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首页> 外文期刊>Socio-economic planning sciences >Office-based and home-care for older adults in primary care: A comparative analysis using the Nash bargaining solution
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Office-based and home-care for older adults in primary care: A comparative analysis using the Nash bargaining solution

机译：初级保健中老年人的办公室式和家庭护理：使用纳什议价解决方案的比较分析

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Three care delivery settings are compared in this study: office-based care, home-care, and mixed-care, i.e., office-based care combined with home-care, in solo, small, medium, and large primary care practices. The objective of this paper is to identify which of these settings better achieves the secondary goals of the so-called quadruple aim, i.e., reducing costs, improving the patient experience, and improving the physician experience. A multiobjective integer programming formulation is developed to capture the elements of strategic health care planning. The formulation considers the minimization of four objective functions: the total cost of care workers, the total number of care workers, the total rejected demand and unsatisfied preferred care location, and the total panel size of the providers. Instead of computing the entire Pareto frontier, we used the Nash bargaining solution to determine a single Pareto optimal solution for the problem. The approach was tested using real world instances, which can be adjusted to any specific primary care practice. The numerical results show that none of the settings provides the smallest values in all objective functions. The choice of a setting for a primary care practice depends on the secondary goals that the practice desires to emphasize, and, in most cases, it is independent of the type of practice size. For the analyzed instances, a calculated overall score for each setting determined that, on average, the settings based on home-care strengthen the achievement of the secondary goals of the quadruple aim more so than in comparison to the office-based physician settings.
机译：在本研究中比较了三种护理提供设置：基于办公室的护理，家庭护理和混合护理，即基于办公室的护理与家庭护理相结合的单独，小型，中型和大型初级护理实践。本文的目的是确定这些设置中的哪一个可以更好地实现所谓的四重目标的次要目标，即降低成本，改善患者体验并改善医师体验。开发了一种多目标整数规划公式，以捕获战略卫生保健计划的要素。该表述考虑了四个目标函数的最小化：护理人员的总成本，护理人员的总数，拒绝的总需求和不满意的首选护理地点以及提供者的总小组人数。代替计算整个帕累托边界，我们使用纳什讨价还价解决方案来确定该问题的单个帕累托最优解决方案。该方法已使用实际实例进行了测试，可以针对任何特定的初级保健实践进行调整。数值结果表明，所有设置均未在所有目标函数中提供最小值。初级保健实践的环境选择取决于该实践希望强调的次要目标，并且在大多数情况下，它与实践规模的类型无关。对于所分析的实例，针对每个设置的计算出的总体得分确定，与基于办公室的医生设置相比，基于家庭护理的设置平均更能实现四重目标的次要目标。

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