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The Institute of Medicine proposed six aims for healthcare quality improvement. Nevertheless, trauma care quality research still focuses on one aim at a time. This research investigates how to incorporate all aims into trauma care quality assessments using data from the Michigan Trauma Quality Improvement Program. Through a literature review, we identified quantifiable metrics for most aims, except for equity and patient-centeredness. We proposed two approaches to build composite scores accounting for equity via an adjustment procedure based on observed disparities. The single- and multi-aim approaches were compared through correlation, concordance of trauma centre categorisations, and hypothetical incentives. The differences in the approaches stemmed mainly from the weights allocated to the different aims. Results indicated the potential value of multi-aim quality assessment and provided insights about implementation challenges and opportunities. The methods are applicable to the preferred metrics; nevertheless, further research is needed in measuring patient-centeredness.

Childhood and adolescent obesity is a serious health problem that is on the rise at the global level. Earlier, certain diseases such as Type 2 diabetes, high blood pressure, and heart disease affected only adults, but now they are being detected in young children as well. Several studies based on machine learning have been proposed to develop obesity prediction models or to determine key determinants of obesity for designing intervention tools. Despite having a rich and diverse set of literature on obesity prediction models, obesity rates are at an all-time high for both children and adolescents. There is a need of proper understanding and critical analysis of existing machine learning models in order to design effective strategies for curbing obesity at childhood and adolescent level. This paper surveys the growing body of recent literature on machine and deep learning models for obesity prediction by providing a coherent view (critical analysis) of the limitations of the existing systems. The taxonomy of the existing literature on obesity prediction into methods used, predicted outcome, factors used, type of datasets, and the associated purpose, is discussed for analysis of the state-of-the-art. This analysis revealed that a) prediction-focused models do not use variables from as many domains as predictor-focused models do, b) very few studies proposed gender-specific and race-specific obesity prediction models, c) lack of large-scale multimodal datasets and d) existing predictor-focused models obtain an accuracy range of [53.7%, 96%] with an optimum set of predictors. Further, computer vision-based methods for obesity prediction and interpretable techniques for understanding the outcome of the models are discussed as well. In addition, we have also identified novel research directions. The overall aim is to advance the state-of-the-art and improve the quality of discourse in this field.

This study presents robot-based rehabilitation and its assessment. Robotic devices have significantly been useful to help therapists do the training procedure consistently. However, as robotic devices interface with humans, quantifying the interaction and its intended outcomes is still a research challenge. In this study, human–robot interaction during rehabilitation is assessed based on measurable interaction forces and human physiological response data, and correlations are established to plan the intervention and effective limb trajectories within the intended rehabilitation and interaction forces. In this study, the Universal Robot 5 (UR5) is used to guide and support the arm of a subject over a predefined trajectory while recording muscle activities through surface electromyography (sEMG) signals using the Trigno wireless DELSYS devices. The interaction force is measured through the force sensor mounted on the robot end-effector. The force signals and the human physiological data are analyzed and classified to infer the related progress. Feature reduction and selection techniques are used to identify redundant inputs and outputs.

This paper uses operations research (OR) to investigate inpatient care work planning decisions from the perspective of a single healthcare provider in a hospital unit. While there has been considerable research on the modeling and analysis of healthcare delivery systems to support medium- to long-term decisions (e.g., daily operating room scheduling, weekly nurse scheduling), there is little research focusing on decisions made at the operational level by front-line providers. At this stage, resources have been allocated, personnel have been scheduled, and a set of patients with specific demands needs to be cared for in a safe, effective, efficient, timely, patient-centered, and equitable manner. It is often the responsibility of the actual providers to plan, execute, and adjust their workflow based on their knowledge and experience. This paper describes short-term work planning decisions made by front-line healthcare workers and illustrates how OR can support the analysis of such decisions. Research questions that motivate the use of OR in the design and analysis of inpatient care work are discussed.

The healthcare industry is one of the most important industries in the service field. Due to the complex nature and the number of stakeholders in healthcare systems, healthcare quality is a complex...

Interruptions are a salient component of healthcare care work. While there is a significant amount of literature studying interruptions in inpatient care, most of it focuses on retrospectively asse...

Preventable readmissions are a large and growing concern throughout healthcare in the United States, representing as many as 20% of all hospitalizations (30-day post-discharge) and an estimated $17...

Background Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. Methods The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. Results The total usability score ( P = .0046), visibility ( P = .003), and accessibility of the sanitizer on entrance to the patient room ( P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance ( P = .37). Conclusion Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene.

Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.

El desarrollo de la logística en la empresa durante las últimas décadas ha sido significativo debido a la posibilidad de lograr ventajas competitivas a través de ella. Hoy día existe la posibilidad de recuperar y aprovechar económicamente aquellos productos que dejan de satisfacer las necesidades del consumidor; esto genera un flujo de materiales y productos hacia el productor denominada Logística Inversa. El objetivo de este artículo es relacionar algunas formas de aplicación de Logística Inversa de algunas organizaciones con sus estrategias competitivas, lo que se realizará mediante una revisión bibliográfica sobre los aspectos relevantes del tema y de los resultados de una encuesta realizada en una muestra de empresas barranquilleras pertenecientes a cuatro sectores: periódicos, panaderías, químicos y distribuidores de drogas. Los resultados de dicha encuesta no arrojaron evidencia de uso significativo de la Logística Inversa como motor para la estrategia que les permite permanecer en el mercado, lo que sugiere que las condiciones del mercado local no alcanzan aún un nivel de competencia en el que surjan estas competencias como aspectos diferenciadores, o más probablemente, el desconocimiento de sus potencialidades por parte de los empresarios locales trae consigo este aparente abandono.

El desempeño de una línea de producción siempre será un foco importante de análisis. En este artículo se realiza un análisis progresivo, en su grado de complejidad, un análisis experimental con base en la simulación de una variedad de escenarios compuestos por la combinación de distintas variables en niveles determinados, con el fin de observar la interacción entre éstas e incluyendo el término de estocasticidad en tiempos de procesamiento para la definición de dichos escenarios, con el objetivo de indagar y observar la relación la variable del coeficiente de variación de los tiempos de procesamiento en la obtenida previamente./The performance of a production line will always be an important subject of analysis. In this document, a progressive analysis is experimentally made, based on the simulation of several scenarios That consist of a combination of some variables in different levels. In order to appreciate their interaction, stochasticity in processing times are taken into account for the definition of each scenario, with the objective of observing and inquiring into the relation of the variation coefficient of processing times with the one previously obtained in prior research.