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CRHE Healthcare Engineering: Quantitative Decision Support Models for the Healthcare Industry Michael W. Carter Centre for Research in Healthcare Operations.

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Presentation on theme: "CRHE Healthcare Engineering: Quantitative Decision Support Models for the Healthcare Industry Michael W. Carter Centre for Research in Healthcare Operations."— Presentation transcript:

1 CRHE Healthcare Engineering: Quantitative Decision Support Models for the Healthcare Industry Michael W. Carter Centre for Research in Healthcare Operations Mechanical and Industrial Engineering University of Toronto

2 CRHE 2 Outline Brief Overview of the Health Care Industry Why do we need engineers? Some application examples

3 CRHE 3 The Importance of Health Care o Health care is North Americas largest single industry. o Estimated total spending in Canada was $183 billion (CN) in ($2.5 trillion in the US) o In Canada, in 2009, $5,452 per person was spent on health care compared to $8,047 in US

4 International Trends OECD web site: Oct


6 Unfair Comparison: More $ doesnt = better health?


8 Health Care Delivery (% Public Payor in 2007)

9 Commonwealth Fund Overall Ranking 2007 AUST.CAN.GERN.Z.U.K.U.S. OVERALL RANKING (2007) Quality Care Right Care Safe Care Coordinated Care Patient-Centered Care Access Efficiency Equity Long, Healthy, and Productive Lives Health Expenditures per Capita, 2004$2,876*$3,165$3,005*$2,083$2,546$6,102 * 2003 data Source: Calculated by Commonwealth Fund based on the Commonwealth Fund 2004 International Health Policy Survey, the Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, and the Commonwealth Fund Commission on a High Performance Health System National Scorecard.

10 CRHE 10 Systemic Hospital Issues: The Four Faces of Health Care* Health care is a business, but... Multiple decision makers. Conflicting goals, incentives. Social good. No market, no manager. Managers Control Nursing Care Trustees Community Doctors Cure Status Coalition Insider Coalition Containment Coalition Clinical Coalition *Glouberman & Mintzberg, 2001

11 CRHE 11 The Four Faces of Health Care* The same divisions apply to the overall social health system! Health Authorities Insurance Public Control LTC, Primary Community Care Elected Officials Community Involvement Acute Hospital Acute Cure *Glouberman & Mintzberg, 2001

12 CRHE 12 Some success stories Ontario Waitlist Forecast System Dynamics: Cardiac Surgeons Ministry of Health and Long Term Care and the Local Health Integration Networks (LHINs) Cancer Care Ontario: Chemo Therapy Centres Surgical Planning: Orthopaedic

13 CRHE 13 Ontario Waitlist Initiative Target to reduce wait times to benchmarks for five priority areas: Cardiac, Cataract, Cancer, Hip & Knee Replacement, MRI/CT Problem: How many (cataracts) do we need to do to meet bench mark (90% wait less than 26 weeks) by March 2007?

14 CRHE 14 Data Requirements for Prediction Current Patient Arrival Rate Projected Future Arrival Rate Current Waitlist Distribution of Patients on Waitlist (Priority) Surgical Volumes (Service Rates) Future Funded Surgical Volumes

15 CRHE 15 Observed Waitlist Approximation Cutoff Point

16 CRHE 16

17 CRHE 17

18 CRHE 18 Recent Ontario Performance Oct./Nov./Dec (all priorities) –Hips – 23 weeks (Ont. target 90% in 26 weeks) –Knees – 26 weeks (target 26) –Cataracts – 16 weeks (target 26) –Breast cancer – 5 weeks (target 12) –Colorectal cancer – 6 weeks (target 12) –Cardiac Bypass – 8 weeks (target 26) –MRI – 16.6 weeks (target 4) –CT – 7 weeks (target 4)

19 CRHE Health Human Resources Modelling

20 CRHE Modeling the Future of Canadian Cardiac Surgery Workforce Using System Dynamics Michael Carter 1,Chris Feindel 2,Timothy Latham 2 & Sonia Vanderby 1 1 Centre for Research in Healthcare Engineering, University of Toronto 2 Canadian Society of Cardiac Surgeons

21 CRHE In Canada only 5 out of 11 slots were filled in 2009 match I

22 CRHE But... Retiring Surgeon PopulationDemand patterns … CABG Non-CABG

23 CRHE Population is aging …

24 CRHE Study Motivation Will there be a future shortage of surgeons? Specialty selection decisions being made based on current situation –Current oversupply; unemployed grads –Education Process > 10 years

25 CRHE Causal Loop (Influence) Diagram

26 CRHE Scenario Testing

27 CRHE May 20, 2009Operations Research & Patient Flow27 Other System Dynamics Projects Alberta Health & Wellness –Model for demand for GPs for next ten years Ontario MOHLTC –Model impact of Aging at Home strategy –Model of mental health strategies


29 Local Health Integration Networks (LHINs) Planning Tools for Aging at Home GIS models of Supply & Demand Ali Esensoy, Agnita Pal & Mike Carter

30 Demand Estimation

31 Estimated Adult Day Program Demand in TC LHIN

32 Adult Day Program Supply in TC LHIN

33 Cluster Analysis of ADP Gap in TC LHIN

34 CRHE Cancer Care Ontario How many medical oncologists do we need in Ontario? Graham Woodward, Adriane Castellino, Matt Nelson & Mike Carter

35 CRHE 35 HHR Model How are teams of providers configured in chemo clinics? How are responsibilities/tasks distributed among providers? (i.e., Who does what?) Focus on functions that could be performed by more than one type of provider Are there differences among sites? Best practice


37 37 Data Collection Each centre has different people doing the tasks. Need rough estimate of time required for each task by type of patient (expert opinion) Only trying to get a high level sense of who does what to answer questions like: –How many Medical Oncologists do we need at this centre?

38 CRHE 38 Integer Programming Models 1.Given current volume and mix of patients, determine ideal provider configuration. 2.Given current set of providers, how many patients can be treated? (% of current volume) 3.How many providers are needed under different models of care? 4.How do sites compare to each other in terms of resource use? (Best Practice.)

39 CRHE Surgical Planning & Scheduling Sherry Weaver, Daphne Sniekers, Dionne Aleman, Solmaz Azari-Rad, Carolyn Busby & Mike Carter

40 CRHE Several current projects Western Canada Wait List: Orthopaedic surgery –Alberta Bone & Joint Health Institute: Calgary, Edmonton, Winnipeg –Bone & Joint Canada General Perioperative Simulation –Hamilton, UHN, St. Mikes, Mt. Sinai, William Osler (Brampton Civic & Etobicoke General) Sunnybrook Health Sciences –Urgent Ortho & Smoothing Resource Use 40

41 CRHE 41 Conclusions Health Care is major industry The current system is not sustainable Quantitative methods (Operational Research) can help The health care industry is beginning to recognize the value of systems thinking

42 CRHE 42 Opportunities for Operations Research? Watch your newspaper: Patient flow Supply Chain ED Wait times Queueing/Simulation Surgical Wait Lists Better scheduling Infectious Diseases Logistics, Modelling Health Human Resources Forecasting

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