Decision, Operations & Information Technologies Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2761
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Item THE IMPACT OF RESOURCE MANAGEMENT ON HOSPITAL EFFICIENCY AND QUALITY OF CARE(2013) Anderson, David Ryberg; Golden, Bruce L; Business and Management: Decision & Information Technologies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Managing scarce resources plays a significant role in hospital operations. Effective use of resources (e.g., operating rooms, specialized doctors, etc.) allows hospitals to efficiently provide high-quality care to patients. In this dissertation, we study how hospitals manage scarce resources to identify systematic ways in which quality of care and efficiency might be improved. We study four different types of hospital resources: post-operative beds, specialist surgeons, resident physicians, and patient information. For each resource type, we show how better utilization could increase the quality of care delivered by the hospital or increase the efficiency of the system. We show that as post-operative bed utilization increases the discharge rate increases as well, meaning that bed shortages impact physician decision making. Further, we show that patients discharged on days with high bed utilization are significantly more likely to be readmitted to the hospital within 72 hours, which implies that poor bed management can lead to worse health outcomes for surgical patients. We also study how quality of care differs between night and day arrival in trauma centers. Based on a large national dataset, we conclude that a lack of specialized resources at hospitals during the off hours leads to significantly worse patient outcomes, including higher mortality and longer lengths of stay. Further, we exploit a natural experiment to determine the impact that residents have on efficiency in an academic emergency department. Using regression analysis, queueing models, and simulation, we find that when residents are present in the emergency department, treatment times are lowered significantly, especially among high severity patients. Finally, we show two novel uses of medical data to predict patient outcomes. We develop models to predict which patients will require an ICU bed after being transferred from outside hospitals to an internal medicine unit, using only five commonly measured medical characteristics of the patient. We also develop a model using MRI data to classify whether or not prostate cancer is present in an image.Item APPROPRIATING VALUE FROM INFORMATION TECHNOLOGY IN HEALTHCARE(2011) Goh, Jie Mein; Agarwal, Ritu; Business and Management: Decision & Information Technologies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The value potential of information technology (IT) in healthcare settings has generated considerable optimism yet, significant questions remain unanswered. This dissertation employs the lens of social structure to investigate the value of information technology in healthcare situated in two distinct contexts: hospitals, that exemplify the traditional institutional form for the delivery of healthcare services, and online patient communities that represent new organizational forms enabled by IT. It seeks to address the following fundamental research questions "What is the impact of information technology in healthcare settings? How does social structure influence the appropriation of the value of information technology in healthcare?" Each of the two contexts is investigated in a separate essay, drawing upon distinct bodies of literature and using both qualitative and quantitative analytical methods. Essay 1: Evolving Work Routines: A Theory of Successful Adaptation to Information Technology in Healthcare The first essay investigates the impact of healthcare technologies such as electronic medical record systems in the traditional hospital environment. It traces the development of changes in social structure before and after an IT implementation. Using a longitudinal field study, the process of how information technology and routines interact is deconstructed. A theory of the co-evolution of routines and technology is proposed and described. Essay 2: The Social Value of Online Health Communities The second essay examines the impact of health information technology in the form of online patient communities by uncovering the social structure of the community. Using data collected from a popular online patient community, I identify the generative processes using support patterns between patients within the community. I find that online patient communities yield social value through information and emotional support to patients by enabling the transfer of support between patients with differential needs. Results also provide descriptive insights into the attributes of patients that contribute to variation in the provision of support within such online patient communities. The two studies in this dissertation make theoretical and empirical contributions. They shed light on the impact of information technology in healthcare, and further inform us about the appropriation of HIT value from a social structure perspective.