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首页> 外文学位 >Evaluating increasing hospital closure rates in U.S.: A model framework and a Lean Six Sigma deployment approach for quality improvement initiatives to prevent further closures in rural and disadvantaged locations.
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Evaluating increasing hospital closure rates in U.S.: A model framework and a Lean Six Sigma deployment approach for quality improvement initiatives to prevent further closures in rural and disadvantaged locations.

机译：在美国评估医院关闭率上升的情况：质量改进计划的模型框架和精益六西格玛部署方法，以防止在农村和处境不利地区进一步关闭医院。

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摘要

Hospital Closures occur from time to time. Several rural hospitals were closed in the U.S. recently in an unprecedented manner and hundreds of others are at the risk of closing. The Patient Protection and Affordable Care Act (PPACA) which was amended in 2010, has brought sea of changes in the healthcare industry right from changing the way how hospitals receive reimbursements by introducing several new programs targeting hospitals' quality of care to expanding health insurance for millions of poor and underprivileged populations in the country.;The goal of this study is to understand the closure of rural hospitals in line with the recent reform changes and identifying counter measures to prevent further closures in the future.;The first section of the research identifies and evaluates the factors behind the closures by creating a binary logistic model to predict closures of hospitals. Three models were created, first using patient and market characteristics factors (Financial Importance), second using hospitals core measure processes (Operational Importance) and a final model combining the above both models.;The second section of the research identifies and evaluates process improvement initiatives by deploying Lean Six Sigma projects in the hospitals. A Hospital Enterprise System (HES) which encompass three hospitals is used for the study. A 0-1 Integer Linear Programming method (Knapsack Method) is proposed for the selection of projects. Two scenarios are created in which the first scenario optimizes the cost savings by selecting projects among three hospitals. In the second scenario, one among the three hospitals are assumed to be present in a disadvantaged location and few core measure projects are mandatorily implemented to improve the performance of processes to avoid penalties, reimbursement cuts and achieve cost savings to prevent closures in the future.
机译：医院有时会关闭。最近，美国有几家乡村医院以前所未有的方式关闭，而其他数百家则有关闭的危险。于2010年修订的《患者保护和负担得起的医疗法案》（PPACA）引入了针对医院质量的新计划，扩大了针对医护质量的新计划，从而改变了医疗行业获得报销方式的方式，为医疗保健行业带来了巨变。该国数以百万计的贫困和贫困人口。这项研究的目的是根据最近的改革变化了解关闭农村医院的情况，并确定防止将来进一步关闭的对策。通过创建二进制逻辑模型来预测医院的关闭，从而识别和评估关闭的原因。创建了三个模型，第一个使用患者和市场特征因素（财务重要性），第二个使用医院的核心度量流程（运营重要性），最后一个将上述两个模型结合在一起的最终模型。研究的第二部分，确定并评估了流程改进计划通过在医院中部署精益六个西格玛项目。这项研究使用了包括三家医院的医院企业系统（HES）。提出了一种0-1整数线性规划方法（背包法）来选择项目。创建了两个方案，其中第一个方案通过在三家医院中选择项目来优化成本节省。在第二种情况下，假定三所医院中的一所位于劣势地区，并且强制执行了很少的核心措施项目以提高流程的绩效，以避免罚款，削减报销并节省成本以防止将来关闭。

著录项

  • 作者

    Balasubramanian, Soma Sekar.;

  • 作者单位

    The University of Texas at Arlington.;

  • 授予单位 The University of Texas at Arlington.;
  • 学科 Industrial engineering.;Folklore.
  • 学位 Ph.D.I.E.
  • 年度 2016
  • 页码 126 p.
  • 总页数 126
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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