Promoting Peer-to-Peer Ridesharing Services as Transit System Feeders

2017 ◽  
Vol 2650 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Neda Masoud ◽  
Daisik Nam ◽  
Jiangbo Yu ◽  
R. Jayakrishnan
Keyword(s):  
Los Angeles ◽  
Travel Demand ◽  
Decision Support Tool ◽  
Peer To Peer ◽  
Successful Implementation ◽  
Modeling Framework ◽  
Transit System ◽  
Support Tool ◽  
Demand Shifts ◽  
Red Line

Peer-to-peer (P2P) ridesharing is a recently emerging travel alternative that can help accommodate the growth in urban travel demand and at the same time alleviate problems such as excessive vehicular emissions. Prior ridesharing projects suggest that the demand for ridesharing is usually shifted from transit, but its true benefits are realized when the demand shifts from single-occupancy vehicles. This study investigated the potential of shifting demand from private autos to transit by providing a general modeling framework that found routes for private vehicle users that were a combination of P2P ridesharing and transit. The Los Angeles Metro Red Line in California was considered for a case study because it has recently shown declining ridership trends. For successful implementation of a ridesharing system, strategically selecting locations for individuals to get on and off the rideshare vehicles is crucial, along with an appropriate pricing structure for the rides. The study conducted a parametric analysis of the application of real-time P2P ridesharing to feed the Los Angeles Metro Red Line with simulated demand. A mobile application with an innovative ride-matching algorithm was developed as a decision support tool that suggested transit-rideshare and rideshare routes.

Queuing network-based methodology for designing and assessing performance of centralized maintenance workshops

2014 ◽  
Vol 25 (4) ◽  
pp. 510-527 ◽  
Author(s):  
Zineb Simeu-Abazi ◽  
Maria Di Mascolo ◽  
Eric Gascard
Keyword(s):  
Sojourn Time ◽  
Decision Support Tool ◽  
Repair Process ◽  
Spare Parts ◽  
Modeling Framework ◽  
Corrective Maintenance ◽  
Content Type ◽  
Support Tool ◽  
Evaluation Of Performance ◽  
Replacement Technique

Purpose – In this paper, the authors are concerned with a maintenance workshop (MW) centralizing all corrective maintenance activities. The purpose of this paper is to propose a methodology for designing a central maintenance workshop, enabling the evaluation of performance in terms of cost and sojourn time, for a given budget. Design/methodology/approach – The authors propose a modeling framework based on queuing networks. The aim is to maximize operational availability of the production workshop, by reducing the sojourn time of failed equipment in the MW. Findings – The proposed methodology leads to a maintenance decision support tool enabling to give the structure of the MW, performing at a higher level, but at a reasonable configuration cost. Simulation results illustrate the influence of different parameters, such as the number of stations and the level of spare parts in the MW, on the sojourn time of the equipment. Research limitations/implications – Only corrective maintenance is taken into account and only equipment that can be taken out of the production workshop are considered. The preventive replacement of some equipment items can be taken into account by the repair process by considering them as failed. Originality/value – The work falls within a more general framework for optimizing maintenance costs, in the context of integration of multi-site services in a distributed context. The paper is concerned with centralized maintenance, and proposes to integrate the so-called repair by replacement technique in a MW, used for a multi-site production workshop.

scholarly journals 1163 Nickel, Dime or Dollar: Breaking Down Broken Notions of Cost in Sleep Diagnostics

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A444-A444
Author(s):  
N Jambulingam ◽  
R Stretch ◽  
D Butz ◽  
M Zeidler
Keyword(s):  
Los Angeles ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Fixed Costs ◽  
Medicare Reimbursement ◽  
Support Tool ◽  
Contribution Margin ◽  
Occupancy Rates ◽  
Relative Profitability ◽  
Unit Basis

Abstract Introduction Home sleep apnea tests (HSATs) are convenient alternatives to in-lab polysomnograms (PSGs) but high non-diagnostic rates limit their utility. A clinical decision support tool (CDST) to triage patients to HSAT versus PSG was developed at the Greater Los Angeles VA Healthcare System (GLA-VAHS). It uses a random forest ensemble to reduce non-diagnostic HSAT rates by 46%. While prior studies have found PSGs to be more profitable than HSATs on a per unit basis, these analyses do not factor in relative profitability over time. Additionally, no prior studies have quantified the financial impact of a CDST in diagnostic sleep testing. Methods We performed an analysis of the overall profitability of HSATs and PSGs in 2018-2019 within GLA-VAHS which has 6 PSG beds. Revenue was calculated using 2019 Medicare reimbursement rates. Contribution margin (CM) analysis was used to factor out the high fixed costs of healthcare infrastructure, instead focusing on variable direct costs (VDCs). CM analysis is especially useful when calculated on a per diem basis instead of per study, adjusting for number of tests performed in a given day. CM was calculated by subtracting VDCs from revenue under two simulated conditions: with and without the CDST. Results PSGs were 2.5 times more profitable than HSATs on a per unit basis (CM $200/study vs. $81/study). However, on a per day basis, PSGs were only 1.4 times more profitable than HSATs at average nightly occupancy rates of 75% (CM $902/day vs. $646/day). Using the CDST to guide testing, 2.2 times more diagnostic HSATs could be performed per day. As a result, HSATs were 1.3 times more profitable than PSGs on a per day basis with CDST use (CM $1,211/day vs. $902/day). Conclusion This analysis demonstrates that implementing a CDST and maximizing utilization of HSATs allow hospitals to better allocate limited sleep lab resources, increase diagnostic throughput and generate higher profits. Analyzing costs using contribution margin avoids erroneous assumptions about profitability and leads to better-informed administrative decisions regarding sleep lab expansion. Support  

scholarly journals The views of New Zealand general practitioners and patients on a proposed risk assessment and communication tool: a qualitative study using Normalisation Process Theory

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sharon Leitch ◽  
Alesha Smith ◽  
Sue Crengle ◽  
Tim Stokes
Keyword(s):  
Risk Assessment ◽  
Decision Support ◽  
General Practitioners ◽  
Decision Support Tool ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Successful Implementation ◽  
Communication Tool ◽  
Support Tool ◽  
Patient Relationships

Abstract Background Communicating risks of medication harm and obtaining informed consent is difficult due to structural barriers, language and cultural practices, bias and a lack of resources appropriately tailored for the health literacy of most patients. A decision support tool was proposed to alert prescribers of risk and provide tailored information for patients to facilitate informed decision-making with patients and their whānau (family) around medication use. Patient and prescriber co-design was used to ensure the tool was designed to best meet the needs of end-users and avoid increasing health inequity. This paper describes the first stage of the co-design process. Method Normalisation Process Theory (NPT) was used to prospectively evaluate the tool. Semi-structured interviews were held with fifteen patients (five Māori, five Pasifika and five NZ European) and nine general practitioners (two Māori and seven European). Results Three themes were identified, which related to the three NPT concepts most relevant to developing the tool. Theme 1 (coherence: meaning and sense making by participants) explored participants’ understanding of prescribing safety, medication harm and risk, which is based on experience. Patients want as much information as possible about their medications and risk, but doctors find it difficult to communicate that information. Theme 2 related to the NPT concept of cognitive participation (commitment and engagement by participants) explored what participants thought about a prescribing decision support tool. Participants were cautiously optimistic, but worried about potential harm arising from its use. They also identified requirements for the tool and features to avoid. Theme 3 describes the collective action required for successful implementation of the tool; namely, culturally safe and trustworthy doctor-patient relationships. Conclusion Patients and general practitioners provided different perspectives when prospectively evaluating the proposed risk assessment and communication tool. This co-design research identified important pre-requisites for the tool and features to avoid and novel ideas for the proposed tool. Overall participants supported the development of the proposed risk assessment and communication tool, but identified the important role that doctor-patient relationships would play to ensure successful implementation. The use of Māori and Pacific languages in the proposed tool may enhance engagement and understanding.

scholarly journals Use of Clinical Decision Support to Improve the Quality of Care Provided to Older Hospitalized Patients

2012 ◽  
Vol 03 (01) ◽  
pp. 94-102 ◽  
Author(s):  
H. Groshaus ◽  
A. Boscan ◽  
F. Khandwala ◽  
J. Holroyd-Leduc
Keyword(s):  
Decision Support ◽  
Knowledge Translation ◽  
Clinical Decision Support ◽  
Pragmatic Trial ◽  
Length Of Hospital Stay ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Successful Implementation ◽  
Support Tool ◽  
Order Set

SummaryBackground: Frail older inpatients are at risk of unintended adverse events while in hospital, particularly falls, functional decline, delirium and incontinence.Objective: The aim of this pragmatic trial was to pilot and evaluate a multi-component knowledge translation intervention that incorporated a nurse-initiated computerized clinical decision support tool to reduce harms in the care of older medical inpatients.Methods: A stepped wedge trial design was conducted on six medical units at two hospitals in Calgary, Alberta, Canada. The primary quantitative outcome was the rate of order set use. Secondary outcomes included the number of falls, the average number of days in hospital, and the total number of consults ordered for each of orthopedics, geriatrics, psychiatry and physiotherapy. Qualitative analysis included interviews with nurses to explore barriers and facilitators around the implementation of the electronic decision support tool.Results: The estimated mean rate of order set use over a 2 week period was 3.1 (95% CI 1.9–5.3) sets higher after the intervention than before. The estimated odds of a fall happening on a unit over a 2-week period was 9.3 (p = 0.065) times higher before than after the intervention. There was no significant effect of the intervention on length of hospital stay (p = 0.67) or consults to related clinical services (all p <0.2). Interviews with front-line nurses and nurse managers/educators revealed that the order set is not being regularly ordered because its content is perceived as part of good nursing care and due to the high workload on these busy medical units.Conclusions: Although not statistically significant, a reduction in the number of falls as a result of the intervention was noted. Frontline users’ engagement is crucial for the successful implementation of any decision support tool. New strategies of implementation will be evaluated before broad dissemination of this knowledge translation intervention.

The First Decade of Effort: Progress Toward a Hospital Information System at the UCLA Hospital, Los Angeles, California

1970 ◽  
Vol 09 (02) ◽  
pp. 75-80
Author(s):  
B. G. Lamson ◽  
W. S. Russell ◽  
J. Fullmore ◽  
W. E. Nix
Keyword(s):  
Los Angeles ◽  
Medical Record ◽  
Communication Systems ◽  
The United States ◽  
Computer Applications ◽  
Record Management ◽  
Successful Implementation ◽  
Accounting System ◽  
Accrual Accounting ◽  
Medical Specialties

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.

A protocol for sampling pastures in hill country

2016 ◽  
Vol 78 ◽  
pp. 203-209 ◽  
Author(s):  
K.J. Hutchinson ◽  
D.R. Scobie ◽  
J. Beautrais ◽  
A.D. Mackay ◽  
G.M. Rennie ◽  
...  
Keyword(s):  
Random Sampling ◽  
Geographical Information Systems ◽  
Field Measurements ◽  
Decision Support Tool ◽  
Accurate Estimate ◽  
Ease Of Use ◽  
Geographical Information ◽  
Support Tool ◽  
Topographic Complexity ◽  
Hill Country

To develop a protocol to guide pasture sampling for estimation of paddock pasture mass in hill country, a range of pasture sampling strategies, including random sampling, transects and stratification based on slope and aspect, were evaluated using simulations in a Geographical Information Systems computer environment. The accuracy and efficiency of each strategy was tested by sampling data obtained from intensive field measurements across several farms, regions and seasons. The number of measurements required to obtain an accurate estimate was related to the overall pasture mass and the topographic complexity of a paddock, with more variable paddocks requiring more samples. Random sampling from average slopes provided the best balance between simplicity and reliability. A draft protocol was developed from the simulations, in the form of a decision support tool, where visual determination of the topographic complexity of the paddock, along with the required accuracy, were used to guide the number of measurements recommended. The protocol was field tested and evaluated by groups of users for efficacy and ease of use. This sampling protocol will offer farmers, consultants and researchers an efficient, reliable and simple way to determine pasture mass in New Zealand hill country settings. Keywords: hill country, feed budgeting, protocol pasture mass, slope

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