The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing

Standfield, L., Comans, T., Raymer, M., O'Leary, S., Moretto, N. and Scuffham, P. (2016) The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing. Applied Health Economics and Health Policy, 14 4: 479-491. doi:10.1007/s40258-016-0246-1


Author Standfield, L.
Comans, T.
Raymer, M.
O'Leary, S.
Moretto, N.
Scuffham, P.
Title The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing
Journal name Applied Health Economics and Health Policy   Check publisher's open access policy
ISSN 1179-1896
1175-5652
Publication date 2016-08
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s40258-016-0246-1
Open Access Status Not Open Access
Volume 14
Issue 4
Start page 479
End page 491
Total pages 13
Place of publication Auckland, New Zealand
Publisher Adis International
Collection year 2017
Language eng
Formatted abstract
Background: Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients.

Objectives: To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services; (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg); or (3) additional TOMS without added surgical resources (TOMS − Surg).

Methods: A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care.

Results:
The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %).

Conclusion: Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.
Keyword Economic modelling
OPSC
Orthopaedic physiotherapy screening clinic
Orthopaedic outpatients
Traditional orthopaedic medical services
TOMS
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
Versions
Version Filter Type
Citation counts: Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 10 May 2016, 00:38:29 EST by System User on behalf of Learning and Research Services (UQ Library)