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Assessing the capacity performance of virtual care pathways : a case study of stroke patients in Isala Hospital

Bollgoenn, Ole (2023) Assessing the capacity performance of virtual care pathways : a case study of stroke patients in Isala Hospital.

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Abstract:Introduction: Due to increasing numbers of patients hospitals are faced with the need to explore alternative treatment paths that allow treating larger patient volumes with the existing amount of resources. This research, therefore, aims to gain comprehensive information and insights regarding the performance of virtual care, specifically in terms of capacity and costs. To this end, we conduct a case study at the Isala Hospital in Zwolle, the Netherlands, on cerebrovascular accident (CVA) patients during their rehabilitation phase. We compare the capacity performance of the CVA rehabilitation pathway before (conventional pathway) and after the transformation into a virtual pathway. We define the following main research question: What is the impact of a virtual rehabilitation pathway from a capacity management perspective? We initiate our research by conducting a systematic literature review on capacity assessment in hospitals with a specific emphasis on telemedicine. Subsequently, we define a list of key performance indicators (KPIs) based on the literature to assess the capacity performance of a pathway and define our research methods. It follows a context analysis of the two pathways and a descriptive and diagnostic data analysis assessing six experiments based on two samples of patients. The first data sample, which we refer to as the control group was collected in 2019, before the implementation of the virtual pathway, and contains 238 patients. The second data sample, which we refer to as the e-coach group, was collected in 2022/2023, after the implementation of the virtual pathway and includes 163 patients. These analyses serve as the foundation for the derivation of the conclusions. Capacity in Healthcare: During our systematic literature review, we found that the majority of articles assessing hospital capacity relied on KPIs that use numbers related to beds as a primary metric to evaluate performance. However, this gives rise to several challenges, one of which is the difficulty of assessing the capacity of virtual care by simply measuring the number of beds. Furthermore, we discovered that virtual care can save costs for all stakeholders (Peters et al., 2022) and lead to 26% shorter appointments than in�person appointments (Tan et al., 2020). Moreover, virtual care is more suitable for follow-up appointments of controlled patients than for treating uncontrolled patients (Yu & Bayram, 2021). Ultimately, to the best of our knowledge, there is no research assessing the effect of virtual pathways on the capacity performance of the hospital using a range of capacity KPIs. Results: Derived from several research articles and the constraints of our case study we determined a list of KPIs for our data analysis containing, the number of appointments per patient and by appointment type, the total appointment length per patient, the total working time of healthcare professionals per patient and the total treatment costs per patient. Assessing the context, our findings revealed the following primary distinguishing factors between the virtual pathway and the conventional pathway. The conventional pathway includes two outpatient visits (hospital visits without staying overnight) with the specialized nurse, whereas the virtual pathway only includes one optional outpatient visit at the end of the rehabilitation and three planned telephonic consultations. In addition to that, the virtual pathway offers the opportunity to incorporate the use of an e-coach (mobile application). The e-coach is monitored by nurses of the hospital that conduct follow-up consultations in case patients indicate symptoms of a certain condition. The data analysis shows that patients in the e-coach sample had 4.5 times more appointments per patient compared to the control group and a shorter average appointment duration of 16 minutes compared to 22 minutes. When examining a breakdown of the appointment time it became evident that the number of outpatient visits per patient is about the same (0.4) for both sample groups and that the high number of appointments of the e-coach sample patients is mainly caused by unplanned telephonic consultation that make up approximately 50% of all appointments. Investigating the average total appointment duration we showed that the total working time of healthcare professionals for patients of the e-coach group is, in all experiments, larger than for patients of the sample group and that the total appointment time is at least twice as high for e-coach sample patients (67 min, 30 min). Lastly, we conducted a cost analysis measuring the total treatment costs per patient. In all experiments, costs range between 171€ and 210€. The virtual pathway approximately breaks even in costs with the conventional pathway in experiments 4 and 5. Experiment 4 assumes that administrative appointments that currently exist due to set-up activities of the e-coach and one planned telephonic consultation are removed and the number of outpatient visits is reduced to 0.5 per patient. Experiment 5 supposes that administrative appointments and one planned telephonic consultation are removed, and unplanned telephonic consultations are reduced by 80% to 7 minutes per patient. In these experiments, the virtual pathway and the conventional pathway would have average treatment costs per patient of approximately 172€. Overall, reducing the number of outpatient visits seems more reasonable, as these appointments cause the highest costs. Conclusion: We conclude that the virtual pathway for CVA patients in Isala in its current state has a negative impact on the capacity performance of the hospital, due to a greater number of appointments, longer treatment times, and higher costs. Nevertheless, when adjusted and even further conducted virtually, it has the capability to become more cost-efficient. Moreover, since patients have more contact moments with healthcare professionals in the virtual pathway, it could outperform the conventional pathway in terms of quality of care. This research could be extended and continued by gathering larger samples and more accurate data about appointments and costs. Moreover, other patient types could be taken into account and a more detailed cost scheme applied, as well as a wider range of KPIs assessed. We recommend Isala to keep the virtual care pathway and continue improving its performance by replacing outpatient visits with telephonic consultations. Furthermore, we believe this research provides valuable support to hospitals in the implementation of virtual care pathways by emphasizing the importance of reducing outpatient visits and contributing to a better healthcare system and scientific research within healthcare.
Item Type:Essay (Bachelor)
Isala Hospital Zwolle, Zwolle, The Netherlands
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:01 general works, 44 medicine, 70 social sciences in general
Programme:Industrial Engineering and Management BSc (56994)
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