Ambulatory care performance: A simulation study of the role of appointment scheduling rules, patient classification and environmental factors.
Item
-
Title
-
Ambulatory care performance: A simulation study of the role of appointment scheduling rules, patient classification and environmental factors.
-
Identifier
-
AAI3144087
-
identifier
-
3144087
-
Creator
-
Cayirli, Tugba.
-
Contributor
-
Adviser: Emre A. Veral
-
Date
-
2004
-
Language
-
English
-
Publisher
-
City University of New York.
-
Subject
-
Business Administration, Management | Operations Research
-
Abstract
-
This paper investigates the effects of patient classification on ambulatory care performance. Using a simulation model, two approaches to patient classification are evaluated: (i) patient classification used only for sequencing patient appointments at the time of booking, and (ii) patient classification used for both sequencing and appointment interval-adjustment. In the latter approach, appointment intervals are adjusted to match the consultation time characteristics of different patient classes. This paper uses the terminology "new/return" to differentiate patient classes. However, the results are applicable to any classification criteria based on consultation time length.;Several appointment systems which combine appointment rules, sequencing rules and interval-adjustment approaches are evaluated under various clinic environments, characterized by walk-ins, no-shows, patient punctuality, number of appointments per session, the percentage of new patients, and the ratio of the mean consultation time of new patients to the mean consultation time of return patients. The effects of decision factors and environmental variables are analyzed by ANOVA. Apart from the primary measures of doctor idle time, doctor overtime and patient waiting time, two secondary measures are used to assess ambulatory care performance. These include the "fairness" measured by the uniformity of waiting times, and the percentage of patients seen within 30 minutes of their appointment times.;Results indicate that the major performance differences between appointment systems result from the choice of sequencing rules and interval-adjustment approaches. This finding suggests that when designing appointment systems, decisions pertaining to patient classification are more critical than the choice of an appointment rule, which determines the template for appointment slots. Appointment systems that use patient classification perform better than the traditional 'first-call-first-appointment' systems. The improvement is more significant when the percentage of new patients is high, and/or there is a greater dispersion among the mean consultation times of different patient classes. Furthermore, other environmental factors such as walk-ins, no-shows, patient punctuality, and overall session volume, largely affect the performance and the ultimate selection of an appointment system.
-
Type
-
dissertation
-
Source
-
PQT Legacy CUNY.xlsx
-
degree
-
Ph.D.
