcare Systems, Laila Nadime Cure Vellojin

USF Tampa Graduate Theses and Dissertations

Healthcare systems require continuous monitoring of risk to prevent adverse events. Risk analysis is a time consuming activity that depends on the background of analysts and available data. Patient safety data is often incomplete and biased. This research proposes systematic approaches to monitor risk in healthcare using available patient safety data. The methodologies combine traditional healthcare risk analysis methods with safety theory concepts, in an innovative manner, to allocate available evidence to potential risk sources throughout the system. We propose the use of data mining to analyze near-miss reports and guide the identification of risk sources. In addition, we propose …

Apparent Total Evaporative Resistance Values From Human Trials Over A Range Of Metabolic And Heat Stress Levels, Matthew David Dooris

USF Tampa Graduate Theses and Dissertations

Failure to maintain thermal equilibrium can cause uncontrollable increases in body core temperature beyond critical upper limits. In selecting clothing, consideration must be given to the heat transfer properties of clothing that may restrict the cooling capacity of the human body under heat stress conditions, most importantly, apparent total evaporative resistance (R_e,T,_a). This study calculated and compared R_e,T,_a for five clothing ensembles under varying heat stress conditions, including three relative humidity (RH) levels and three stages of heat stress to determine if R_e,T,_a values varied or remained the same with …

Modeling And Surveillance Of Pandemic Influenza Outbreaks, Diana Prieto

USF Tampa Graduate Theses and Dissertations

Pandemic outbreaks are unpredictable as to their virus strain, transmissibility, and impact on our quality of life. Hence, the decision support models for mitigation of pandemic outbreaks must be user-friendly and operational, and also incorporate valid estimates of disease transmissibility and severity. This dissertation research is aimed at 1) reviewing the existing pandemic simulation models to identify their implementation gaps with regard to usability and operability, and suggesting research remedies, 2) increasing operability of simulation models by calibrating them via an epidemiological model that estimates infection probabilities using viral shedding profiles of concurrent pandemic and seasonal influenza, and 3) developing …

Decision Aid Models For Resource Sharing Strategies During Global Influenza Pandemics, Alfredo Santana Reynoso

USF Tampa Graduate Theses and Dissertations

Pandemic influenza outbreaks have historically entailed significant societal and economic disruptions. Today, our quality of life is threatened by our inadequate preparedness for the imminent pandemic. The key challenges we are facing stem from a significant uncertainty in virus epidemiology, limited response resources, inadequate international collaboration, and the lack of appropriate science-based decision support tools. The existing literature falls short of comprehensive models for global pandemic spread and mitigation which incorporate the heterogeneity of the world regions and realistic travel networks. In addition, there exist virtually no studies which quantify the impact of resource sharing strategies among multiple countries. This …

Identification Of Patient Recovery Patterns After Cardiovascular Surgery Based On Laboratory Tests Results, Alcides Ricardo Santander Mercado

USF Tampa Graduate Theses and Dissertations

In this dissertation is proposed a methodology to identify patient's recovery patterns after cardiovascular surgery based on laboratory tests results. The main purpose is to enhance the understanding of the manifestations of postsurgical complications in patients who underwent cardiovascular surgery. The analysis of patients' recovery process is based on the relationship between plasma calcium, ionized calcium and platelet count over time.

Laboratory results from the James A. Haley Veterans' Hospital databases, related to patients admitted to the Surgical Intensive Care Unit (SICU) after cardiac surgery (coronary artery bypass, aortic value replacement and mitral valve replacement), are used. These databases contain …

Heat Stress Evaluation Of Protective Clothing Ensembles, Amanda Lee Pease

USF Tampa Graduate Theses and Dissertations

Clothing directly affects the level of heat stress exposure. Useful measures to express the thermal characteristics are WBGT (wet bulb globe temperature) clothing adjustment factor (CAF) or apparent total evaporative resistance (R_e,T,_a). The CAF is assigned through laboratory wear trials following a heat stress protocol in which the air temperature and humidity are progressively increased until the participant clearly loses the ability to maintain thermal equilibrium. The critical condition is the point of thermal transition and from these conditions both the CAF and Re,T,a are computed. The first objective of this study is to compare the …