Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital

Abstract

Background. The Health Technology Assessment (HTA) is used to evaluate health services, manage healthcare processes more efficiently, and compare medical technologies. The aim of this paper is to carry out an HTA study that compares two pharmacological therapies and provides the clinicians with two models to predict the length of hospital stay (LOS) of patients undergoing oral cavity cancer surgery on the bone tissue. Methods. The six Sigma method was used as a tool of HTA; it is a technique of quality management and process improvement that combines the use of statistics with a five-step procedure: “Define, Measure, Analyze, Improve, Control” referred to in the acronym DMAIC. Subsequently, multiple linear regression has been used to create two models. Two groups of patients were analyzed: 45 were treated with ceftriaxone while 48 were treated with the combination of cefazolin and clindamycin. Results. A reduction of the overall mean LOS of patients undergoing oral cavity cancer surgery on bone was observed of 40.9% in the group treated with ceftriaxone. Its reduction was observed in all the variables of the ceftriaxone group. The best results are obtained in younger patients (−54.1%) and in patients with low oral hygiene (−52.4%) treated. The regression results showed that the best LOS predictors for cefazolin/clindamycin are ASA score and flap while for ceftriaxone, in addition to these two, oral hygiene and lymphadenectomy are the best predictors. In addition, the adjusted R squared showed that the variables considered explain most of the variance of LOS. Conclusion. SS methodology, used as an HTA tool, allowed us to understand the performance of the antibiotics and provided variables that mostly influence postoperative LOS. The obtained models can improve the outcome of patients, reducing the postoperative LOS and the relative costs, consequently increasing patient safety, and improving the quality of care provided.

Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle

“…The 5 phases of DMAIC are, usually, the following [ 43 , 44 , 45 , 46 ]: Define aims at defining the project, the issues, and the scopes. Measure aims at measuring quantitatively the critical to quality (CTQ) of the current process.…”

“…Because SS provides policy makers with a systematic and quantitative scheme through the DMAIC cycle, which is generalizable for an extensive variety of applications, it can represent a valuable support tool for HTA [ 24 , 38 ], providing comprehensive analysis, evidence-based decisions, and efficient control plan. Indeed, several studies of HTA have employed SS as a rigorous methodology to compare biomedical technologies and understand which can be considered the best according to some parameters defined according to the specific analysed domain [ 40 , 46 ].…”

Regression Models to Study the Total LOS Related to Valvuloplasty

“…Biomedical data analytics is key to improving processes, reducing costs, and giving clinicians new tools to manage all different patients. There are many approaches used in the literature for data analysis, including lean six sigma [ 15 , 16 , 17 , 18 , 19 ], health technology assessment [ 20 , 21 , 22 , 23 ], machine learning algorithms [ 24 , 25 , 26 ], and mathematical modelling [ 27 , 28 , 29 ]. The latter approach was chosen for this study.…”

Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting

“…Six Sigma was introduced by Motorola to optimise its manufacturing processes by reducing their variability through the rigorous application of process metrics collection and statistical analysis [5]. Since the early 2000s, LSS thinking has been adapted into healthcare with the goal to improve patient safety, quality of care, efficiency, patient satisfaction, and performance [6][7][8][9][10][11][12][13][14]. LSS puts an emphasis on working with and eliciting the customers' voice [15] and has been shown to be synergistic with person-centred approaches to engagement [14].…”