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  1. Long-term care spending and hospital use among the older population in England
    Autor*in: Crawford, Rowena; Stoye, George; Zaranko, Ben
    Erschienen: 07 Dec 2020
    Verlag:  The Institute for Fiscal Studies, London

    This paper examines the impact of changes in public long-term care spending on the use of public hospitals among the older population in England, and the cost and quality of this care. Mean per-person long-term care spending fell by 31% between... mehr

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    Standort:
    ZBW - Leibniz-Informationszentrum Wirtschaft, Standort Kiel
    Signatur:
    DS 141
    Fernleihe:
    keine Fernleihe

     

    This paper examines the impact of changes in public long-term care spending on the use of public hospitals among the older population in England, and the cost and quality of this care. Mean per-person long-term care spending fell by 31% between 2009/10 and 2017/18 as part of a large austerity programme, but cuts varied considerably geographically. We instrument public long-term care spending with predicted spending based on historical national funding shares and national spending trends. We find public long-term care spending cuts led to substantial increases in the number of emergency department (ED) visits made by patients aged 65 and above, explaining between a quarter and a half of the growth in ED use among this population over this period. The effects are most pronounced among older people and those living in more deprived areas. This also resulted in an increase in 7-day ED revisits and emergency readmissions. However, there was no wider impact on inpatient or outpatient hospital use, and consequently little impact on overall public hospital costs. These results suggest that the austerity programme successfully reduced combined public spending on health and long-term care, but had adverse effects on the health of vulnerable users.

     
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    Quelle: Verbundkataloge
    Sprache: Englisch
    Medientyp: Buch (Monographie)
    Format: Online
    Weitere Identifier:
    hdl: 10419/242899
    Schriftenreihe: Working paper / lnstitute for Fiscal Studies ; 20, 40
    Schlagworte: Long-term care; Hospital use; Emergency Department; Quality of care; Health expenditure; Austerity
    Umfang: 1 Online-Ressource (circa 51 Seiten), Illustrationen
  2. Under-Promising and Over-Delivering to Improve Patient Satisfaction at Emergency Departments
    Evidence from a Field Experiment Providing Wait Information
    Autor*in: Ansari, Sina; Debo, Laurens; Ibanez, Maria; Iravani, Seyed; Sanjeev Malik, M.D.
    Erschienen: 2022
    Verlag:  SSRN, [S.l.]

    Overcrowded Emergency Departments (EDs) across locations struggle to improve patient experience while dealing with long waits, which erodes medical and financial performance. We investigate whether and how managers could improve patient satisfaction... mehr

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    Overcrowded Emergency Departments (EDs) across locations struggle to improve patient experience while dealing with long waits, which erodes medical and financial performance. We investigate whether and how managers could improve patient satisfaction by communicating waits to patients.We conduct a field experiment at an urban ED. We develop a machine learning-based wait time prediction application and implement it within the electronic medical records system. Our treatments provide patients with personalized estimated waits with no overestimation (the median), moderate overestimation (70th-percentile), or high overestimation (90th-percentile). Patients report higher satisfaction when receiving their estimated waits, but the effect vary widely depending on the announcement. Drawing on Prospect theory, we hypothesize that the announced wait acts as a reference point against which patients compare the actual wait and that patients are lossaverse (end effect): Waits longer than announced will lower satisfaction more than waits shorter than announced will increase satisfaction. Overestimating waits will then improve satisfaction. At the same time, however, rising the announced wait will reduce satisfaction initially and while waiting (initial effect), and this effect will dominate over the end effect for high levels of overestimation. Accordingly, we hypothesize and show that patients are more satisfied when they are told an estimate based on the 70 or 90th-percentiles, with the benefit being the largest for the 70thpercentile announcement. Wait estimates based on the median have a null effect.Despite the benefits from wait announcements in settings where queues are unobservable, less is known about their effects in EDs, where queues are partially observable. With the Centers for Medicare & Medicaid Services tying reimbursements to patients’ ratings, our research suggests a cost-effective lever to improve patients’ satisfaction and hospitals’ financial performance: under-promising and over-delivering by providing moderately overestimated wait information

     
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    Quelle: Verbundkataloge
    Sprache: Englisch
    Medientyp: Buch (Monographie)
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    Schriftenreihe: Tuck School of Business Working Paper ; No. 4135705
    Schlagworte: Wait; Patient Satisfaction; Emergency Department; ED; Prospect Theory; Healthcare
    Umfang: 1 Online-Ressource (33 p)
    Bemerkung(en):

    Nach Informationen von SSRN wurde die ursprüngliche Fassung des Dokuments June 13, 2022 erstellt
  3. Vertical Patient Streaming in Emergency Departments
    Autor*in: Feizi, Arshya; Orfanoudaki, Agni; Saghafian, Soroush; Hudgson, Nicole
    Erschienen: [2023]
    Verlag:  SSRN, [S.l.]

    Addressing hospital emergency department (ED) overcrowding is a critical challenge for many healthcare systems worldwide. Many hospitals (including our partner hospital) have been experimenting with innovative patient flow designs to address this... mehr

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    Addressing hospital emergency department (ED) overcrowding is a critical challenge for many healthcare systems worldwide. Many hospitals (including our partner hospital) have been experimenting with innovative patient flow designs to address this challenge. A promising new design is to separate patients who can be served vertically (e.g., on a regular chair as opposed to horizontally on an ED bed) and route them to a different area termed the Vertical Processing Pathway (VPP) unit. While this can potentially increase operational efficiency by removing the burden caused by a main ED bottleneck---lack of bed availability---it can degrade performance if patients that are routed to the VPP unit need to be sent back to be served in an ED bed, or if some patients that could have been served in the VPP unit end up occupying an ED bed. Successful implementation of this design, thus, significantly depends on understanding which patients should be routed to the VPP unit and when.To assist our partner hospital and other EDs, we develop a machine learning model trained on large-scale data capable of providing a personalized risk score for each arriving patient on whether or not they will eventually need an ED bed. We then feed these risk scores to an analytical model of patient flow to characterize the optimal protocol for utilizing the VPP unit. We find that the optimal protocol depends not only on the predicted risk scores but also on the machine learning model's accuracy as well as some of the main ED characteristics (e.g., patient arrival intensity and congestion level). To gain deeper insights, we make use of simulation analyses calibrated with hospital data and compare the performance of our recommended VPP-based patient streaming design with more traditional ED flow approaches such as “fast track” or “physician in triage.” Our results suggest that following the VPP design under our recommended protocol can bring several advantages to EDs, allowing them to significantly improve their operations

     
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    Sprache: Englisch
    Medientyp: Buch (Monographie)
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    Schriftenreihe: HKS Working Paper ; No. RWP23-014
    Schlagworte: Emergency Department; Machine Learning; Operational Efficiency; Vertical Processing; Patient Flow
    Weitere Schlagworte: Array
    Umfang: 1 Online-Ressource (57 p)
    Bemerkung(en):

    Nach Informationen von SSRN wurde die ursprüngliche Fassung des Dokuments May 31, 2023 erstellt
  4. Models of primary care organization and the use of emergency departments
    Autor*in: Almeida, Alvaro Santos; Vales, Joana
    Erschienen: November 17, 2017
    Verlag:  School of Economics and Management, University of Porto, Porto

    Standort:
    ZBW - Leibniz-Informationszentrum Wirtschaft, Standort Kiel
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    Hinweise zum Inhalt
    Volltext (kostenfrei)
    Quelle: Verbundkataloge
    Sprache: Englisch
    Medientyp: Buch (Monographie)
    Format: Online
    Schriftenreihe: FEP working papers ; n. 598 (nov 2017)
    Schlagworte: Overcrowding; Emergency Department; Primary care; family physician
    Umfang: 1 Online-Ressource (circa 20 Seiten)