We examine performance-based payment contracts to promote the use of an optional diagnostic test for newly diagnosed cancer patients. Our work is inspired by three ongoing trends: tremendous increases in the cost of new advanced cancer drugs, development of new diagnostic tests to allow physicians to tailor treatment to patients, and changes in healthcare funding models that reward quality care. Our study suggests that advent of new diagnostic tests necessitates new reimbursement models. We also find that physicians should not use the test for all patients, even if the diagnostic test can be available for free. Furthermore, we demonstrate the importance of understanding the behavioral effects of physicians’ concerns about their treatment decisions by showing that the social welfare may increase from an increase in reputational concerns and altruistic behaviour of a provider.
Researchers: Salar Ghamat, Gregory S. Zaric, Hubert Pun
The development of a microsimulation model of alcohol consumption to determine if pharmacological and/or psychosocial interventions are cost-effective for reducing alcohol consumption in the general Canadian population, and in underserved populations.
Researchers: Estefania Ruiz-Vargas, Gregory S. Zaric
We use dynamic programming to model ambulance systems. Our model can potentially assist ambulance dispatchers to proactively avoid states at which most, or all, of scheduled ambulances are busy by taking appropriate actions timely. Possible actions that we consider are: Calling in additional ambulances from neighboring cities, expediting the service, and repositioning available ambulances following a desired compliance table. The objective is to maximize the expected proportion of time that the system spends in states with low utilizations by using reward functions that penalize being in high-utilization states. We use a detailed simulation model to validate our results.
Project Manager: Amir Rastpour, Gregory S. Zaric
In partnership with Ontario’s Ministry of Government and Consumer Services, the Centre is leading a global search for best practices in health sector supply chain management. Involving participants from across Canada, the United States, the United Kingdom, Australia, and Finland, this study is pooling together the best policies and practices. This research is focused on the specific health system challenges of driving product standardization and categorization, clinician engagement, and public sector back office reform. Ultimately, the findings from this study will promote effective and informed decision making for our provincial supply chain strategy and knowledge sharing between health system stakeholders.
In highly congested hospitals, it may be common for patients to overstay at Intensive care units due to unbalanced downstream capacity. Step-down beds, also known as Level 2 beds, have become an increasingly popular and cheaper alternative to deal with this delicate issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a university hospital (LHSC). The model innovates by simulating the daily Death/Stay/Step-down stochastic routine at the ICU based on nursing workload scoring, i.e. NEMS. We show our model provides a useful, more realistic framework for bed capacity panning in hospitals.
Researchers: Felipe Rodrigues, Gregory S. Zaric, David Stanford, Judy Kojlak, Fran Priestap, Claudio Martin
The healthcare industry has been relatively slow at adopting global standards for supply chain product identification when compared with other industries. Adoption of unique device identifiers and barcoding standards is becoming mandatory in most developed nations, yet approaches to standardization still vary country to country. The lack of a consistent approach to standardization has led to increased inefficiencies for both product vendors and purchasers. The Centre’s research will identify and examine different current state models of standardization from multiple countries and industries, conduct an objective analysis on which model is most efficient from a health system perspective, and make recommendations for the future state model selection/design and deployment in Canada taking into account enablers, capabilities and capacity for adoption.
London’s Healthcare Materials Management Services (HMMS) is currently undergoing a transformative shift in its supply chain processes, transitioning from a traditional push model of supply chain (projection-driven) to a pull supply chain (demand-driven) for all of London Health Sciences Centre. The Centre is working with HMMS, providing project steering and developing a best practices guide to share the learnings from this initiative with other hospitals across Canada. Unique to this approach is its low-cost nature – while many supply chain transformation projects require heavy IT investment, HMMS’ strategy achieves many of the same outcomes (point-of-use data capture, SSO asset management, accurate case costing, standardized physician preference items, and automatic requisitioning) without relying on expensive software solutions. The findings from this study will help other hospitals and health care organizations, regardless of budget, reap the benefits associated with supply chain transformation effectively.
The Centre is leading a national study examining how organizations across Canada are currently embedding patient-reported outcomes in the decision-making process for material purchases. Traditional hospital tendering processes are most often conducted at a distance from the patient. Hospital clinical teams or procurement leaders set minimum performance criteria, and vendors are incentivized only to reach those criteria. In an effort to enhance value-based procurement, many procurement departments are beginning to involve patients in the tendering process through patient-reported outcome testing. Patient-reported outcome tendering has the opportunity for hospitals to improve patient outcomes and reduce costs by making procurement decisions based on the total cost of care rather than price alone. This research will encourage collaboration and sharing of resources/knowledge across the system so that a shared set of best practices can be adopted as system stakeholders are ready. The study is currently being funded by the Ministry of Government and Consumer Services.
Facilitated by the Health Care group at MaRS, the project pairs health care providers (generally hospitals) with vendors who are early stage customers to bring new and innovative solutions to market. The goal is to use Design Thinking to develop solutions that transfer to practice better. Dr. Darren Meister is investigating best practices for the improvement of this approach to procurement for possible broader adoption in the health sector.