Objectives: To investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants and to compare patient outcomes and cost effectiveness of off-the-shelf and CIM implants. Methods: A system dynamics simulation model was developed to study adoption dynamics of CIM and meet the research objectives. The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within 3 years of primary knee replacement implants were used as performance metrics. Results: The simulation results indicate that by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time and cut down cumulative healthcare costs by approximately $38 billion. Conclusions: CIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents the first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be used to consider the adoption of any emerging customized therapies for personalized medicine.Reports have indicated that patient satisfaction with off-the-shelf (OTS) implants can range from 75% to 92%. 12e18 Customized

With greater demand for outpatient services, the importance of patient-centric clinic layout design that improves timeliness of patient care has become more elucidated. In this paper, a novel simulation-optimisation (SO) framework is proposed focusing on the physical and process flows of patients in the design of a paediatric orthopaedic outpatient clinic. A discrete-event simulation model is used to estimate the frequency of movements between clinic units. The resulting information is utilised as input to a mixed integer programming (MIP) model, optimising the clinic layout design. In order to solve the MIP model, Particle Swarm Optimisation (PSO), a metaheuristic approach enhanced with several heuristics is utilised. Finally, the optimisation model outputs are evaluated with the simulation model. The results demonstrate that improvements to the quality of the patient experience can be achieved through incorporating SO methods into the clinic layout design process.

Background Total joint replacements are high-volume and high-cost procedures that should be monitored for cost and quality control. Models that can identify patients at high risk of readmission might help reduce costs by suggesting who should be enrolled in preventive care programs. Previous models for risk prediction have relied on structured data of patients rather than clinical notes in electronic health records (EHRs). The former approach requires manual feature extraction by domain experts, which may limit the applicability of these models. Objective This study aims to develop and evaluate a machine learning model for predicting the risk of 30-day readmission following knee and hip arthroplasty procedures. The input data for these models come from raw EHRs. We empirically demonstrate that unstructured free-text notes contain a reasonably predictive signal for this task. Methods We performed a retrospective analysis of data from 7174 patients at Partners Healthcare collected between 2006 and 2016. These data were split into train, validation, and test sets. These data sets were used to build, validate, and test models to predict unplanned readmission within 30 days of hospital discharge. The proposed models made predictions on the basis of clinical notes, obviating the need for performing manual feature extraction by domain and machine learning experts. The notes that served as model inputs were written by physicians, nurses, pathologists, and others who diagnose and treat patients and may have their own predictions, even if these are not recorded. Results The proposed models output readmission risk scores (propensities) for each patient. The best models (as selected on a development set) yielded an area under the receiver operating characteristic curve of 0.846 (95% CI 82.75-87.11) for hip and 0.822 (95% CI 80.94-86.22) for knee surgery, indicating reasonable discriminative ability. Conclusions Machine learning models can predict which patients are at a high risk of readmission within 30 days following hip and knee arthroplasty procedures on the basis of notes in EHRs with reasonable discriminative power. Following further validation and empirical demonstration that the models realize predictive performance above that which clinical judgment may provide, such models may be used to build an automated decision support tool to help caretakers identify at-risk patients.

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The use of renewable electricity is vital for the decarbonization of industry. Industrial firms source renewables through off-site power purchase agreements or on-site installations, though the latter currently supplies <0.1% of industrial electricity demand in the U.S. Manufacturing buildings typically have large, flat rooftops that are ideal for solar photovoltaic (PV) arrays. This study investigates the feasibility of using rooftop solar PV to cover the net annual electricity needs of industry across all U.S. states and manufacturing sectors. Modeled electricity supply intensity for solar PV arrays is compared with the electricity demand per unit of floorspace for average manufacturing buildings derived from the U.S. Department of Energy Manufacturing Energy Consumption Survey. Results show that, depending on geographical location, rooftop solar PV can completely fulfill the electricity requirements of 5%–35% of manufacturing sectors considered on a net annual basis (assuming net metering). Furniture, textiles, and apparel manufacturing can be powered through on-site means in nearly every location, representing 2% of U.S. manufacturing electricity use and 6% of floorspace. Considering seasonal potential during summer months expands the list of feasible sites, particularly in the U.S. Southwest. Compared to off-site sourcing of renewable energy, pursuing on-site PV installations can also enable manufacturers to maintain limited operations during periods of grid disruption, especially when coupled with on-site energy storage. Overall, the results indicate a substantial physical opportunity for industrial firms to expand rooftop solar PV from currently low levels to help meet decarbonization goals.