Analytical methods for integrating state-of-the-art healthcare quality frameworks into decision-making

Abstract

In 2001, the Institute of Medicine proposed the use of six quality aims to guide healthcare improvement efforts. These aims specify that healthcare should be effective, efficient, safe, timely, patient-centered, and equitable. Since then, academics, practitioners, and policy-makers have made countless efforts to improve the quality of healthcare systems; however, most of these efforts still focus on a single dimension when measuring a system's performance. This dissertation investigated the integration of the Institute of Medicine quality aims into operational decisionmaking through the design and evaluation of possible solutions for two problems from different healthcare settings. The first part of this dissertation analyzed and evaluated analytical approaches to integrate simultaneously all six aims of quality into performance assessment of trauma care. A novel multi-criteria approach based on deterministic dominance theory and a traditional single composite approach were analyzed and compared in terms of the categorization of the trauma centers. Based on the results, an approach is proposed to integrate the six quality aims into the performance evaluation of trauma care by adjusting an initial composite to include the aim of equity. The second part of this dissertation analyzed and characterized the short-term inpatient care work planning problem considering the IOM quality aims. This study, proposed an optimization model for the problem considering an optimization criteria consistent with the IOM quality aims. Research opportunities to support the analysis of the inpatient care work planning problem were identified based on the results of the case study. Further, the study proposed a methodology to develop unit-specific practical heuristics for the problem. The results of this two-part study provided insights for decision-makers about the practical challenges and significant benefits of integrating the Institute of Medicine quality aims into operational decision-making in healthcare settings.